NICE issues guidelines on wisdom teeth

BMJ 2000; 320 doi: (Published 01 April 2000) Cite this as: BMJ 2000;320:890
  1. Helen Morant
  1. BMJ

    The routine practice of prophylactic removal of disease free, impacted third molars should be discontinued on the NHS, according to new guidance from the National Institute for Clinical Excellence.

    The institute has produced guidelines on the removal of wisdom teeth as the first in their technology appraisal guidance series. It estimates that if the guidelines are followed the savings could be as much as £5m ($8m).

    The guidelines are broadly in line with those published by the Royal College of Surgeons' faculty of dental surgery in September 1997. They reinforce the currently accepted practice that asymptomatic wisdom teeth should not be operated on and that surgical removal should be limited to those patients with evidence of disease, such as unrestorable caries, osteomyelitis, trauma, and tumours.

    The guidelines state that only a second or particularly severe episode of pericoronitis (inflammation of the gingiva surrounding the crown of a tooth) should indicate removal.

    Removal of wisdom teeth is one of the commonest surgical procedures in the United Kingdom, with about 50000 operations being carried out in 1998-9. The institute estimates that between a quarter and a half were removed for prophylactic reasons in 1994-5.

    Mr David Barnard, dean of the faculty of dental surgery at the Royal College of Surgeons of England, said that the majority of dental surgeons should now be following its 1997 guidelines, and that it was unlikely that the new NICE guidelines would have a major impact on clinical practice.

    The institute claims that its guidance is to reinforce the already authoritative guidelines from the royal college and to give NHS trusts a baseline from which to audit their work. The guidelines suggest that NHS trusts should look at their waiting lists in the light of this guidance and cancel any unnecessarily planned operations.

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    (Credit: BSIP VEM/SPL)

    NICE says that healthy impacted wisdom teeth should be left alone

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