Surgical removal of the third molar or ‘wisdom’ tooth is one of the most common procedures undertaken in oral and maxillofacial practice. It is also a common cause of litigation. In the United Kingdom, even the indications for removal of third molar teeth excited controversy, although this has now been addressed by guidelines developed both by the British Association of Oral and Maxillofacial Surgeons (BAOMS; www.baoms.org.uk) and the National Institute for Health and Care Excellence (NICE; www.nice.org.uk). UK guidelines are being reviewed in 2014. The 2013 guidelines of the German Society of Oral and Maxillofacial Surgeons
Aims 107 Learning outcomes 107 Indications for removal of third molar teeth 108 Contraindications to removal of third molars 109 Assessment 109 ‘Buying time’ – treating pericoronitis, temporizing 112 Taking consent – what can the patient expect? 112 Surgical technique – lower third molars 113 Surgical technique – upper third molars 116 Postoperative care 116 Complications 116 Does it need doing and when to refer 119 North America 119
are fairly similar. Many other countries have devised their own guidelines, and there is a lack of international consensus on when and when not to remove third molars; the American Association of Oral and Maxillofacial Surgeons views are quite different from those in the United Kingdom. The prevention of lower labial segment crowding is not an evidence-based indication (Figure 8.1). The safest way to remove wisdom teeth is a source of continual controversy – this relates particularly to how the lingual nerve is best protected.