informed decisions about when statistical incidence. The to integrate the technology into argument becomes circular their practices. because we lower the incidence I apologize if the information of problems by early removal of reported was perceived to be a impacted teeth and thereby misrepresentation of the Sopha fuel the argument of those Bioconcept System or any other who favor treating only system and wish Dr. D uret well those impactions with as he continues his pathology because of developments. the low rate of E. D ianne Rekow, occurrence. M.S.M.D., D.D.S., PH.D. T. J. Nidiffer, D.D.S., Baltim ore M.S.D. Steven L. Thom as, D.D.S., Editor’s note: The financial M.S. disclaimer was identical for Dr. Overland Park, Kan. Duret’s article and Dr. Rekow’s M O RE ON M O LARS article. We made no attem pt in either case to disguise any Dr. Leonard suggests th a t the financial interest. degree of difficulty we may anticipate in surgically T H IR D -M O L A R R E V IE W removing an impacted third “Removing Third Molars: A molar can be determined by the Review for the General radiograph alone. Merely Practitioner” by Dr. Myer S. determining the number of Leonard (February) rekindles roots, deviation in angulation the old controversy about the and proximity of the inferior removal of impacted teeth. Dr. alveolar canal are only a few of Leonard’s article contains some the criteria th a t should go into valid points. It is written, a dentist’s decision as to however, from the typical whether they are competent to perspective of an academician. remove an impacted third Interestingly, the American molar. Association of Oral and Maxillo­ Many things, both tangible facial Surgeons released its and intangible, go into arriving position paper regarding the at th at determination; the management of impacted teeth degree of pressure with which only a few weeks after Dr. the patient bites, the size of the Leonard’s article was printed. mouth, the character of the Although Dr. Leonard is a bone, together with years member of the American of experience in Association of Oral and Maxillo­ performing this facial Surgeons, his views procedure on a daily appear to be diametrically basis, may accurately opposed to those of the predict the degree of difficulty association. to expect in removing an Those of us who manage the impacted third molar. complications and pathology When an oral surgeon has to associated with the retention or finish a job begun by the late removal of impacted teeth general practitioner, the result are well aware th a t the is always swelling, pain, pro­ magnitude of the problems th a t tracted healing period and a can develop outweighs the very unhappy patient—to say 14

JADA, Vol. 123, June 1992

nothing about a potential lawsuit. If you truly desire to keep this publication on a par with the JAMA and other respons­ ible medical journals, you should be more selective when choosing its content. To the best of my knowledge, Dr. Leonard is not a board certified oral and maxillofacial surgeon and should not be pontificating to the rest of the profession. Frederick R. Kaye, D.D.S. Scarsdale, N.Y. IM P O R T A N C E O F C R IT IC A L R E A D IN G

Dr. Leonard’s article was well written and at the risk of being picky, I think a few significant controversial points should be mentioned. “ The comment th at there is greater incidence of paresthesia in the 25 to 35 age group than in the 35 to 75 age group is open to dispute. However, the point of the article by Dr. Osborne was, “removal of mandibular third molar teeth during the teenage years resulted in decreased operative and postoperative morbidity.” This was lost in the verbiage. ■■ To compare prophylactic cholecystec­ tomy to prophylactic removal of a third molar borders on the ludicrous. ™ The advice to the generalist, “If no progress has been made in five to six minutes” the dentist should stop and “radiograph the patient at the next visit” is not