The removal of the asymptomatic mandibular third molar is one of great debate and frequent controversy. Sometimes these teeth need to be removed early for signs or symptoms of pathology and sometimes they can be observed for further pathologic progression. This course details some of the reasons to remove third molars, with or without associated symptoms or pathology, and reviews surgical considerations involving third molars with associated pathology. The discussion includes developmental variations, impaction, anatomical abnormalities, caries, infections, cysts, and tumors, as well as complications of removal. A differential diagnosis is presented, with current treatment options and recommendations.