Back in 2000 NICE the National Institute for Clinical Excellence published guidelines for the removal of wisdom teeth. Up until that time many wisdom teeth were just removed “because they were there”. Publication of these guidelines was supposed to give clarity as to when to remove wisdom teeth and when not to. It advised that removal of symptomatic disease free wisdom teeth should cease and that only teeth with active evidence of disease should be removed.
The thinking behind it was that it would save the NHS millions of pounds because removal of wisdom teeth in hospital was one of the commonest procedures done on the NHS. It was felt that many wisdom teeth were being removed “unnecessarily.”
Amazingly there was not a single dentist on the NICE assessment panel. That is something that I find astonishing even 12 years after the event.
NICE guidance has been used as a stick by health care commissioners to beat dentists over the head with by refusing to pay for the removal of wisdom teeth unless they rigidly fulfilled the NICE guidance. This has led to a crazy state of affairs with many patients suffering in pain just because “they don’t fit.” Is this what our health care system should really be about?
A superb recent article in the British Dental Journal by Tara Renton and Louis McArdle has just blown the NICE wisdom teeth myth away. It points to a new state of affairs whereby instead of patients presenting in their late teens to early 20s to have wisdom teeth out they are presenting around a decade later. In this age group the surgery is certainly more difficult and there may be additional medical complications both of which lead to increased morbidity for patients. Not only that, it pointed out that although there was an initial drop in the number of wisdom teeth being removed in the immediate years after 2000 it is now costing the NHS more to get these teeth out than before NICE. There are also problems where the impacted wisdom tooth causes decay on to the tooth in front – the lower second molar – and this decay cannot be treated by anything other than an extraction. So instead of losing one tooth the patient loses two. These are trends that I have noticed in my own clinical practice over the past decade. There is also inconsistency of entering coding data in hospitals so the true nature of the problem and real state of affairs may be hidden.
In America NICE wisdom teeth guidance is viewed with scepticism as a purely economic measure designed to pander to the needs of our “bankrupt” NHS. We however tend to view the American philosophy of blanket removal as pandering to their private practice. Perhaps the truth lies somewhere in between.
The current state of affairs is confusing and unsustainable and the situation must be looked at again urgently. NICE and the Department of Health need to revise and review the current guidelines urgently and provide a solid evidence based set of new guidelines.