Sir, I write in response to the letter published in the BDJ by A. Aslam regarding the NICE guidelines for the extraction of lower wisdom teeth. Dr Aslam refers in his letter to the Bolam test1 which would allow any practitioner to be defended by opposing expert opinion in the event of any accusation of negligence regarding lower wisdom tooth removal.

The Bolam test has been misused and misquoted since its inception in the Bolam v Friern case in 1957. For example in the case of De Freitas,2 only 11 surgeons out of 1,000 supported the defendant's actions. Despite this, the court found that this was a reasonable body of medical opinion. Due to incidents such as this, Bolam has been since modified by the case of Bolitho,3 which adds a layer of clarification to Bolam and prevents expert opinion which is illogical being used to defend allegations of negligence. It is for the judge in any case to decide what constitutes expert opinion being illogical.

Dr Aslam relies on the belief that the English judiciary does not discriminate between expert opinion from this jurisdiction and outside. This may be the case in theory, but it is likely that opinion from the jurisdiction the case originates from will be accepted over and above that of foreign opinion when the two contrast. This is because foreign opinion is sometimes likely to lack the cultural and legal context that might mean its application to a different jurisdiction is impaired. In the example given of wisdom teeth extraction, one must remember that these extractions will most likely be privately funded in the USA whereas they are funded by the taxpayer in the UK, which is likely to affect the guidelines surrounding their removal. I would argue that the AAOMS guidelines don't have the same authority in England that the NICE guidelines do. With regards to the debate over best practice, I share Dr Aslam's confusion, but until the guidelines are modified to change this, it would be better to heed the NICE guidelines from a point of view of avoiding a negligence claim.