Sir, as a dental student five years ago, when questioned about wisdom teeth removal my response was to quote the NICE guidelines. I was just grateful to be asked an easy question! Visits to overseas dental facilities in recent years, however, have helped me delve deeper into the subject and question this UK convention.

Firstly, I must congratulate the BDJ for publishing the recent Mansoor et al. article which claimed: 'The NICE guidance on wisdom teeth published in 2000 clearly stated that they had “no” research evidence to support their recommendations'.1

Indeed upon reviewing the guidelines, no peer-reviewed articles, clinical trials and so forth are referred to. The guidelines do, however, take the opinions of dentists and dental institutes into account.2

The problem with opinions more often than not is that you will find somebody that has a directly opposite one. According to the American Association of Oral and Maxillofacial Surgeons' (AAOMS') press release from 2010, retaining your seemingly innocent asymptomatic wisdom teeth may well be killing you and harming your unborn child by leading to 'cardiovascular disease and preterm birth'.3

In fact, studies by AAOMS strongly recommend prophylactic removal of wisdom teeth.4

It is certainly odd that that AAOMS display such vitriol and contempt towards wisdom teeth, whereas NICE have an alternative view. It is of course speculation to question why there is such a difference, but health economics (make or save money, depending on which side of the Atlantic you're from) may well be playing a role here.

NICE does hasten to point out that: 'This guidance does not, however, override the individual responsibility of health professionals to make the appropriate decisions in the circumstances of the individual patient'.2

Ultimately the decision to extract wisdom teeth should not be based solely on guidelines (NICE or otherwise), especially guidelines where you can quite easily find an alternative reasonable (albeit American) stand-point.

UK dentists may be worried that by not following UK guidelines they may be open to claims of negligence, however, as evidenced by the Bolam test, the AAOMS would appear to be a responsible body of medical opinion, and as the law takes no account of geographical boundaries of medical opinion it does seem inconceivable to be negligent on this basis alone.5

At worst, our (over)reliance upon NICE guidelines may be having the corrosive effect of blunting the debate surrounding wisdom teeth removal in the UK. Certainly, this is a convention that deserves debate and questioning. Unfortunately, as it turns out, the answer to my question is anything but easy.