National Third Molar Audit

Background

The surgical treatment of the third molar is one of the priority areas identified by The British Association of Oral and Maxillofacial Surgeons (BAOMS) for a national audit. Wisdom teeth may erupt normally into correct dental alignment and function. Sometimes they develop in non-functional or minimally functional positions. Impaction occurs when there is prevention of complete eruption due to lack of space, obstruction or development in an abnormal position. This may result in a tooth erupting partially or not at all. Impaction may be associated with pathological changes including infection in the overlying tissues, an increased risk of caries and periodontal disease in adjacent teeth, and cyst formation. Current best practice according to the National Institute for Health and Care Excellence (NICE) guidelines (Technology Appraisal No. 1 – Guidance on the Extraction of Wisdom Teeth, issued March 2000) recommends the removal of impacted third molars which have caused these pathological changes.

This audit will record patients’ symptoms and allow comparison of practice to the current NICE guidelines. It will also assess if the referral letter is an accurate reflection of the symptoms. Using patient-reported outcome measures (PROMs) will help to determine whether the treatment was of benefit and will record any treatment- related problems. Ultimately, higher case submission rates will lead to a more comprehensive picture of patient care and help improve patient care in the future.

This will be the first national audit on third molars examining the incidence of problems from third molars, the treatment decisions made and the long-term outcomes of those decisions.

Aims:

• To determine the extent of morbidity caused by third molar pathology in the UK
• To determine whether patients are referred with relevant problems related to their third molars
• To determine whether patients are offered treatment that is in accordance with relevant guidelines (NICE Technology Appraisal No 1 – Guidance on the Extraction of Wisdom Teeth, March 2000)
• To determine whether patients are benefiting from their treatment
• To determine whether innovative treatments such as coronectomy are safe in the long-term
• To determine any significant longer-term clinical or economic implications of following the current NICE guidance for third molar treatment

Objectives:

• To support clinicians in satisfying revalidation requirements relating to participation in clinical audit and improvement activity
• To ensure that surgery resolves the patients’ problems with minimal morbidity
• To provide clinically meaningful information for comparative purposes and to help explain variations
• To confirm best practice and provide an opportunity to share this
• To provide a basis for the development of local action plans

Who manages the audit?

The project has been instigated by the Council of BAOMS and been developed and approved by its Clinical Effectiveness Sub-committee. It is being funded by Saving Faces – The Facial Surgery Research Foundation and co-ordinated by the National Facial and Oral Research Centre (NFORC), a branch of Saving Faces. The Health and Social Care Information Centre (HSCIC) is providing the IT infrastructure and data management support.

NFORC Director
Prof Iain Hutchison

BAOMS Chair of Clinical Effectiveness Committee
James Gallagher

Clinical Research Manager
Fran Ridout