Updated guidelines for lower third molar management

24 April 2021
1 min read

An expert working group has updated the 20-year-old National Institute for Health and Care Excellence (NICE) guidelines for lower third molar surgery to give them a fresh approach to patient care, explaining that retaining third molars can often have a detrimental impact on patients.

The group – led by consultant oral and maxillofacial surgeon (OMFS) Geoff Chiu, consultant in oral surgery at Barts Health NHS Trust Professor Paul Coulthard, and specialist in oral surgery Professor Tara Renton based at King’s College London – updated the guidelines for lower third molar surgery that were originally published in 1999.

Parameters of care for patients undergoing mandibular third molar surgery’ has recently been published by the Faculty of Dental Surgery Clinical Standards Committee (Royal College of Surgeons of England).

Geoff Chiu says:, “Over these 20 years we have been able to see the effects that NICE guidelines have had on the oral health of patients in the UK. The new guidelines take into account all the developments since the NICE guidelines were published. This includes management of ‘high risk’ third molars, the current status of patient’s social wellbeing and their involvement in the decision-making.”

Since 1999 there have been developments, advancements and research in: technology (cone beam CT scans); pharmacology (steroids and local anaesthetics); and outcomes in supreme court judgements (Lanarkshire vs Montgomery), all of which have changed the management of third molars. 

The East Lancashire and Bolton NHS Trusts-based OMFS Geoff Chiu says that retaining third molars in some patients has had a detrimental impact, “This has led to patients developing latent caries or periodontal disease, which can often result in the loss of both the third and second molars.”

He is also concerned that many studies have shown the removal of third molars in older age can cause surgical morbidity that increases with age.

“The updated guidelines provide a fresh approach to the comprehensive management of third molars,” Geoff Chiu concluded.