Journal of the Dental Association of South Africa, 48, 235-240. Should impacted third molars be removed? A review of the literature

'WJ van der Linden, 'JF Lownie and PE Cleaton-Jones

Division of Maxillo-Facial and Oral Surgery, Department of Surgery, University of the Witwatersrand, Johannesburg and Dental Research Institute, Medical Research Council and the University of the Witwatersrand, Johannesburg

Mead (1954) defined an impacted tooth as 1. Lack of space one that is prevented from erupting into posi­ For optimal dental health and function a tion because of malposition, lack of space, or full complement of teeth is required. They other impediments. should be completely erupted and well aligned in their respective dental arches. The impacted third molar has been a point of Each tooth ought to be functional and discussion in the dental literature for many surrounded by healthy, attached gingiva. years - the debatable question is: "..... to Any tooth that has not been able to attain extract or not to extract?” A great deal has this ideal position is regarded as an im­ been written by eminent clinicians for and pacted tooth. against prophylactic extraction of impacted third molars (Laskin, 1969, 1971; Raley, Impacted teeth have a propensity for caus­ Chapnick and Baker, 1977; Goodsell, 1977; ing discomfort and causing pathologic le­ Lyttle, 1979; Bishara and Andreasen, 1983). sio n s. This often leads to confusion in the minds of the general practitioner who has doubts about It is often advisable to remove offending referment or treatment of these patients and third molars rather than to attempt coura­ is not sure whether or not he should abide by geous surgical and restorative procedures the old adage “let sleeping dogs lie”. There that have a poor prognosis and involve the seems to be little doubt that the removal of patient in a great deal of expense and symptomatic impacted third molars is indi­ aggravation. cated. Controversy arises however, regard­ ing the prophylactic removal of asymptomatic 2. Pericoronitis teeth and the debate concerns the likelihood Pericoronitis has been described as an of problems developing in the future. inflammation of the gingival tissues over the crown of a partially erupted molar The prevalence of impacted teeth has been (Laskin, 1969). For practical purposes studied in various population groups. Most pericoronitis can be divided into chronic, studies showed that the frequency of impac­ subacute and acute categories. In chronic tion varies between 17 and 22 per cent (Mead, pericoronitis the patient is largely una­ 1930; Bjork, Jenson and Palling, 1956; ware of a problem except for occasional Haralabakis,1957; Dachi and Howell, 1961; discomfort and possibly a bad taste that Brown e t al., 1982). All of these studies have exudes from under the gum flap from time shown that impacted third molars are the to time. The clinical signs and symptoms most common form of tooth impaction. Some of a subacute pericoronitis is far more studies have suggested that impacted third specific, and a well localised, dull pain is molars are more common in females than in present in the retromolar pad area. The males (Heilman, 1938; Bjork, Jenson and gum is painful, red and swollen. Often Palling, 1956; Pindborg, 1970) and another indentations from the cusps of the upper study that whites have a significantly higher third molars may be seen where they are prevalence than blacks (Brown e t al., 1982). pinching the pericoronal tissues and the adjacent buccal mucosa. A foetid oris is Indications for the removal of impacted or often present and pus can sometimes be unerupted third molar teeth expressed from underneath the gum flap. The submandibular lymph nodes may be There are a number of indications for surgical palpable and tender and mild trismus and removal of these teeth. pain on swallowing may also be present.

WJ van der Linden, BDS, MDent (Wits), FFD(SA) (MFOS) Patients suffering from acute pericoronitis JF Lownie, BDS, HDDent, MDent (Wits) are usually in severe discomfort, may be PE Cleaton-Jones, BDS, MB Bch, DA, PhD (Wits) pyrexial and suffering from malaise and Article received: 2 8 /6 /1 9 9 2 approved for publication: 30/9/1992 anorexia. The pain they suffer is severe

Journal of the D.A.S.A. — May 1993 WJ van der Linden, JF Lownie & PE Cleaton-Jones and throbbing, preventing them from per­ and possibly entrapment of food resulting forming their normal function, including in the development of caries as well as sleep. Trismus may be marked and swal­ loss of periodontal support in the adjacent lowing very painful. The affected side is tooth. Goodsell (1977) claimed that more often swollen with a tender submandibular second molars are lost due to third molars lymphadenopathy. Intra- orally the gingiva being left in place than for any other rea­ overlying the retro-molar area is inflamed son. In addition, inaccessibility for restora­ and swollen, as well as the adjacent buc­ tion of second molars may influence the cal and pharyngeal tissues. The clinical quality of restoration and so increase the features of the subacute variety are usu­ potential for carious pulpal exposure and ally present in a more severe form. If dental abscess formation, with all the en­ untreated this infection is likely to spread suing possible complications. into the adjacent tissue spaces, and if occurring bilaterally and not controlled with The early removal of impacted third mo­ antibiotics at an early stage, can develop lars results in a better prognosis for the into life threatening submandibular, second molar because bony defects cre­ sublingual, submental and parapharyngeal ated by surgical removal of teeth in young space infection or Ludwig’s Angina. adults fill rapidly and more completely than in older individuals (Marmary e t a/., Hendrix and Tall (1971) claim that well 1986). over 75 percent of all young adults with partially erupted or impacted third molars Developing third molars have been impli­ develop pericoronitis. Kay (1970) and Rud cated in causing root resorption of adja­ (1970) believe that 10 per cent of third cent second molar teeth. Nitzan, Keren molars extracted are afflicted with and Marmary, (1981) reported a preva­ pericoronitis. Radiologically, pericoronitis lence of 7,5 percent, with a striking male will only be observed if there has been predominance, in resorption of roots of osseous destruction distal to the second second molars caused by pressure from and also the third molars. This usually adjacent mainly asymptomatic third mo­ occurs following recurrent bouts of lars. They postulated that, apart from pres­ pericoronitis and can be seen as a sure, there are other elements — probably radiolucent area either on the mesial or systemic factors which play an active part the distal aspects of the impacted or em­ in resorption. They also found that root bedded third molar, that has no distinct resorption mainly occurred in patients cortical outline. On the distal aspect of the under the age of 30 years, and so sug­ partially erupted third molar, a flame shape gested that in attempting to prevent root radiolucency is indicative of the presence resorption of an adjacent tooth, extraction of an osteitis, due to recurrent pericoronitis. of the impacted tooth after this age will (Langland, Langlais and Morris; 1982). have little bearing on the development of These infections also tend to be more resorption of the adjacent second molar severe with each recurrence (Rud, 1970). tooth root. Fitzgerald (1953) has described peri­ coronitis arising in an unerupted, appar­ 4. Caries and internal resorption of the ently completely embedded third molar, impacted tooth and postulated that there might be a minute Dental caries as well as internal or exter­ fistula connecting it to the oral cavity nal resorption of an impacted tooth is an thereby permitting the ingress of oral mi­ indication for its removal (Lyttle 1979). crobes. This theory is supported by Baab, Unless a minimally impacted tooth is serv­ Morton and Page (1984) who reported a ing a vital function such as an abutment for most unusual case of an unerupted, em­ a partial denture or a sole remaining, func­ bedded third molar that presented for treat­ tional molar tooth, these teeth ought to be ment because of pulpitis due to a large extracted. Endodontic therapy of such carious lesion in the crown of an embed­ teeth has a poor prognosis due to the ded tooth, presumably due to the ingress inaccessibility of the canals, as well as the of cariogenic bacteria through the fistula. often complex nature of the root canal The authors have noted similar paradoxi­ s yste m . cal situations in their own experience. 3. Damage to adjacent teeth 5. Facilitation of orthodontic or periodon­ Due to their position in the dental arch and tal treatment relative inaccessibility for routine oral hy­ The influence of third molars on the dental giene procedures, impacted partially arch is still controversial (Hannah 1978). If erupted teeth allow a build-up of plaque posterior movement of first and/or second

Tydskrif van dieT.V.S.A. — Mei 1993 236 Third molar removal molars is required, to facilitate retraction and radicular cysts. The odontogenic or to avoid impacting third molars, it may keratocyst and lateral periodontal cysts be deemed advisable to remove third are developmental in origin and the im­ molars before starting retraction proce­ pacted status of the widsom tooth has little dures (Bishara and Andreasan 1983). The bearing on the pathogenesis of these cysts. area of controversy involves the indication for advi- sing removal of impacted third Ackerman, Cohen and Altini, (1987) re­ molars to prevent future crowding of lower viewed the development of the paradental anterior teeth, or to cause the forward cyst, and linked it specifically to the par­ relapse of the posterior movement of both tially erupted third molar that had under­ first and second molars following ortho­ gone several episodes of pericoronitis. dontic treatment. After an in depth study of They believe that this cyst is quite com­ these factors Bishara and Andreasen mon, but it’s reported prevalence is not (1983) came to the conclusion that there that high due to the fact that many sur­ was no scientific basis for this assump­ geons do not routinely send specimens of tio n. this nature for histological examination. The presence of the cyst is confirmed Grondhal and Lekholm (1973) studied the either radiologically or at time of surgery. periodontal condition around the distal aspect of the second molars behind which A continuous radio-opaque line forming impacted third molars were present. They the boundary of a radiolucent space sur­ found that oral hygiene can be improved rounding the tooth crown is defined as a by extraction of impacted and semi-impac- normal follicular border. Absence of part ted third molars. Poor oral hygiene can (or all) of this line indicates resorption of lead to loss of osseous support and the the follicle. Whenever the radiolucent periodontal condition worsens. Hannigan space diameter exceeds 3mm and root (1976) stated that periodontal pockets formation is complete, as indicated by the distal to second molars were difficult to closure of the apices of the tooth, then the treat surgically. This problem can be elimi­ eruptive potential of the tooth is greatly nated by early removal of impacted teeth. diminished and cystic transformation of 6. Impacted teeth related to odontogenic the tooth can be said to have occurred. cysts and neoplasms (Langland, Langlais and Morris, 1982.) The formation of a cystic lesion or neo­ Classically, the paradental cyst presents plasm in relationship to an impacted third as a radiolucent space on the distal aspect molar is probably the most serious compli­ of a partially erupted third molar, which cation associated with these teeth. The often extends into the inter-radicular area. first clinical sign of development of such a lesion will either be expansion of the man­ When the impacted tooth has been re­ dible or maxilla causing swelling of the moved a smooth concavity will be present face, or pain due to secondary infection of in the ascending ramus of the mandible the pathological condition. Fortuitous dis­ just distal to where the impacted tooth was covery of the lesion during routine dental present. The cyst lining is usually attached radiography will greatly improve the prog­ to the neck of the tooth and is often fused nosis for the patient following treatment. with the surrounding oral mucosa, thus Fortunately this is not a very common making it difficult to remove intact. This is occurrence and when present occurs more probably the main reason why specimens often in the mandible than the maxilla are not routinely sent off for histology. (B row n e t al., (1982). A radicular cyst can also develop in a Whether an ameloblastoma can arise in grossly carious impacted wisdom tooth the wall of a dentigerous cyst is controver­ due to pulpal degeneration. sial. Shafer, Hine and Levy, (1983) re­ ported a study by Stanley and Diehl (1965) Recently, Shiratsuchi and Kurihara (1987) in which they found that approximately 17 reported the development of an per cent of their sample of 641 cases of haemorrhagic cyst of the mandible asso­ ameloblastoma were definitely associated ciated with a retained root apex of a lower with an impacted tooth and/or a third molar. dentigerous cyst. The problems that cystic lesions cause Other odontogenic cysts that may involve are weakening of the angle region of the third molars are the odontogenic mandible increasing the possibility of frac­ keratocyst, lateral periodontal, paradental ture, possible malocclusion due to the

Journal of the D.A.S.A. — May 1993 237 WJ van der Linden, JF Lownie & PE Cleaton-Jones movement of adjacent teeth, expansion of molars in athletes who engaged in sport the cortices of the mandible limiting the with a high prevalence of facial trauma, normal range of motion, and secondary and who, therefore, are at greater risk for infection causing pain (Goodsell, 1977). fractured mandibles should they have im­ pacted third molars. Other odontogenic tumours - amelo­ blastoma and its varieties, odontomas, Contra-indications for the removal of im­ (Morning, 1980) as well as odontogenic pacted teeth myxoma may involve impacted third mo­ There are also very sound reasons for advis­ lars. ing against the prophylactic removal of im­ pacted wisdom teeth. 7. Pain of unknown aetiology Removal of an impacted third molar has 1. Possible damage to adjacent structures reported to have relieved pain in the An asymptomatic impacted tooth, the po­ temporomandibular joint, the ear, the neck, sition of which in the mandible or maxilla is opposing dental arch on the same side as such that its removal will adversely influ­ well as headaches (Lyttle, 1979). How­ ence any adjacent structures should be ever, Lyttle (1979) guarded against the left in place. Such structures includes the assumption that these teeth actually maxillary antrum, infra-temporal fossa, the caused the pain, because of the lingual nerve and inferior dental neuro­ multiciplicity of factors which result in pain vascular bundle. in the oro-facial regions. The potential complications affecting these Raley, Chapnick and Baker (1977) cited structures are; pressure of the third molar on the a. oro-antral communication; neurovascular bundle of the mandible b. displacement of the tooth into the infra­ causing a neuritis or diffuse neuralgia as temporal fossa and possible damage possible mechanisms for the pain referred to structures such as the pterygoid ve­ to the ear, due to linking of neural path­ nous plexus, maxillary artery and ways causing referred pain. Our belief is pterygoid muscles; that removal of these impacted teeth al­ c. damage to roots, crowns or lows the mandible an opportunity to rest periodontium of adjacent teeth; during the post-operative healing phase d. lingual or labial dysaesthesia with a due to protective muscle splinting causing varying length of time for recovery. a reduction in movement. This will allow an inflamed temporomandibular joint, (TMJ 2. Compromised health status and the age pain and earache) and painful muscle of the patient spasm (muscular headache) the neces­ These factors either singly or in combina­ sary rest to allow for relief of symptoms. tion may be a contra-indication to the Removal of infected impacted teeth can removal of asymptomatic impacted or relieve earache (referred pain due to in­ unerupted teeth of long standing. The pros fection) as well as neck pain due to sub­ and cons of undertaking the procedure in siding of a tender lymphadenopathy due such patients should be carefully evalu­ to the removal of the cause. ated (Goodsell, 1977). A good principle to follow is that the cure should not be worse 8. Pre-irradiation removals than the disease in this type of patient In order to prevent the disaster of (Lyttle, 1979). osteoradionecrosis it is advisable to re­ move all potentially troublesome teeth in 3. Abutment teeth and adequate space for the radiation field prior to commencement third molars of such radiation therapy. This is espe­ Unerupted teeth could be used for possi­ cially pertinent to partially erupted and ble bridge abutments once erupted. This impacted teeth (Lyttle, 1979). is especially true where there has been loss of a first or second molar tooth. In 9. Prophylactic removals addition if a person does have enough Carl and Schaff (1972) highlighted the space in the dental arch for full eruption of problem of an impacted tooth in an the wisdom teeth and the patient has the edentulous area causing weakening of ability to clean this area, the unerupted or the mandible following the resorption of partially erupted teeth could be left in place. the alveolar process. Schwimmer, Stern, If, however, oral hygiene is going to be a and Kritchman (1983) recommended the problem, the long term well being of the prophylactic removal of impacted third second molar could be affected in which

Tydskrif van die T.V.S.A. — Mei 1993 9 3 f t Third molar removal case the third molar should be removed middle to late teens to be the ideal time. (Goodsell, 1977). Raley, Chapnick and Baker, (1977) expanded on this and proposed that in these patients 4. O rth o d o n tic s third molars be removed for the following Where no specific indication for the re­ re a so n s: moval of third molars exists, there are a. osseous tissue is less sclerotic than in some orthodontic contra-indications for older individuals extraction of third molars. b. there is usually much better osseous regeneration of bone distal to second For example, when orthodontic treatment m o la rs planning calls for extraction of first or sec­ c. the follicular space facilitates dislodge- ond permanent molars or when first or ment of the tooth in younger individu­ second permanent molars have been ex­ als, whereas this space if often missing tracted due to extensive caries and/or in older persons with ankylosis being a periapical involvement the fate of the third great possibility molar should be carefully evaluated d. post-operative alveolitis is more com­ (Bishara and Andreasen, 1983). mon in older individuals e. ideal removal time is when two-thirds of 5. Transplantation of impacted teeth the root development has occurred, Third molars have been successfully trans­ before any tortuous curvature of the planted into extraction socket sites of both apical portion of the root has taken first and second molars (Cook, 1972; place. Therefore, the best age group to Brown, 1973). Goodsell (1977) reported a consider removal is 18-25 years. 75 percent success rate in properly se­ lected cases where the wisdom tooth had O sbo rn e ta l., (1985) did a prospective study of been transplanted into the first molar site. complications related to mandibularthird molar surgery and concluded that increased numbers 6. Patient is unwilling to have the tooth of complications occur after the removal of third rem o ved molars of older patients. On this basis they A patient with an asymptomatic impacted advocated the early, judicious removal of third tooth, who is unwilling to have the tooth molars, when indicated, to decrease the removed should have his wishes re­ prevalence of post-operative morbidity. s p e cte d . CONCLUSION DISCUSSION The arguments both for and against the pro­ phylactic removal of impacted third molar Third molars, as determined by clinical and/or teeth are all valid. In order to make a decision radiological considerations should be re­ that is going to benefit the patient the authors moved to improve the patient’s oral status as believe that each case should be assessed well as his general medical condition. Chronic on its merits. The decision whether or not to infection present for a long period of time is remove the third molars should take the over­ known to adversely affect the body’s immune all benefit to the patient’s oral status and system, and therefore elimination of a septic general health into account. However, the focus is a very important principle. Dental benefits of practising preventive medicine problems such as periodontal disease, recur­ and dentistry are endorsed. rent pericoronitis, caries, paradental cyst for­ mation and the possibility of root resorption ACKNOWLEDGEMENTS occurring in males under the age of thirty years are very real problems. In older indi­ The authors are indebted to the Librarians of viduals the completely unerupted, embedded the University of the Witwatersrand, Dental impacted wisdom tooth could well be left in School Library for their assistance during the situ and reassessed at regular intervals to information retrieval and to Ms Anne-Marie make sure that no pathological process is Muller and Miss Juanita Gomes for typing the taking place (Lyttle, 1979). script. Goodsell (1977) believed that where patients are aware of the benefits of preventive medi­ cine and dentistry, it is wise to advise the REFERENCES removal of all four wisdom teeth if they serve Ackerman, G, Cohen, MA & Altini, M (1987) The paradental cyst: A no useful function. He believed too that ben­ Cliniccopathological study of 50 cases. Oral Surgery Oral Medicine efits from performing this surgery at a younger and Oral Pathology 64, 308-312. Baab, DA, Mortan, TH & Page, RC (1984) Caries and periodontitis age are that patients tolerate surgery better associated with an unerupted third molar. Oral Surgery Medi­ and recover more quickly, and suggested the cine and OraI Pathology. 58, 428-430.

Journal of the D.A.S.A. — May 1993 239 WJ van der Linden, JF Lownie & PE Cleaton-Jones

Bishara, SA & Andreasen, G (1983) Third Molars: A review. Lyttle, JJ (1979) Indications and contra-indications for removal of American Journal of Orthodontics, 83, 131-137. the impacted tooth. Dental Clinics of North America, 23, 333-346. Bjork, A, Jensen, E & Palling, M (1956) Mandibular growth and third MacGregor, AJ (1985) The impacted lower wisdom tooth. Ch. 1, pp. molar impaction. Acta Odontologica Scandinavia, 14, 231-272. 16. Oxford: Oxford University Press. Brown, LH, Berkman, S, Cohen, D, Kaplan, AL & Rosenberg, M Marmary, Y, Brayer, L, Tzukert, A & Feller, L (1986) Alveolar bone (1982) A radiological study of the frequency and distribution of repair following extraction of impacted mandibular third molars. impacted teeth. Journal of the Dental Association of South Oral Surgery Oral Medicine Oral Pathology , 61, 324-326. A frica , 37, 627-630. Mead, SV (1930) Incidence of impacted teeth. International Carl, W & Schaff, NG (1972) Impacted teeth in denture - bearing Journal of Orthodontics, 16, 885-890. areas: A potential source of problems. Journal of Oral Surgery, Mead, SV (1954) O ra l S u rg e ry 4th Ed., pp. 5 0 7 -5 1 0 . St. Louis: CM 33, 331-334. M osby Co. Dachi, SF & Howell, FV (1961) A survey of 3874 routine full mouth Morning, P (1980) Impacted teeth in relation to odontomas. radiographs II. A study of impacted teeth. Oral Surgery Oral International Journal of Oral Surgery, 9, 8 1 -91. Medicine Oral Pathology, 14, 1165-1169. Nitzan, D, Keren, T & Marmary, Y (1981) Does an impacted tooth Fitzgerald, LM (1953) The impacted mandibular third molar. cause root resorption of the adjacent one? Oral Surgery Oral Oregon Dental Journal, 22, 27-31. Medicine Oral Pathology, 51, 221-224. Goodsell, JF (1977) An overview of the third molar problem. Osborn, TP, Frederickson, G, Small, IA & Torgerson, TS (1985) Quintessence International, 10, 11-18. A prospective study of complications related to mandibular third Grondhal, H & Lekholm, U (1973) Influence of mandibular third molar surgery. Journal of Oral Maxillo-Facial Surgery, 43, 767- molars on related supporting tissues. International Journal of 7 6 9 . Oral Surgery, 2, 137-142. Pindborg, J (1970) Pathology of the dental hard tissues, pp 242. Hannah, DR (1978) Unerupted third molars (letter). A u s tra lia n Toronto: WB Saunders Co. Dental Journal, 2 3 , 36 6. Raley, L, Chapnick, P & Baker, G (1977) The impacted third Hannigan, EJ (1976) The impacted third molar: to extract or not m olar. Journal of the Canadian Dental Association, 8, 364-366. to extract? Oral Health, 66:40. Rud, J (1970) Removal of impacted lower third molars with acute Haralabakis, H (1957) Observations on the time of eruption, pericoronitis and necrotising gingivitis. British Journal of Oral congenital absence and impaction of third molar teeth. T ra n s S u rg e ry, 7, 153-160. European Orthodontic Society, 33, 308-309. Schwimmer, A, Stern, R & Kritchman, D (1983) Impacted third Heilman, M (1938) Some aspects of wisdom teeth and their molars: A contributing factor in m andibular fractures in contact impactions. Archives of Clinical Oral Pathology, 2, 125-132. sports. American Journal of Sports Medicine, 11, 262-266. Hendrix, W & Tall, J (1971) Reasons for removing third molars. Shafer, WG, Hine, MK & Levy, BM (1983) A textbook of Oral Los Angeles County USC Medical Center. Presented Southern P a th o lo g y . 4th Ed., Ch.4, pp 258-317. Philadelphia: W.B. Californian Dental Association May 1971. [Quoted in Goodsell, Saunders Co. JF. (1977)] Shah, RM, Boyd, MA & Vakil, TF (1978) Studies of permanent Hutton, MB, Timcke, PH, Tindall, RJ & Wilson, RMH (1974) A compara­ tooth anomalies in 7886 Canadian individuals. 1: Impacted tive study of radicular, dentigerous and primordial cysts. Journal of the teeth. Journal of the Canadian Dental Association, 44, 262-264. Dental Association of South Africa, 29, 21 -23. S harm a, JN (1 9 8 3 ) H aem orrhagic cyst of the m andible in relation Kay, LW (1966) Investigations into the nature of pericoronitis. to horizontally impacted third molars. Oral Surgery Oral Medi­ British Journal of Oral Surgery, 3, 188-205. cine Oral Pathology, 55, 17-18. Langland, OE, Langlais, RP & Morris, CR (1982) Principles and Shiratsuchi, Y, Tashiro, HM & Kurihara, K (1987) Haemorrhagic Practice of Panoramic Radiography Ch, 7-10, pp 194-273. cyst of the mandible associated with a retained root apex of the Philadelphia : W.B Saunders Co. lower third molar. Oral Surgery Oral Medicine Oral Pathology, Laskin, DM (1969) Indications and contra-indications for removal of 63, 661-663. impacted third molars. Dental Clinics of North America, 13, 919-928. Stanley, HR & Diehl, DL (1965) Ameloblastoma potential of Laskin, DM (1971) Evaluation of the third molar problem. J o u rn a l follicular cysts. Journal of OraI Surgery, 20, 260-268. of the American Dental Association, 82, 824-828.

Applications for the 1992 Conditions of the Award FLOYD MEMORIAL 1. Articles may be written by not more than three (3) authors, the AWARD first-named of whom shall be un­ are invited to reach the der the age limit of 35 (thirty-five) years at the time of submission of Executive Director the article. Private Bag 1, Houghton, 2041 2. In the event of multiple author­ before 30 June 1993 ship, each author will be awarded a Bronze Medal and the cash prize of R1 500 will be equally divided The award is in the form of a Bronze between the authors. Medal and a cash prize of R1 500 funded by the Research, Education 3. Papers by eligble authors will be and Development Fund. considered annually. 4. Papers will be judged by two per­ The award is made to persons under sons appointed by the Editorial the age of 35 (thirty-five) for the best Panel of the JOURNAL of the scientific paper published in the Jour­ DASA and their recommendation nal of the Dental Association of South will be made to the Awards Com­ Africa. mittee for final approval.

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