Sir, I would like to bring to your attention the published article Concrescence of a mandibular third molar and a supernumerary fourth molar (BDJ 2006; 200: 141–142).

This case report suggests that the third molar was extracted due to intermittent pain experienced by the patient. Upon careful examination of the published radiographs, I have come to the conclusion that the tooth is fully impacted and shows no evidence of infection. The clinicians have failed to notice the deep occlusal and proximal caries lesion associated with 7 which I think is the cause of the symptoms experienced by the patient.

Although the article summarises concrescence of wisdom teeth, it fails to establish a proper diagnosis for the patient's chief complaint (pain). Instead of treating the symptomatic lower right second molar, the lower right third molar and the supernumerary fourth molar were surgically extracted. The above extractions are not compliant with NICE guidelines – which highlights the importance of arriving at a correct diagnosis.