title: What has been the United Kingdom's experience with retention of third molars?
abstract: BACKGROUND
  In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom.
  
  
  METHODS
  Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery.
  
  
  RESULTS
  The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines.
  
  
  CONCLUSIONS
  The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.
authors: Department of Oral Surgery, King's College London Dental Institute, London, United Kingdom.
authors: Tara
authors: T
authors: Renton
authors: Mustafa
authors: M
authors: Al-Haboubi
authors: Allan
authors: A
authors: Pau
authors: Jonathan
authors: J
authors: Shepherd
authors: Jennifer E
authors: JE
authors: Gallagher
mesh_terms: D000038:Abscess / Q000601:surgery; D000328:Adult; D000367:Age Factors; D003729:Dental Care / Q000706:statistics & numerical data; D003731:Dental Caries / Q000601:surgery; D003796:Dental Service, Hospital / Q000706:statistics & numerical data; D004739:England; D019983:Guideline Adherence; D006801:Humans; D008964:Molar, Third / Q000601:surgery*; D010343:Patient Admission / Q000706:statistics & numerical data; D010497:Pericoronitis / Q000601:surgery; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data; D013218:State Dentistry / Q000706:statistics & numerical data; D014076:Tooth Diseases / Q000601:surgery; D014081:Tooth Extraction / Q000706:statistics & numerical data*; D014095:Tooth, Impacted / Q000601:surgery*; D014852:Wales; D057832:Watchful Waiting