NICE guidelines

Sir, NICE guidelines for impacted third molar removal were published in March 2000¹.

Their aim was to discontinue prophylactic removal of pathology-free impacted lower third molars on the NHS. Pathologies that were deemed to indicate surgical removal were; unrestorable caries, severe or recurrent pericoronitis, pulpal or periapical pathology, cellulites, abscesses and osteomyelitis, resorption, fracture, follicular pathology, tumour resection and impedance of surgical field.

It is important to comply with these guidelines to avoid unnecessary complications from surgery, namely lingual and ID nerve paraesthesia, to avoid unnecessary general anaesthetics and it is a waste of NHS resources removing caries free teeth. Our department, the Maxillofacial Unit of Derbyshire Royal Infirmary, recently carried out an audit of the last 50 patients who were referred by their GDP for surgical removal of their lower third molars.

The aim of the audit was to see if GDPs were compliant with NICE guidelines when referring patients. The results showed that 38% of patients were referred back to their dentist without undergoing any treatment i.e. the teeth were non-compliant with NICE guidelines.

This could be seen as a waste of approximately 4.75 hours of clinical time over this period of 3 months. Attending an unnecessary hospital appointment also inconvenienced these patients.

By preventing some of these unnecessary referrals we would potentially decrease waiting list time for other patients, including those with more serious complaints and those who meet NICE criteria.

Our results suggest that some of the referrers in our catchment area would benefit from re-inforcement of the NICE guidelines to cut down on unnecessary referrals.