Article
It is estimated that approximately half a million third molars are extracted every year in the UK (L McArdle, personal communication). In April 2020, Donnell and Clark in ‘Naughty or NICE?’1 highlighted a significant shortcoming of the 2000 NICE guidance on extraction of wisdom teeth: second molar caries.2 Previous papers report additional issues, including the impact of delayed surgery and resultant increased surgical morbidity.3
A health technology assessment was undertaken to review the NICE guidance published in 2020, concluding that ‘The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy’.4
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