Sir, despite the NICE guidance on the removal of impacted wisdom teeth laid out ten years ago we are still receiving a large volume of inappropriate referrals for the removal of wisdom teeth. An audit of referral letters was carried out and new referral guidelines disseminated which resulted in an overall improvement in the standard of the referrals received by our Oral and Maxillofacial Surgery (OMFS) department.

However, there still remains a large number of patients referred that do not comply with NICE guidelines. As a reminder, 'the routine practice of prophylactic removal of pathology-free impacted third molars should be discontinued by the NHS'.1 Surgical removal should only be embarked upon in patients with evidence of pathology. Such pathologies include:

  1. 1

    Two or more episodes of pericornitis

  2. 2

    Unrestorable caries

  3. 3

    Non-treatable pulpal or periapical pathology

  4. 4

    Cellulitis

  5. 5

    Abscess

  6. 6

    Osteomyelitis

  7. 7

    Internal or external resorption of the tooth or adjacent teeth

  8. 8

    Fracture of the tooth

  9. 9

    Disease of the follicle including a cyst or tumour

  10. 10

    Tooth or teeth impeding surgery or reconstructive jaw surgery

  11. 11

    When a tooth is in or within the field of tumour resection.

I urge readers to re-familiarise themselves with this guidance as it is imperative that clinicians refer only those patients with a recognised clinical treatment need. Compliance with this should help to reduce the numbers of patients on OMFS out-patient and surgical waiting lists, avoid patient confusion relating to wisdom tooth extraction and maintain a high standard of evidence-based clinical practice.