Characteristics of disease related to mesio-angular mandibular third molar teeth.

The aim of this study was to identify the indications for the removal of mesio-angular mandibular third molars based on age and dental health as measured by the DMFT (decayed, missing, and filled teeth) score, and to find out if early intervention should be considered. We studied 319 patients who had 431 mesio-angular mandibular third molars removed. Variables recorded were age, primary indication for removal, and the DMFT score. Indications for removal included distal cervical caries (DCC) in the mandibular second molar (n=180, 44%), pericoronitis (n=131, 32%), and caries and related disease (n=62, 15%). The frequency of distal cervical caries (DCC) in the mandibular second molar increased linearly as patients became older and was the most common reason why mesio-angular third molar teeth were removed. This suggests that patients should be advised of the consequences of retaining thesetypes of third molars, and offered prophylactic removal of asymptomatic teeth.

The effects of NICE guidelines on the management of third molar teeth.

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. FINDINGS: 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.

Specialisation in oral surgery.

The 1994 report by the chief dental officer on specialist dental training in the UK focuses on the need for a more structured approach to post-graduate education and practice. As the report is designed to produce a broad choice of specialist dental services that will be based in the primary rather than the secondary care sector, specialist services will become more accessible to both the dental profession and patients.