The effects of NICE guidelines on the management of third molar teeth

Abstract

More patients are requiring third molar removal with an increasing number of patients having caries related to their third molars. Patients are, on average, older confirming that the removal of third molars is shifting from a young adult population group to an older adult population group. NICE guidelines did appear to have contributed to a fall in the volume of third molars removed within the NHS post 2000. However, concluding that this reduction demonstrates the success of NICE's guidance would be a premature assumption. The number of patients now requiring third molar removal is comparable to that of the mid 1990s. NICE has influenced the management of patients with third molars but this has not resulted in any reduction in the number of patients requiring third molar removal. Coding and data collection for third molars is not uniform, leading to potential misrepresentation of data. This perhaps raises the issue that an improved universal coding system is required for the NHS and that the NICE guidelines need review.

Distal caries of the second molar in the presence of a mandibular third molar – a prevention protocol

“…12,13 There is also evidence that the restricted third molar removal indications (Table 1) from the National Institute of Health and Care Excellence (NICE) 14 contribute to the increasing incidence of this almost exclusively observed caries pattern by promoting third molar retention and restricting decay related third molar removal merely to situations in which caries rendered the tooth unrestorable. 15,16 However at present the evidence base for the benefit of timely surgical removal of wisdom teeth is still developing 17 and the purpose of this paper is to present the risk factors associated with DC in the mandibular second molar. Previously very little detail has been reported in the literature on the fate of the second mandibular molar and this paper addresses this knowledge gap and provides original data.…”

NICE or not so NICE?

“…The mean age of patients requiring removal of wisdom teeth increased from 25 years to 32 years over the time period. Their analysis also revealed an increase in those experiencing caries as an indication for removal, 23 despite continuing improvement in oral health within the UK population.…”

Economic and health implications of routine CBCT examination before surgical removal of the mandibular third molar in the Danish population

“…A British study reported a drop in the number of removals up to the millennium. 5 The change was interpreted to be induced by new indications from the National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. 19,20 The data from Norway 4 are therefore probably quite congruent with the data from the present study, although the Norwegian data are based on a study design with limited external validity.…”

“…A recent study focusing on England, Wales and Scotland pertained to determine the trend in the number of surgically removed mandibular third molars over time, but data describing the absolute numbers of removals in these populations are lacking. 5 Owing to the risk of nerve injuries following third molar removal, new diagnostic methods and surgical procedures have been introduced in recent years. CBCT scanning and coronectomy are examples of diagnostic and treatment strategies, which have been suggested to reduce complications and decrease morbidity following removal of the mandibular third molar.…”