DENTOALVEOLAR SURGERY

The Presence of Visible Third Molars

Negatively Inuences Periodontal Outcomes
in the Maternal Oral Therapy to Reduce
Obstetric Risk Study
Kevin L. Moss,* Steven Offenbacher, DDS, PhD,y James D. Beck, PhD,z
and Raymond P. White Jr, DDS, PhDx
Purpose: To assess the relationship between the presence or absence of visible third molars and out-
comes for periodontal inammatory disease.
Methods: Obstetric subjects, at enrollment in an institutional review boardapproved, multisite study,
Maternal Oral Therapy to Reduce Obstetric Risk (N = 1,798), were divided into 2 groups, those with no
visible third molars (n = 692) and those with at least 1 visible third molar (n = 1,106), the predictor vari-
ables for this study. The principal outcome variables were the patient-level periodontal status of the
rst/second molars: mean periodontal probing depths, mean attachment levels, and mean extent scores.
Periodontal disease severity also was assessed by criteria from the Oral Conditions and Pregnancy trial and
the Centers for Disease Control and Prevention/American Academy of Periodontology. Outcomes accord-
ing to the presence or absence of third molars were compared with c
2
statistics and multivariable analyses.
Signicance was set at P < .05.
Results: Signicantly more subjects had at least 1 third molar (62%) as compared with subjects with
no visible third molar (38%) (P < .01). Ethnic characteristics of the 2 groups were similar. Overall, more
subjects were white (61%), with most identifying their ethnicity as Latino. African-American subjects
were well represented (37%). Subjects with a visible third molar were more likely to be signicantly older,
to be receiving medical assistance, and to have used tobacco before pregnancy. If subjects had at least
1 visible third molar, the mean rst/second molar probing depths, attachment levels, and scores for bleed-
ing on probing were signicantly greater even after adjustment for covariates. On the basis of either Oral
Conditions and Pregnancy criteria or Centers for Disease Control and Prevention/American Academy of
Periodontology criteria, subjects were signicantly more likely to have moderate or severe periodontal dis-
ease if a third molar was detected.
Conclusion: If at least 1 visible third molar was detected in subjects in the Maternal Oral Therapy to
Reduce Obstetric Risk study at enrollment as compared with no detected third molars, periodontal out-
comes were signicantly worse.
2013 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 71:988-993, 2013
Received from the School of Dentistry, University of North Carolina,
Chapel Hill, NC.
*Research Applications Specialist.
yChair and OraPharma Distinguished Professor, Department of
Periodontology.
zKenan Distinguished Professor, Department of Dental Ecology,
and Executive Associate Dean.
xDalton L. McMichael Distinguished Professor, Department of
Oral and Maxillofacial Surgery.
Funding was provided by the Oral and Maxillofacial Surgery Foun-
dation and American Association of Oral and Maxillofacial Surgeons,
as well as oral and maxillofacial surgery departmental funds fromthe
Dental Foundation of North Carolina.
Conict of Interest Disclosures: None of the authors reported any
disclosures.
Address correspondence and reprint requests to Dr White:
Department of Oral and Maxillofacial Surgery, School of Dentistry,
University of North Carolina, Chapel Hill, NC 27599-7450; e-mail:
ray_white@dentistry.unc.edu
2013 American Association of Oral and Maxillofacial Surgeons
0278-2391/13/00093-1$36.00/0
http://dx.doi.org/10.1016/j.joms.2013.01.012
988
Population or clinical trial data from third molars re-
main limited because third molars are often missing
in those aged over 30 years without data on the reasons
for removal, and third molar data fromyoung and older
subjects often have not been collected or have been ex-
cluded in the analyses.
1-4
Moss et al
5
have shown that
periodontal probing measures could be assessed as
accurately on third molars as on other teeth. Subse-
quently, third molar periodontal data have been re-
ported more often from both clinical and population
studies.
6-8
On the basis of the high prevalence of increased peri-
odontal probing depths (PDs) in molar regions of the
mouth associated with retained third molars, White
et al
9
suggested that inyoung adults the presence of a vis-
ible third molar alone may be a risk indicator for more se-
vere periodontal inammatory disease requiring clinical
assessment for conrmation. Data from 1,020 subjects
at enrollment in the Oral Conditions and Pregnancy
(OCAP) trial conducted at a single clinical academic cen-
ter supported this association.
10
Visible third molars
were detected in 405 subjects at enrollment. Subjects
with visible third molars were signicantly more likely
to have moderate/severe periodontal disease and less
likely to be periodontally healthy. If at least 1 third molar
was visible, the odds for more severe periodontal inam-
matory disease were more than double as compared
with subjects with no visible third molars, withthe inves-
tigators controlling for covariates such as tobacco use or
low socioeconomic status.
The specic aims of these analyses were to assess
the relationship between the presence of visible third
molars and clinical indicators at the rst/second mo-
lars of periodontal inammatory disease in a multisite
study of obstetric subjects, the Maternal Oral Therapy
to Reduce Obstetric Risk (MOTOR) study. In addition,
subjects level of periodontal disease according to the
presence or absence of third molars was categorized
by the recently promulgated Centers for Disease Con-
trol and Prevention (CDC)/American Academy of Peri-
odontology (AAP) classication system.
Methods
SAMPLE
The MOTORstudy was an institutional reviewboard
approved, National Institutes of Healthsupported
trial enrolling pregnant subjects with clinically de-
tected periodontal disease to assess the impact of
periodontal treatment on obstetric outcomes, preterm
birth, and low birth weight.
8
Subjects at 3 academic
clinical centers and afliated clinics (Duke University,
University of Alabama at Birmingham, and The Uni-
versity of Texas at San Antonio) were enrolled over
a 4-year period beginning in 2003 and randomized to
periodontal treatment before ultrasound conrmed
23 weeks of gestation or delayed treatment until after
delivery. Treatment at the stated intervals for both
study groups consisted of mechanical debridement
of supragingival and subgingival biolm accompanied
by oral hygiene instructions.
DATA COLLECTION
To be eligible for the MOTORstudy, pregnant subjects
had to have at least 20 teeth in total and a minimum of
3 teeth with a clinical attachment level (AL) of at least
3 mm, the inclusion criteria for the study. We excluded
subjects with criteria that might impact periodontal out-
comes, conditions suchas diabetes mellitus, or a require-
ment for antibiotic prophylaxis as part of periodontal
assessment. Conducted by trained, calibrated dental ex-
aminers, subjects periodontal examinations included
periodontal PDs, 6 sites per tooth on all visible teeth in-
cluding the third molars. PDs were rounded to the low-
est whole number (eg, a measured PD of 4.8 mm was
recorded as a PD of 4 mm). No radiographs were avail-
able to complement the clinical examinations. The arti-
cle by Offenbacher et al
8
provides additional details on
the design and conduct of the MOTOR study.
DATA ANALYSES
Specic to our assessment, all obstetric subjects at
enrollment were divided into 2 groups, those with no
visible third molars and those with at least 1 visible
third molar, the principal predictor variables for the
analyses. Covariates included study center, race/ethnic-
ity, age, smoking before pregnancy, body mass index
(BMI), and medical assistance status. Because molar
teeth were more affected than teeth more anterior in
subjects in the OCAP trial, outcome variables chosen
for these analyses were the patient-level periodontal
status of the rst/second molar teeth categorized by
the following clinical indicators: mean periodontal
PDs, mean ALs, and mean percentage of rst or second
molars with bleeding on probing (BOP).
11
We per-
formed multivariate modeling with SAS Proc GLM
(SAS Institute, Cary, NC) to calculate the least squares
means, adjusting for the study outcome variables and
covariates. Variables were selected for inclusion into
the adjusted models based on a signicant (P < .05)
bivariate association with outcome. In addition, race/
ethnicity was included because it is often a standard
control variable. Signicance for reported outcomes
was set at P < .05.
It has been difcult to compare subjects periodontal
severity among clinical and population studies because
no single standard for periodontal pathology has been
applied. For comparison purposes, we have reported
outcomes for patient-level periodontal disease severity
compared by presence or absence of third molars,
based on denitions from the prior reported study of
MOSS ET AL 989
obstetric subjects inthe OCAPtrial and the most current,
recently derived classication fromthe combined efforts
of the CDCand AAP.
10,12
In the OCAP trial, subjects were
categorized as healthy/disease absence, mild disease, and
moderate/severe disease. Healthy was dened as no
periodontal probing site (PD) of 4 mm or greater and
no probing sites greater than 3 mm with BOP; mild
disease, at least 1 PD of 4 mm or greater or at least 1 PD
of 3 mm or greater with BOP up to a maximum of 15
PD sites of 4 mm or greater; and moderate/severe
disease, 15 or more PD sites of 4 mm or greater. On the
basis of CDC/AAP criteria, subjects were categorized
as healthy/mild disease, moderate disease, or severe
disease. Healthy/mild disease was dened as neither
moderate nor severe disease. Moderate disease was
dened as at least 2 teeth with interproximal probing
sites with clinical ALs of at least 4 mm or at least 2 teeth
with interproximal PDs of at least 5 mm. Severe disease
was dened as at least 2 teeth with interproximal
probing sites with clinical ALs of at least 6 mm and at
least 1 tooth with an interproximal PD of at least 5 mm.
In addition, patient-level extent scoresthe number of
probing sites with BOP (numerator) of all possible
probing sites (denominator) for visible teethwere
reported. Outcomes for the severity of disease based on
the 2 classication systems by the presence or absence
of third molars were compared by use of c
2
statistics.
Signicance was set at P < .05.
Results
Data from 1,798 obstetric subjects at enrollment
were available for analyses. Signicantly more subjects
had at least 1 visible third molar (1,106 [62%]) as com-
pared with subjects with no visible third molars (692
[38%]) (P < .01) (Table 1). Ethnic characteristics of
the 2 groups were similar. Most subjects were white
(61%), but African-American subjects were well repre-
sented (37%). Latino was the reported ethnicity for
85% of the white subjects; fewer than 10% of subjects
were non-Latino white. Subjects with a visible third mo-
lar, as compared with those with no visible third molars,
were more likely to be signicantly older, with a mean
age of 26 years versus 24.3 years (P < .01); to have
a higher mean BMI, 28.8 versus 27.7 (P < .01); to re-
ceive medical assistance, 63% versus 37% (P = .03);
and to have used tobacco before pregnancy, 56%versus
44% (P = .04).
In subjects with at least 1 visible third molar, the
mean rst/second molar PD was signicantly greater
than that in subjects who did not have a third molar vis-
ible, 3.74 mm versus 3.50 mm (P < .01) (Table 2). Simi-
larly, for subjects with at least 1 visible third molar,
the mean rst/second molar AL was signicantly greater
compared with subjects with no visible third molars,
2.06mmversus 1.96mm(P<.01). Themeanpercentage
of rst/second molars with BOP was greater if a third
molar was visible as compared with no visible third mo-
lars, 63.9% versus 53.9% (P < .01). These relationships
continued to be signicantly different (P < .01) after
we adjusted for the following covariates: study clinical
center, race/ethnicity, age, smoking before pregnancy,
BMI, and medical assistance status (Table 3).
Table 1. SUBJECTS CHARACTERISTICS (N = 1,798)
No Third
Molar
Visible
(n = 692)
$1 Third
Molar
Visible
(n = 1,106)
P
Value
Race/ethnicity .19
African
American
240 (34.8%) 430 (39.1%)
White
including
Latino
440 (63.9%) 655 (59.5%)
Other 9 (1.3%) 15 (1.4%)
Mean maternal
age (SD) (y)
24.3 (5.8) 26.0 (5.1) <.0001
Mean BMI at
baseline (SD)
27.7 (6.8) 28.9 (6.8) .0007
Married .57
Yes 328 (47.4%) 509 (46.0%)
No 364 (52.6%) 597 (64.0%)
Medical
assistance
.03
Yes 405 (58.5%) 693 (64.5%)
No 276 (41.5%) 381 (35.5%)
Smoke before
pregnancy
.04
Yes 129 (18.7%) 166 (15.0%)
No 562 (81.3%) 937 (85.0%)
Note: Of white subjects, 85% identied their ethnicity as
Latino (52% of the total number of subjects).
Moss et al. Visible Third Molars and Periodontal Outcomes. J Oral
Maxillofac Surg 2013.
Table 2. PATIENT-LEVEL CLINICAL PERIODONTAL
OUTCOMES FOR FIRST AND SECOND MOLARS AT
ENROLLMENT
First and
Second Molar
Measurement
No Third
Molar
Visible
(n = 667)
$1 Third
Molar
Visible
(n = 1,106)
P
Value
Mean PD (SE) (mm) 3.50 (0.02) 3.74 (0.02) <.0001
Mean AL (SE) (mm) 1.96 (0.02) 2.06 (0.02) <.0001
Mean % BOP (SE) 53.9 (1.16) 63.9 (0.76) <.0001
Note: Signicance was set at P < .05.
Moss et al. Visible Third Molars and Periodontal Outcomes. J Oral
Maxillofac Surg 2013.
990 VISIBLE THIRD MOLARS AND PERIODONTAL OUTCOMES
The mean PD for rst/second molars was greater if
subjects had 4 third molars visible as compared with
only 1 third molar visible, 3.83 mm versus 3.65 mm
(data not shown). Similarly, the mean AL for rst/second
molars was greater if subjects had4thirdmolars visible as
comparedwithonly1thirdmolar visible, 2.07mmversus
1.98 mm. The mean percentage of rst/second molars
with BOP followed the same pattern: if subjects had 4
third molars visible as compared with only 1 third molar
visible, the extent for BOP was 66.6% versus 64.7%.
Because subjects in the MOTOR study had to have
evidence of at least mild periodontal disease as an in-
clusion criterion, most subjects had at least 1 PD of
at least 5 mm or a probing site with BOP, detected
more often on molars. However, if subjects had at least
1 third molar visible, subjects were signicantly more
likely to have at least 1 PD of 5 mm or greater as com-
pared with subjects with no visible third molar, 96%
versus 84% (P < .01) (Table 4). Similarly, subjects hav-
ing an extent of BOP of at least 10% was signicantly
more likely if a visible third molar was detected as com-
pared with no visible third molar (P < .01).
On the basis of either OCAP or CDC/AAP criteria for
the absence or presence of periodontal disease, subjects
were signicantly more likely to have moderate or se-
vere disease if a third molar was detected (P < .01)
(Table 4). For example, by CDC/AAP criteria, moderate
or severe disease was detected in 61%MOTOR subjects
if a third molar was visible compared with 41% of sub-
jects with no third molar visible. Similarly, based on
OCAP criteria, 93% of subjects had moderate or severe
disease if a third molar was visible compared with 77%
of subjects with no third molar visible.
Discussion
These analyses of data from a population of
obstetric subjects enrolled in the rst trimester of
pregnancy were designed to assess the relationship
between the presence of visible third molars and
clinical indicators of periodontal inammatory dis-
ease. If subjects in the MOTOR study had at least 1
third molar visible at enrollment, clinical indicators
of more severe periodontal inammatory disease
for the rst and second molarsperiodontal PDs,
ALs, and scores for BOPwere detected more often
as compared with subjects with no visible third mo-
lars. To be included in the MOTOR study, subjects
could not be periodontally healthy. Having at least
20 teeth in total and 3 teeth with periodontal ALs
of 3 mm or greater were important inclusion criteria
for the principal aims of the MOTOR study. However,
subjects with at least 1 visible third molar at enroll-
ment in the MOTOR study were more likely to have
moderate or severe periodontal disease detected
throughout the entire mouth, as compared with sub-
jects with no visible third molars, based on the clas-
sication used in the OCAP trial or the more
recently promulgated CDC/AAP classication.
10,12
Although similarities in the study of pregnant sub-
jects enrolled in the OCAP trial and MOTOR study exist,
important differences suggest that the periodontal out-
comes that we detected are more than complementary.
In both the OCAP trial and the MOTOR study,
periodontal assessment by trained, calibrated exam-
iners was based on full-mouth periodontal probing at
Table 3. PATIENT-LEVEL CLINICAL PERIODONTAL
OUTCOMES FOR FIRST AND SECOND MOLARS AT
ENROLLMENT ADJUSTED FOR DIFFERENCES IN
STUDY CLINICAL CENTER, RACE/ETHNICITY, AGE,
SMOKING BEFORE PREGNANCY, BMI, AND MEDICAL
ASSISTANCE
First and
Second Molar
Measurement
No Third
Molar
Visible
(n = 667)
$1 Third
Molar
Visible
(n = 1,106)
P
Value
Mean PD (SE) (mm) 3.54 (0.02) 3.72 (0.02) <.0001
Mean AL (SE) (mm) 1.95 (0.02) 2.06 (0.01) <.0001
Mean % BOP (SE) 55.2 (0.99) 62.6 (0.78) <.0001
Note: Signicance was set at P < .05.
Moss et al. Visible Third Molars and Periodontal Outcomes. J Oral
Maxillofac Surg 2013.
Table 4. PREVALENCE OF SUBJECTS OVERALL
CLINICAL PERIODONTAL CONDITIONS BY PRESENCE
OF AT LEAST 1 VISIBLE THIRDMOLAR (N= 667) OR NO
VISIBLE THIRD MOLARS (N = 1,106)
No Third
Molar
Visible
[n (%)]
$1 Third
Molar
Visible
[n (%)]
P
Value
CDC/AAP criteria <.0001
Healthy/mild 394 (59.1) 432 (39.1)
Moderate 263 (39.4) 632 (57.1)
Severe 10 (1.5) 42 (3.8)
OCAP criteria <.0001
Healthy 0 (0.0) 0 (0.0)
Mild 153 (23.0) 80 (7.2)
Moderate/severe 514 (77.0) 1,026 (92.8)
PD <.0001
All PDs <5 mm 106 (15.9) 43 (3.9)
$1 PD $5 mm 561 (84.1) 1,063 (96.1)
Extent of BOP <.0001
<10% 117 62
$10% 550 1,044
Note: Patient-level extent scores for BOP were calculated
as the number of probing sites with BOP (numerator) of all
possible probing sites (denominator) for all teeth.
Moss et al. Visible Third Molars and Periodontal Outcomes. J Oral
Maxillofac Surg 2013.
MOSS ET AL 991
6 designated sites for all visible teeth including the third
molars. No radiographs were available in either study to
complement clinical examinations. However, as com-
pared with the OCAP trial, which was conducted at
a single clinical center, more subjects were enrolled in
the MOTOR study at multiple clinical centers, a third
molar was detected more frequently in MOTOR sub-
jects, the racial/ethnic mix was more diverse inMOTOR
subjects, and more subjects in the MOTOR study were
receiving medical assistance.
Subjects in the MOTOR study (N = 1,798) were en-
rolled at 3 clinical centers as compared with the single
clinical center in the OCAP trial (N = 1,020). Subjects
in the MOTOR study were more likely to have a third
molar visible (62%) as compared with those in the
OCAP trial (40%). Fewer subjects in the MOTOR study
were African American (37%) compared with the
OCAP trial (46%). Most white subjects in the MOTOR
study (85%) reported their ethnicity as Latino, a popu-
lation with limited data on third molar periodontal
inammatory disease in the literature. Although eligi-
bility differs by state, subjects in the MOTOR study
were more likely to be receiving medical assistance
(61%) than were those in the OCAP trial (18%). In
summary, data from the OCAP trial and MOTOR add
support to the possibility that in young adults the
presence of a visible third molar alone may be a risk
indicator for more severe periodontal inammatory
disease, suggesting that a clinical examination is im-
portant for conrmation.
9
Clinicians may question the clinical importance of
the small differences in mean rst/second molar PDs
between groups that we report and the relationship
of these differences to periodontal pathology. As an ex-
ample, the difference inrst/second molar mean PDbe-
tween subjects with visible third molars and no visible
third molars was 0.24 mm. If considered at only a single
probing site, clinicians could dismiss this small differ-
ence without reection. However, the 6 periodontal
probing sites for each tooth approximate the total sur-
face area of the biolm-gingival interface (BGI) around
that tooth. For this analysis, the mean difference in
PD for each probing site must be amplied by multiply-
ing 6 probing sites measured for all rst/second molars
in each patient, a total of 48 probing sites, yielding
a mean increase in PD of 11.5 mm per patient. This dif-
ference reects a substantial and clinically important in-
creased surface area at the BGI as compared with
subjects with no visible third molar. Any increase in
PD is more often found at the deeper periodontal prob-
ing sites. The overall greater surface area of the BGI for
affected subjects contributes to an enhanced anaerobic
clinical environment for possible colonization by sub-
gingival pathogens and resulting increased expression
of inammatory mediators in the gingival crevicular
uid and blood.
Clinicians should exercise some caution when apply-
ing our ndings to individual subjects. Subjects in the
MOTOR study and OCAP trial were enrolled for a study
of obstetric outcomes, not a study of the association be-
tween third molars and levels of periodontal inamma-
tory disease. Although subjects in the MOTOR study
were a diverse group, the subjects were not representa-
tive of the US population. All subjects were pregnant;
subjects in the same age range who were men or who
were not pregnant may have different outcomes. Few
Asians were included, non-Latino white subjects were
under-represented, and Latino subjects were over-
represented, comprising 52% of the study population.
In both the MOTOR study and OCAP trial, 16% of sub-
jects used tobacco before pregnancy, a marginally lower
outcome than might be expected for this age group and
socioeconomic status.
13
Subjects knowledge about the
risks of smoking while being pregnant may account for
the lower prevalence of tobacco use. However, the data
we report do suggest that the association between third
molars and periodontal inammatory disease should be
studied further with a population more representative
of the US population.
How might clinicians apply our data to their subjects?
Once third molars are exposed to the oral cavity and can
be probed, oral ora colonize on the surfaces in a non-
sheddable biolm.
14
Because the third molars are the
most posterior teeth in each jaw, erupting most often af-
ter jawgrowth is complete, individuals are likely to have
deeper periodontal PDs, harboring anaerobic pathogens
that are difcult to eradicate by mechanical debridement
alone.
15,16
The data from subjects in the MOTOR study
suggest again that in young adults, retained third molars
require careful monitoring for the presence of deeper
periodontal PDs as potential sources for the initiation of
periodontal inammatory disease. If periodontal PDs of
at least 4 mm are detected, removal of the third molars
should be considered as the only current treatment
available to effectively reduce the local and systemic
inammatory immune response to pathogenic bacteria.
References
1. Hugoson A, Kugelberg CF: The prevalence of third molars in
a Swedish population, an epidemiological study. Commun
Dent Health 5:121, 1988
2. Thomson WM, Broadbent JM, Welch D, et al: Cigarette smoking
and periodontal disease among 32-year-olds: Aprospective study
of a representative birth cohort. J Clin Periodontol 34:828, 2007
3. Tanner ACR, Kent R Jr, Van Dyke T, et al: Clinical and other risk in-
dicators for early periodontitis in adults. J Periodontol 76:573, 2005
4. Elter JR, Cuomo C, Slade GD, et al: Relationship of third molars
to periodontal health in NHANES III. J Oral Maxillofac Surg 62:
440, 2004
5. Moss KL, Mauriello SM, Ruvo AT, et al: Reliability of third molar
probing measures and the systemic impact of periodontal pa-
thology. J Oral Maxillofac Surg 64:652, 2006
6. Moss KL, Beck JD, Mauriello SM, et al: Risk indicators for third
molar caries and periodontal disease in senior adults. J Oral Max-
illofac Surg 65:958, 2007
992 VISIBLE THIRD MOLARS AND PERIODONTAL OUTCOMES
7. Garaas R, Moss K, Fisher E, et al: Prevalence of third molars in
middle-aged and older Americans with no caries experience or
periodontal pathology. J Oral Maxillofac Surg 69:463, 2011
8. Offenbacher S, Beck JD, Jared HL, et al: Effects of periodontal ther-
apy on rate of preterm delivery. Obstet Gynecol 114:551, 2009
9. White R, Fisher E, Phillips C, et al: Visible third molars as a risk
indicator for increased periodontal probing depths. J Oral Max-
illofac Surg 69:92, 2011
10. Moss KL, Serlo AD, Offenbacher S, et al: The oral and systemic
impact of third molar periodontal pathology. J Oral Maxillofac
Surg 65:1739, 2007
11. Moss KL, Beck JD, Offenbacher S: Clinical risk factors associated
with incidence and progression of periodontal conditions in
pregnancy. J Clin Periodontal 32:493, 2005
12. Page RC, Eke PI: Case denitions for use in population-based sur-
veillance of periodontitis. J Periodontol 78:1387, 2007
13. Centers for Disease Control and Prevention (CDC): Vital
signs: Current cigarette smoking among adults aged $18
yearsUnited States 2005-2010. MMWR Morb Mortal Wkly
Rep 60:1207, 2011
14. Socransky SS, Haffajee AD, Cugini MA, et al: Microbial com-
plexes in subgingival plaque. J Clin Periodontol 25:134, 1998
15. Rantanen AV: The age of eruption of the third molar teeth. A clin-
ical study based on Finnish university students. Acta Odontol
Scand Suppl 48:1, 1967
16. Fisher E, Blakey G, Offenbacher S, et al: The clinical impact of
mechanical debridement of sub-gingivalbiolm on third molar
periodontal pathology. J Oral Maxillofac Surg 71:467, 2013
MOSS ET AL 993