title: The effects of NICE guidelines on the management of third molar teeth.
abstract: BACKGROUND
  Third molar surgery (TMS) is probably one of the most commonly performed surgical procedures undertaken in the NHS. In 2000, the National Institute of Clinical Excellence (NICE) introduced guidelines relating to TMS. These recommended against the prophylactic removal of third molars and listed specific clinical indications for surgery. The impact of these guidelines has not been fully evaluated and this research hopes to focus the effect of these guidelines over the last ten years.
  
  
  METHODS
  Using data obtained from a variety of NHS databases such as HES (Eng & Wales), the NHSBSA and data from NHS Scotland, we looked at the age range of patients requiring third molar removal and the number of patients having third molars removed in both primary and secondary care environments from 1989 to 2009. In addition we looked at the clinical indications for TMS activity in secondary care.
  
  
  RESULTS
  The mean age of patients increased from 25 years in 2000 to 32 years in 2010, with the modal (most common) age increasing from 26 to 29 years. After the introduction of clinical guidelines the number of patients requiring third molar removal in secondary care dropped by over 30%, however, since 2003 the number of patients has risen by 97%. There is also a significant increase in caries as an indication for third molar removal.
  
  
  CONCLUSIONS
  More patients are requiring third molar removal with an increasing number of patients having caries related to their third molars. Patients are, on average, older confirming that the removal of third molars is shifting from a young adult population group to an older adult population group. NICE guidelines did appear to have contributed to a fall in the volume of third molars removed within the NHS post 2000. However, concluding that this reduction demonstrates the success of NICE's guidance would be a premature assumption. The number of patients now requiring third molar removal is comparable to that of the mid 1990s. NICE has influenced the management of patients with third molars but this has not resulted in any reduction in the number of patients requiring third molar removal. Coding and data collection for third molars is not uniform, leading to potential misrepresentation of data. This perhaps raises the issue that an improved universal coding system is required for the NHS and that the NICE guidelines need review.
authors.affiliation: King's College London Dental Institute, UK. lwmcardle@msn.com
authors.forename: L W
authors.initials: LW
authors.lastname: McArdle
authors.forename: T
authors.initials: T
authors.lastname: Renton
mesh_terms: D000328:Adult; D000367:Age Factors; D003731:Dental Caries / Q000601:surgery; D003796:Dental Service, Hospital / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D008334:Mandible / Q000601:surgery; D008964:Molar, Third / Q000601:surgery*; D010482:Periapical Abscess / Q000601:surgery; D010518:Periodontitis / Q000601:surgery; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data; D063127:Secondary Health Care / Q000706:statistics & numerical data; D013218:State Dentistry / Q000706:statistics & numerical data; D014081:Tooth Extraction / Q000706:statistics & numerical data*; D014095:Tooth, Impacted / Q000601:surgery*; D006113:United Kingdom