Main

A. A. Anjrini, E. Kruger and M. Tennant British Dental Journal 2014; 216: E16

Editor's summary

Someone once quipped that it was not the person who invented the wheel who was a genius but rather, it was the person who invented the other three. A witty observation but one which I think is very relevant to this research paper. In essence the underlying theme is that as well as discovery or innovation it is development and application which provide the route to human progress.

The starting point of this paper, from Australian authors, was the NICE guidelines issued in the year 2000 in relation to wisdom tooth removal in the UK. Developed by a committee (not always a recipe for success) of 24 experts in health economics, epidemiology, public health and surgery, the guidelines recommended that the practice of extraction of pathology-free impacted third molars should be discontinued. In the intervening years, this has dramatically reduced the number of hospital admissions in particular for this surgical procedure under general anaesthetic. Although the exact clinical value and benefits of the guidelines have come under recent review and discussion in this journal, as in other forums, the interest of the authors of this paper has been to compare the effect of the guidelines with the health systems in two other countries, Australia and France, where no such restrictions apply.

Of great value is the finding that there appears to be very significant differences in the rates of hospitalisation for impacted teeth across the world. In terms of one country learning from another (the analogy of adding those other three wheels) the results raise the potential that the presence of good-quality clinical guidelines for dental procedures, especially those requiring access to sophisticated health system facilities, may have a beneficial influence on the future organisation and costs of healthcare; an area of third-party and personal expenditure coming under sustained and increasing pressure worldwide.

In this context the presence and application of the NICE guidelines in the UK (also reflected by the Scottish Intercollegiate Guidelines Network) provide a very useful case study which may have resonances further afield. Similarly, there may be opportunities for UK-based researchers to study guidelines in other countries in other areas of oral healthcare which might have significant benefits to us here in these islands.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 216 issue 7.

Stephen Hancocks

Editor-in-Chief

Author questions and answers

1. Why did you undertake this research?

Our group has been interested in oral health-related hospitalisation analysis since 2000. Our previous work indicated high trends of hospitalisations for removal of impacted teeth in Western Australia (WA). However, we could not find any published comparative study in this area of research to be able to assess whether the levels of hospitalisations in WA were excessive or not. We were surprised that no one compared England (with its unique guidelines) to other jurisdictions. In fact, no one has ever compared any oral health-related hospitalisations on an international scale.

Our hope was that this research would enrich the ongoing debate in England about the NICE guidelines and also encourage health authorities in other countries, such as Australia, to learn from the English experience and consider the implementation of high quality guidelines.

2. What would you like to do next in this area to follow on from this work?

Our future work would include:

  • Strengthening our new comparative methodology by gathering data from other jurisdictions such as the US, Canada and Japan. This might include collaboration with local researchers in those countries.

  • Analysing the cost-effectiveness of the presence of guidelines. How much the NHS has saved by implementing the guidelines and how much could be saved by the healthcare system in Australia and France if they opted or had opted for similar guidelines.

  • Trying to raise the awareness and concern in Australia over the frequency of this procedure, and learn from the English experience with the NICE guidelines (both the pros and cons) to suggest the introduction of good-quality guidelines in Australia.

Figure 1
figure 1

Total number of admissions for impacted/embedded teeth in Western Australia, France and England for the period 1999/2000–2008/2009

Full size image