Exodontia.Info
Wisdom Teeth Removal Guidelines
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
.
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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 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These were superseded, legally and clinically by the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.

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 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.