Wisdom Teeth Removal Guidelines

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Hi All Removal of Wisdom Teeth is one of the most common surgical procedures performed in the UK.There is no reliable research evidence to support a health benefit to patients from the prophylactic removal of pathology-free impacted third

molar teeth.

Excerpt from the NICE Guidelines on the Extraction of Wisdom Teeth

Every procedure for the removal of an impacted wisdom tooth carries risk for the patient, including temporary or permanent nerve

damage, alveolar osteitis, infection and hæmorrhage as well as temporary local swelling, pain and restricted mouth opening.There are also risks associated with the need for general anæsthesia in some of these procedures, including rare and unpredictable death. Such patients are therefore being exposed to the risk of undertaking a surgical procedure

unnecessarily.Guidelines for the removal of Wisdom Teeth have been developed over the years by the Royal College of Surgeons of England and ish Intercollegiate Guidelines Network.These were superseded, legally and clinically by the NICE Guidelines. NICE states that their guidelines take precedence over other guidelines. Unfortunately, even though the NICE Guidelines have been extant since 2000, Dentists, Oral Surgeons and Maxillofacial Surgeons seem to have problems with them.The Oral & Maxillofacial Surgeons (often consultants looking to their private practice) will 'cherry pick' from all 3 sets of

guidelines.Some dentists refer in patients for a 'job-lot' removal of all 3rd molars (often seen with South African and Antipodean dentists) even though the clinical need doesn’t

warrant it.Other dentists refer patients in as they have developed lower incisor crowding. There is no evidence to show wisdom teeth cause this crowding or that the crowding will be relieved by the removal of the wisdom teeth (which is presumably why in the NICE guidance, there is no orthodontic indication for Wisdom

Tooth removal).Some surgeons demand a refinement of the Guidelines and accept mesially-impacted lower 3rd molars as being an indication for removal.A major problem seems to be that the referrers have problems with the concept of non-prophylactic

removal of 3rd

molars.Wisdom teeth cannot be prophylactically / preventively removed (according to the NICE Guidelines). Just

because wisdom teeth are present, it does not mean they have to be removed.

The Guidelines boil down to waiting for some pathology to develop, such as decay in the wisdom tooth or the adjacent tooth, gum disease around the wisdom tooth, infection around the tooth crown, cellulitis, abscess and including cyst / tumour, tooth / teeth impeding surgery or reconstructive jaw surgery and when a tooth is involved in or within the field of tumour resection etc.This is regarded by some as supervised neglect.Upper wisdom teeth and / or the patient is having a General

Anæsthetic to remove wisdom tooth / teeth, seems to be a conundrum for some clinicians.What is often cited is, that if the patient is having a general anæsthetic, then the upper ones should be removed as well as the lower ones.The upper third molars, once the lower ones have been removed, may do one of 3 things:1. Nothing2. Start to erupt and then ‘run out of steam’ or3. Erupt and start to traumatise the lower

mucosa.When the latter

stage has been arrived at, then I think you should consider removal of the upper third molar.Also, there is the argument that the upper third molar is functionless and hence should be removed. Why? Is there an indication for this in the guidelines? Is it due to a wish to tidy things up? Often, the rationale is again for prophylactic reasons.

Kind regards

Alena

Ozieva