Many third molar teeth are probably removed unnecessarily in Sandwell

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1171a (Published 11 April 1998) Cite this as: BMJ 1998;316:1171
  1. Victor Lopes, Senior house officer, surgical rotation
  1. City Hospital, Birmingham B18 7QH

    EDITOR—Jones et al report their interview study to assess dentists' agreement on the treatment of asymptomatic impacted third molar teeth.1 They state that a quarter of these teeth are removed without being diseased, and give as a reference for this statement a paper by colleagues and myself; in fact the figure was half, not a quarter.2

    It is reassuring to see that Jones et al used as the gold standard guidelines that had been outlined at a consensus development conference of the National Institutes of Health. Their findings are alarming but not unexpected. The purchasers for Birmingham have prepared guidelines for third molar surgery largely based on the consensus guidelines. This document, however, still says that impacted third molars can be removed “on the decision of a consultant”—in other words, without any clinical basis that can be justified.

    The increase in the number of third molars being extracted by general dental practitioners is alarming. In Sandwell (adjacent to Birmingham) during 1994-5 the ratio of the actual to expected episodes of hospital extraction of third molars was the second lowest in the West Midlands region.3 Even more worrying, however, is the fact that the number of claims per thousand population aged 15-39 made by dentists in Sandwell for the removal of third molars in 1994-5 was the highest in the West Midlands.3 If the dentists in Sandwell have the same attitudes as those in the study group then I suspect that many third molars are removed unnecessarily. The challenge is for the Dental Practice Board to monitor and audit this, and for the profession to bring about pressure to stop such activity.


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