Sir,- In March 2000 the National Institute for Clinical Excellence (NICE) published guidelines on the removal of wisdom teeth. The Appraisal Committee determined that there was no reliable research to support a health benefit to patients from the prophylactic removal of pathology-free impacted third molar teeth, and that the removal of these teeth exposed patients to unnecessary surgical or anaesthetic complications. We would like to draw your readers' attention to a case that suggests even in the presence of asymptomatic pathology, a prudent watch and wait policy may be considered in the case of an anticipated difficult surgical extraction.

A 41-year-old male was referred for the assessment of lower left wisdom tooth roots retained following an unsuccessful attempt at extraction. The OPG demonstrated unfavourable root morphology and close proximity of the roots to the inferior alveolar nerve (Fig. 1). Since the patient was asymptomatic and in light of the radiographic findings, surgical intervention was delayed.

Figure 1
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Figure 1.

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Three years later the patient began to experience recurrent infections associated with the wisdom tooth roots in the lower left quadrant. An OPG at this time demonstrated that the roots had “erupted∀ further (note new bone formation adjacent to roots), had a more favourable root morphology and were no longer in close proximity to the inferior alveolar nerve (Fig. 2). The roots were removed without complication under local anaesthesia.

Figure 2
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Figure 2.

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