Should the NICE Guidelines for Management of Wisdom Teeth (Third Molars) be Reevaulated?

An article titled “Changes in Demographics of Patients Undergoing Third Molar Surgery in a Hospital Setting Between 1994 and 2012 and the Influence of the National Institute for Health and Care Excellence Guidelines,” written by Vahe Petrosyan and Phillip Ameerally appears in the February 2014 issue of the Journal of Oral and Maxillofacial Surgery, pp. 254-258. The article discusses how National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) were published around 2000 recommending against prophylactic removal of wisdom teeth. This led to a reduction in surgeries performed.

In the article the authors question whether or not the NICE guidelines on wisdom teeth should be updated. They mentioned a 2009 study which said 27% of previously symptom free wisdom teeth can become symptomatic after 1 year, especially those that are distoangularly impacted. In the article the authors looked at data from Northampton General Hospital in England which services around 0.7% of the population over the time period from 1994 to 2012. A total of 10,447 patients older than 16 years were treated during the study period. The mean patient age increased from 29 years in 1994 to 36 years in 2012, with the median increasing from 27 to 31 years of those patients who were treated. An analysis of variance test showed a statistically significant difference for patient age for which wisdom teeth were removed from 1994 through 2012.

The authors say their data supports what they thought would happen, as in their is an increase in age of patients undergoing wisdom teeth surgery. This means that younger patients are not undergoing as much surgery. In the discussion the authors state

“At first glance, this would seem to be a positive outcome in decreasing the cost to the NHS…However, after only 1 year, 27% of previously asymptomatic third molar teeth had become symptomatic, especially those that were distoangularly impacted.”

However, the data doesn’t support this number, this is from a prior study referenced… The authors then go on to discuss other items in their discussion which again is not supported by their data. For example they mention how some wisdom teeth can develop caries which would then require treatment which adds to costs. This is obvious. The authors do mention that as patients get older and undergo surgical treatment for wisdom teeth, the likelihood of complications occurring increases. Further the recovery time can be longer in older patients.

The authors state

The current evidence does not fully support the NICE guidelines and its conservative approach for the management of third molar teeth. The increased risk of complications and prolonged recovery of older patients begs the question: why aren’t third molar teeth being removed sooner? One of the reasons is financial. At Northampton General Hospital, the cost of a single ‘day case’ theater slot for removal of third molar teeth is £593 (US $904) to £ 855 (US $1,303).”

The authors end by saying

“The authors encourage the prophylactic removal of a contralateral, partially erupted, similarly impacted third molar tooth without an obvious radiographic intimate relation to the inferior dental canal if a young patient is undergoing general anesthesia.”

Frankly, I don’t see where the authors are getting their conclusions from based on their study. All their study really shows is what we already know, NICE guidelines caused less prophylactic wisdom teeth surgeries to occur in England and hence the age at which patients undergo wisdom teeth treatment has increased. The authors cite a few other studies in their discussion to support their beliefs but they are not using their own data to support these beliefs…

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