1. RE-EVALUATION OF NICE GUIDANCE COMPLIANCE FOR THE EXTRACTION OF WISDOM TEETH at the Countess of Chester Hospital, Oral & Maxillofacial Surgery Department. Nosa Uwadiae & Miss Katharine Fleming

2. NICE GUIDANCE The routine practice of prophylactic removal of pathology-free impacted third molars should be discontinued in the NHS. Guidance on the extraction of wisdom teeth. National Institute for Clinical Excellence.27 March 2000.

3. CRITERIA FOR EXTRACTION Unrestorable caries Untreatable pulpal and/or periapical pathology Cellulitis, abscess and osteomyelitis Internal/external resorption of the tooth or adjacent teeth Fractured tooth Disease of follicle including cyst/tumour Tooth/teeth impeding surgery or reconstructive jaw surgery, and when a tooth is involved in or within the field of tumour resection Severe or recurrent pericoronitis

4. AUDIT OUTLINE AIM To improve local adherence to NICE guidance STANDARD 100% of extracted wisdom teeth should fulfil the NICE guidance criteria METHOD The case notes of patients with wisdom teeth extracted from October 2010 to December 2010 were retrieved and examined retrospectively. Reasons for extractions was sought in the referral letters and the clinical notes. In cases of bilateral wisdom teeth extraction, an indication for the extraction was sought for each tooth.

5. RESULTS Reasons for Extractions Number of Extractions Pericoronitis 54 Caries 40 Periodontal disease 6 Orthognatic surgery 5 Dental abscess 2 No reasons given 2 Fractured tooth 1 TOTAL WISDOM TEETH EXTRACTED 110

6. RESULTS

7. SUMMARY OF RESULTS COMPLIANT 108 WISDOM TEETH NON-COMPLIANT 2 WISDOM TEETH 98% of 110 extracted wisdom teeth complied with NICE Guidance. 2% non-compliant.

8. NON-COMPLIANT CASES 2 cases did not comply with NICE Guidance. Both cases were bilateral extractions of wisdom teeth under general anaesthetic. 1.A case of unilateral pericoronitis of lower right 8,with no reason given on patient’s case note for the extraction of lower left 8. 2.A case of mesio-angularly impacted lower left 8 causing caries on lower left 7 with no reason also given for the extraction of lower right 8.

9. SUMMARY OF PREVIOUS AUDIT Audit carried-out from September to October 2009 by a colleague at Countess of Chester Hospital, (OMFU). Audit was presented on 23 rd of April 2010 at Aintree Hospital Liverpool, OMFU regional audit meeting. RESULTS OF AUDIT Teeth extractions examined-57 wisdom teeth NICE Guidance compliance -55 wisdom teeth 96% NICE Guidance Compliance was achieved.

10. COMPARISON PREVIOUS AUDIT CURRENT AUDIT

11. DEDUCTIONS There has been an improvement from 96% to 98% NICE Guidance compliance at the Countess of Chester Hospital OMFU. There is still room for more improvement. Target is 100%.

12. RECOMMENDATIONS TO IMPROVE COMPLIANCE All clinicians should endeavour to write reasons for extraction for “each” tooth in cases of bilateral wisdom teeth extractions in patient’s case notes.

13. THANKS Amanda Sadler and her audit team at the Countess of Chester Hospital. Miss Katharine Fleming. Thank you for listening.