Third Molar Agenesis and

How it Relates to the Modern

Hygienist
Presented by: Amanda Stout LIT Dental Hygiene student
Madison East LIT Dental Hygiene Student
Third molar agenesis and impaction
● Third molar agenesis refers to the failure of third molars to develop during embryonic growth and
development due to the absence of primordial tissue.
● Impaction refers to teeth which do not fully erupt into the mouth because of blockage from other teeth.
● We will discuss what the causes of not only agenesis and impaction are, but also what has happened over our
evolution as human beings to cause these phenomenon.
How does evolution of our body structures relate to
the likelihood of developing agenesis or impaction:

- Our skulls are more fragile since we’ve gone from

foraging to farming.
- The use of our masticatory muscles have
dwindeled due to the fact that there is less need
for intense chewing
- Studies have shown that a decrease in jaw size
are directly related to third molar impaction due to
inadequate space.
- Research has also shown that because of the
decrease in jaw size over time the retromolar
areas decreased length is the reason behind 90%
of impacted third molars.
The Correlation between Impaction and Jaw size
● A decrease in jaw size are directly related to third molar
impaction due to inadequate space.
● The decreased jaw size over time correlates to the
retromolar areas decreased length. Is the reason behind
ninety percent of impacted third molars.
● The retromolar area in the oral cavity does not have enough
room to accommodate the third molars which is part of the
reason behind why they erupt at such odd angles.
● A few other studies suggest that agenesis is present
regardless of jaw size and that it is the soft tissue formation
that is to blame.
● So much of our bodies deal with genetics and the things we
inherit through our ancestors but often times the
environmental influences placed upon our bodies get
overlooked.
● For example, during the prime developmental age group
does the consistency and firmness of foods and the force
being placed on developing jaws directly correlate to the
overall size and strength of our facial bone.
Muscles of Mastication
● One example an article used was to compare our muscles of mastication like any muscle to those we work out and build by
running or walking, weight lifting etc.
● If we are not properly working out and using our muscles of mastication and unknowingly only eating ample amounts of soft
processed foods and dairy, then inevitably those muscles and surrounding structures are unable to form to their fullest potential
and possibly atrophy.
● In regard to a change in tools humans do not have the same cutlery and advanced cookware that we have today, so they had to
make due with natural tools that were sometimes forged with not only there hands but their mouths.
History
****When first trying to understand the anomaly of third molar
molar agenesis and impaction it was originally thought by
evolutionists that we as humans evolved from ape like ancestors
that have bigger jaws and mouths than us.

****Scientists now realize that the reasoning behind an

abundance of cases is due to a number of different factors

***There have been numerous indications that most third molar

problems today are due to other rationales.

***These reasons include a change from a rough acerbic diet to

an increased malleability found within the foods of a western diet,
improper practices of oral hygiene, and genetic components
perhaps involving mutations.
Geography

● Geography greatly influences the overall morphology and the

risk of having impacted third molars

● What food sources were more prominent in the particular area

in which you lived greatly influenced the probability of your
developing jaw size

● industrialized nation vs one that’s primary focus is

agriculture. In post agricultural countries there is more
processed foods which results in less use of masticatory
processes.

● People who live in impoverished places do not always have

proper access to the proper nutrition which in turn causes a
greater risk for deficiencies throughout the development of
dentition and bone structure.
Agriculture and food preference changing
Our diet change over the span of generations going from paleolithic to the
agricultural revolution introduced dairy products and grains into the human
diet.

This transitioned us from our once tough, hard and fibrous low calorie diet to
a vastly soft and extremely calorie dense diet.

This in turn, exacerbated over the centuries our consumption of vegetable

oils and refined grains, sugar and processed snack foods. (vending machine
snacks anyone?)
Correlation between growth of industrialization vs
agriculture:
Industrialization has led to a difference in
how we harvest and produce our food
sources.

Easy, fast and accommodating food

production doesn’t necessarily mean they
are beneficial to our dentition
***As we have grown from foraging to agriculture the use of our
muscles of mastication lowered slightly.

****From agriculture to industrialization our muscle use has

lowered exponentially

****not only have we atrophied our muscles we have also

diminished our quality of the foods we consume.
The effectual relationship
between agenesis/impaction
and dental caries:
The angle that the 3rd molar grows into the established dentition has everything to do with whether it is fully
impacted or not, and also if it is going to cause caries on the distal of the second molar.

The contact area between the second and third molar is the start of a carious lesion and it is oftentimes under the
gingival margin where it is virtually impossible to be aware of unless it is seen radiographically or is causing the
patient pain or discomfort.

Unilateral impaction is much more common than bilateral impaction and also mandibular impaction is more
common than maxillary impaction.
Incidence of distal second molar caries due to
impacted third molars:
The angle at which the partially erupted third molar touches
the second molar is a determing factor as to whether the distal
second molar develops a carious lesion.

For example:

If the third molar is partially erupted mesioangularly and it is

touching the CEJ or below it on the second molar it is a higher
risk of developing a carious lesion

But the risk goes down if the third molar is in contact with the
distal of the second molar above the CEJ.

Oftentimes, this is the reasoning behind why oral surgeons

remove impacted third molars.
Second Molar distal caries due to impaction
You also run the risk of having
to do restorations on the second
molar or even extracting it if
you allow the third molar to
continue to decay and damage
the second. It is a kind of
domino effect that if you let
fester can cause many systemic
problems and could eventually
lead to a patient having to get
full dentures in extreme cases.
Effect of caries on second molar and its link to other
oral pathologies:
● There are several oral pathologies that are a direct result of impacted third molars such as Periocoronitis, bone
loss, infection, carious lesions, periodontal disease, odontogenic cysts and tumors.
● The most likely to form Periocoronitis is a vertically impacted mandibular third molar.
● Oral surgeons and dentists must weigh risk vs benefit when talking about the removal of third molars. If done
incorrectly is can cause permanent paresthesia, TMJ pain, and also pain and swelling.
● This is the reason why dentists remove third molars when they first see that they are erupting in order to avoid
the possibility of them causing second molar caries and pain and discomfort for the patient.
Our role as the Dental Hygienist:
To inform and educate our patients about the benefits of
extraction in order to prevent opportunistic infections and
recurrent decay

Proper care with instruction to those patients on the importance

of meticulous oral care and how to best achieve that within their
home

To make oneself as the hygienist self aware of the effects that

third molar impaction can have on the oral cavity and what dental
considerations must come into effect in order to determine our
patients best possible treatment plan.

Most important role of all, treat each and every one of our
patients on an individualistic basis and accomodate the
dental needs tailored specifically for that patient. Everyone is
different and every case is different. Continuing Education is key
Further Research
● Ending the debate on when/if it is best to extract a person’s third
molars.
● More cost effective extraction methods
● Whether or not jaw size is a real cause of impaction or if it is the way the
soft tissue forms that is to blame.
● If genetically, there is a way to tell if someone will have impacted third
molars. And if so, if it is bilateral or unilateral or on both arches or just
one.
● Is this something that is passed down from lineage to lineage or is it
strictly based on environmental influences of the world.
References:
Almpani, K., & Kolokitha, O. (2015, February 16). Retrieved April 09, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317606/

Campbell, John H. Pathology associated with third molar. Retrieved from: http://www.oralmaxsurgery.theclinics.com/article/S1042-

3699(12)00178-1/pdf (8th citation)

Carter, Katherine. 2016. The Evolution of Third Molar Agenesis and Impaction. Doctoral dissertation, Harvard University, Graduate School of Arts

& Sciences.

E. (2018, January 18). How the Western Diet Has Changed the Human Face. Retrieved April 09, 2018, from http://darwinian-medicine.com/how-

the-western-diet-has-changed-the-human-face/

GOYAL, S., VERMA, P., & SUNDER RAJ, S. (2016). Radiographic Evaluation of the Status of Third Molars in Sriganganagar Population -- A

Digital Panoramic Study. Malaysian Journal Of Medical Sciences, 23(6), 103-112. doi:10.21315/mjms2016.23.6.11

Campbell, John. “Pathology Associated with the Third Molar.” Pathology Associated with the Third Molar , 2013,

www.oralmaxsurgery.theclinics.com/article/S1042-3699(12)00178-1/pdf+.)
References
Huang,Cunha-Cruz,Rothen,Spiekerman, Drangsholt,Anderson,& Roset,2014). A Prospective Study of Clinical Outcomes Related to Third Molar

Removal or Retention. American Journal Of Public Health, 104(4), 728-734

Knapton, S. (2017, August 25). Birth of farming caused jaw-dropping changes to the human skull, scientists find. Retrieved April 09, 2018, from

https://www.telegraph.co.uk/science/2017/08/25/birth-farming-caused-jaw-dropping-changes-human-skull-scientists/

MOLAR CARIES; DISTAL SURFACE MANDIBULAR SECOND MOLAR ... (n.d.). Retrieved April 9, 2018, from

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