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The BBC's Fergus Walsh
"Fewer wisdom teeth operations could save up to 5 million"
 real 28k

Monday, 27 March, 2000, 07:08 GMT 08:08 UK
Leave wisdom teeth in, dentists told

NICE has ruled on treatment for wisdom teeth
Dentists have been told not to remove healthy wisdom teeth on the NHS even if their patients want the operation.

The advice comes from the National Institute for Clinical Excellence (NICE) which argues that the removal of healthy teeth is pointless and exposes patients to the risk of nerve damage, infection, bleeding and in extreme cases death.

If they are not causing a specific problem then they should not be removed

Andrew Dillon, NICE
It suggests only diseased teeth should be removed and says that patients currently waiting for the operation should have their cases reviewed.

The institute estimates that following its guidance could release up to 5m.

But the British Dental Association (BDA) says it has been following similar professional guidance for some time and very few teeth are now removed unnecessarily.

Pain and discomfort

The routine removal of wisdom teeth, the "third" set of molars that begin to emerge during teenage years, has always been a controversial area.

If the jaw is not big enough to fully accommodate the teeth, they may become misaligned and start causing pain and discomfort.

When this happens, they may require removal, but sometimes dentists recommend that the teeth are taken out even when they are not causing problems - simply on the strength that they may cause problems in the future.

Although many doctors and dentists believe this is an entirely unnecessary procedure it is still regularly carried out on the NHS.

NICE assesses treatments and tells the NHS whether it is cost effective to use them.

Chief executive of NICE Andrew Dillon said: "If they are not causing a specific problem then they should not be removed. Until it is clearly a problem, there is no reason to do the surgery.

"Sometimes the teeth can right themselves and sometimes, even though they impact, they somehow sort themselves out and there is still no problem.

"It's the idea that we do the surgery on the off-chance that we are addressing."

Not binding

While NICE's advice is not binding, it is unlikely to be ignored by health authorities - particularly if it tells them to stop providing a treatment.

John Lowry, chairman of the BDA's committee for hospital dental services, said: "In the past, if a dentist was removing a wisdom tooth under general or local anaesthetic, they were likely to remove other wisdom teeth at the same time.

"This was done so that they didn't have to give patients a general anaesthetic too often, because of the risks involved, and also to reduce the chance of disease developing at a later stage.

"Nowadays, dentists generally remove a wisdom tooth only when there is a problem, so the NICE guidelines are only confirming current advice."

NHS trusts are being told to review their waiting lists to see if they can cancel operations for patients waiting for the operation at the moment.

Dentists generally remove a wisdom tooth only when there is a problem, so the NICE guidelines are only confirming current advice

John Lowry, British Dental Association
If dentists and surgeons follow the advice to halt such operations it would almost halve the 50,000 carried out every year in England. About 3,000 a year are carried out in Wales.

NICE said there were two reasons for its recommendation.

There was no reliable research to suggest that the removal of disease-free wisdom teeth benefited patients. And patients were being needlessly exposed to the risks of surgery, including nerve damage, damage to other teeth, infection, bleeding and in extreme cases, death.

NICE has already given its verdict on the anti-flu drug Relenza, recommending that it should not be provided to sufferers on the NHS.

NICE is also expected to give its verdict soon on artificial hip joints.

The body has made its decision, but its publication will be delayed while an appeal, believed to be from one of the manufacturers involved, is considered.

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See also:

06 Aug 99 | Health
NHS agenda for expensive drugs
02 Sep 99 | Health
NHS rationing: The key areas
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