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| NICE Guidelines for Removal of Wisdom Teeth |
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The NICE Guidelines for the Removal of Wisdom Teeth is presently being revised. The supposed date for the
new guidelines was June 2017; as yet, the new guidelines have not been published. As far as I can discern, they
will not be published imminently.
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.
new guidelines was June 2017; as yet, the new guidelines have not been published. As far as I can discern, they
will not be published imminently.
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 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 Scottish 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These were superseded, legally and clinically by the NICE Guidelines.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.
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 Scottish 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.
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 if the patient is having a General Anæsthetic (GA) 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 GA, then the upper ones should be removed as well as the
lower ones.
The upper 3rd molars, once the lower ones have been removed, may do one of 3 things:
1. Nothing
2. Start to erupt and then ‘run out of steam’ or
3. 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 3rd 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.
The NICE guidelines are presently under review. The revised guidelines were supposedly to be published in June
2017.
Useful Articles:
Oral Surgery 2010. Influence of SIGN guidelines on removal of third molars in The Lothians, Scotland, a clinical
audit
BJOMS 2012. Oral Presentations. Influence of NICE guidance on the management of mandibular 3rd molars in
British service personnel
JOMS 2012. What Has Been the United Kingdom's Experience With Retention of Third Molars
J Oral Maxillofac Surg 2013. Letters to the Editor. Third Molar Uncertainty
Cochrane Database of Systematic Reviews 2016. Surgical Removal vs. Retention for the Management of
Asymptomatic Disease-Free Impacted Wisdom Teeth
Ortho Update 2018. NICE Guidance on the Extraction of Wisdom Teeth − Time for a Rethink
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 if the patient is having a General Anæsthetic (GA) 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 GA, then the upper ones should be removed as well as the
lower ones.
The upper 3rd molars, once the lower ones have been removed, may do one of 3 things:
1. Nothing
2. Start to erupt and then ‘run out of steam’ or
3. 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 3rd 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.
The NICE guidelines are presently under review. The revised guidelines were supposedly to be published in June
2017.
Useful Articles:
Oral Surgery 2010. Influence of SIGN guidelines on removal of third molars in The Lothians, Scotland, a clinical
audit
BJOMS 2012. Oral Presentations. Influence of NICE guidance on the management of mandibular 3rd molars in
British service personnel
JOMS 2012. What Has Been the United Kingdom's Experience With Retention of Third Molars
J Oral Maxillofac Surg 2013. Letters to the Editor. Third Molar Uncertainty
Cochrane Database of Systematic Reviews 2016. Surgical Removal vs. Retention for the Management of
Asymptomatic Disease-Free Impacted Wisdom Teeth
Ortho Update 2018. NICE Guidance on the Extraction of Wisdom Teeth − Time for a Rethink
| Last Updated 8th January 2020 |