Amanda Stout & Madison East

Research Paper: Third Molar Agenesis

Dental Hygiene Spring 2018

Introduction

Have you ever been curious as to why certain people develop their third molars while others do

not? As we are constantly evolving as a species what will that mean for dentistry in the future,

and what will that mean for future generations as far as their dentition goes.

Thesis Statement

Understanding the difference between men being affected and women in relation to the

particular region in which they live. To better grasp the evolutionary aspect of this phenomena

and to understand the correlation between genetic factors and environmental factors. Is this

something that is passed down from lineage to lineage or is it strictly based on environmental

influences of the world. How the changes frequently seen within our patients’ dentition will

ultimately affect our role as the hygienist, and what sorts of dental considerations must be taken

into account.

Our skulls have become more fragile since we’ve gone from foraging to farming. The use of our

masticatory muscles has dwindled due to the fact that there is less need for intense chewing.

Cultures with more prominent in dairy and soft foods were shown to have a decrease in jaw size

therefore leaving less room for third molars whenever they erupt. Studies have shown that a

decrease in jaw size are directly related to third molar impaction due to inadequate space.

(Vukelic, 2017) Research has shown that because of the decrease jaw size over time 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. (Alpami,

Kolokitha, 2015) 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. (Carter, 2016) In regard to, a change in
Amanda Stout & Madison East
Research Paper: Third Molar Agenesis
Dental Hygiene Spring 2018

tools humans did not have the same cutlery and advanced cookware that we have today so

they had to make do with with the natural tools they had so their food production was much

cruder and their tools much more improvisational. 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. Science and the numerous amounts

of research out there are leaning towards yes. Just as in anything placed upon a child within

their early developmental stages, so much of what is subjected to them or lack thereof will be

the determining factor on how they evolve to become more or less prone to possible third molar

agenesis or impaction. 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. Our diet

change over the span of generations going from the Paleolithic to the agricultural revolution

introduced dairy products and grains into the human diet thus transitioning us from our once

tough, hard and fibrous, low calorie diet to a vastly soft and extremely calorie dense diet.

(Knapton, 2017) This change lead way to and ultimately sped up over the centuries the

consumption of vegetable oils, refined grains and sugars and processed snack foods that are so

conveniently ready made within our grocery stores and vending machines and inadvertently

entering the diets of the mass populations in large quantities. (Eirik, 2016)

Geography greatly influences the overall morphology and the risk of having impacted third

molars and a lot of it is to do with whether you lived in an industrialized nation vs one that’s

primary focus is agriculture. In post agricultural countries there is more processed foods and so
Amanda Stout & Madison East
Research Paper: Third Molar Agenesis
Dental Hygiene Spring 2018

here is less needed with masticatory processes. The theory is that because of this drastic

change in the way food is made that the third molars and larger jaws that accommodate them

are no longer needed which is why there is increased incidences of impaction. (Knapton, 2017)

Research states that in countries where an agricultural economy is present there is a lower

incidence of impacted third molars, but with industrialized economies the number of people who

have impacted third molars increases greatly. The problem with poor nutrition starts from tooth

development when the fetus is 6 weeks old if the mother is not getting adequate nutrition it

affects the overall morphology. A study suggests People living in impoverished places do not

always have access to the proper nutrition and it poses a greater risk of deficiencies throughout

the development of dentition and bone structure. Thus, it creates a situation where people have

a higher risk of infection and systemic involvement. (Carter, 2016) In several studies done some

say women have a higher risk of third molar agenesis while other contradict this and say men

due. The truth is that the origin or etiology of this phenomenon is unknown. (Goyal,Verma,

Sunder Raj, 2016) In countries where poor nutrition is prevalent it has been shown that with

stunted skeletal growth the dental development also is delayed. This can affect overall tooth

size and is a reason why impaction is lower in the impoverished countries vs. the more

industrialized ones. (Carter, 2016)

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. (Shams,

Hassan,Punjabi,Abdullah, 2017) 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
Amanda Stout & Madison East
Research Paper: Third Molar Agenesis
Dental Hygiene Spring 2018

third molars. Unilateral impaction is much more common than bilateral impaction and also

mandibular impaction is more common than maxillary impaction. (Carter, 2016) 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. (Campbell,

2013) 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. Typically, they try to 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. (Campbell, 2013) 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. (Huang,Cunha-

Cruz,Rothen,Spiekerman, Drangsholt,Anderson,& Roset,2014)

Conclusion:

We will provide a look into how a person’s region and sex determine the chance of them having

impacted third molars by examining statistics and the influence of diet on overall oral makeup. In

concern with evolution we will introduce the effects of jaw size on morphology as well how tool

usage and production of food influence changes within our genetics as humans. Our role as

hygienist comes into play with having to examine the effects of impacted or missing third molars

and how that possibly influences overall oral health and what specific dental considerations

must be determined to give our patients the best possible treatment plan. Third molars can

increase the risk for caries on the second molar as well as various other oral pathologies.
Amanda Stout & Madison East
Research Paper: Third Molar Agenesis
Dental Hygiene Spring 2018

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+.

(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
Amanda Stout & Madison East
Research Paper: Third Molar Agenesis
Dental Hygiene Spring 2018

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

https://www.bing.com/cr?IG=3544EA2565B349FE8775077BD87A38D4&CID=3CB3EC04C27D6C1C2C33E7C8

C3D26DA2&rd=1&h=HsMCbBAJ1Qr8qkmJB2lLd57CsCQADCj0NPWaqFKE8Aw&v=1&r=https://www.researc

hgate.net/publication/319014216_MOLAR_CARIES_DISTAL_SURFACE_MANDIBULAR_SECOND_MOLAR

_CARIES_EXISTENCE_AND_ASSOCIATION_WITH_PARTIALLY_ERUPTED_MANDIBULAR_THIRD_M

OLAR&p=DevEx,5035.1

Vukelic, A., Cohen, J. A., Sullivan, A. P., & Perry, G. H. (2017). Extending Genome-wide Association

Study Results to Test Classic Anthropological Hypotheses: Human Third Molar Agenesis and the

“Probable Mutation Effect”. Human Biology, 89(2), 157-169. doi:10.13110/humanbiology.89.2.03