The purpose of this article is to address the following clinical question: Among subjects undergoing mandibular third molar (M3) removal, does an intervention at the time of tooth removal, when compared with no intervention, improve the long-term periodontal health on the distal aspect of the adjacent second molar (M2)? Routine application of interventions to improve the periodontal parameters on the distal of the M2 at the time of M3 removal is not indicated for most subjects. There seems to be a subpopulation of subjects having M3s removed who are at increased risk for periodontal defects after M3 removal, pre-existing periodontal defects, and a horizontal or mesioangular impaction. In the clinical setting of all three risk factors being present, there seems to be a predictable benefit to treating the dentoalveolar defect at the time of extraction.