Appendix C. Wisdom Teeth Removal – Patient Notes

What is NICE guidance?

The National Institute for Clinical Excellence (NICE) is a part of the NHS. It has a team of experts who produce guidance for both the NHS and patients on medicines, medial equipment and clinical procedures.

When the Institute evaluates these things, it is called an appraisal. Each appraisal takes around 12 months to complete and involves the manufacturers of the technology, patient groups and professional organisations.

NICE was asked to look at wisdom teeth removal and provide guidance to the NHS which will help dentists and surgeons decide when wisdom teeth should be removed.

What are Wisdom Teeth and why are they operated on?

Adult teeth normally come through from the age of 6 upwards, with the wisdom teeth being the last to arrive (usually between the ages of 18 & 24 years).

Sometimes, as wisdom teeth come through they cause problems. The term used to describe wisdom teeth that don't come through normally is impacted wisdom teeth. Two reasons for this are a lack of space, or other teeth being in the way.

For most people, impacted wisdom teeth cause no problems at all, but some people can suffer problems such as inflammation of the surrounding gum, a higher risk of tooth decay, gum disease in other teeth, and possibly problems with teeth in later life.

Removal of wisdom teeth is one of the most common operations carried out in the UK. Impacted wisdom teeth have sometimes been removed whether or not they were causing problems. There is no reliable evidence to suggest that operating on impacted wisdom teeth that are not causing problems has any benefit for the patient.

In fact every operation has some risk.

What do NICE recommend about the removal of Wisdom Teeth?

Based on the evidence, NICE has recommended to the NHS that:

1. Impacted wisdom teeth that are free from disease (healthy) should not be operated on. There are two reasons for this

a) There is no reliable research to suggest that this practice benefits patients

b) Patients who do have healthy wisdom teeth removed are being exposed to the risks of surgery.

These can include:

  • nerve damage

  • damage to other teeth

  • infection

  • bleeding and, rarely, death

Also, after surgery to remove wisdom teeth, patients may:

  • have swelling and pain

  • be unable to open their mouth fully

2. Patients who have impacted wisdom teeth that are not causing problems should visit their dentist for their usual check-ups.

3. Only patients, who have diseased wisdom teeth, or other problems with their mouth, should have their wisdom teeth removed.

Your dentist or oral surgeon will be aware of the sort of disease or condition which would require you to have surgery. Examples include:

  • untreatable tooth decay

  • abscesses

  • cysts or tumours

  • disease of the tissues around the tooth

  • if the tooth is in the way of other surgery

What should I do?

If you or a member of your family or someone you care for are having problems with their wisdom teeth you should discuss this with your dentist or surgeon.

Will NICE review its guidance?

Yes. The guidance will be reviewed in March 2003.

There is further research underway in this area. The results of this will be reviewed by NICE to decide if this guidance needs to be updated before 2003.

Further information

Further information on NICE, and the full guidance issued to the NHS, is available on the NICE website.