Wisdom tooth removal claims involve allegations that the dentist has removed a wisdom tooth in breach of the guidelines. There are in fact guidelines on the removal of wisdom teeth and if a dentist removes a tooth when it was not suggested by the guidelines, then a dental claim may be made.
The NICE guidelines regarding wisdom tooth removal say this:
The practice of prophylactic removal of pathology-free impacted third molars should be discontinued in the NHS.
The standard routine programme of dental care by dental practitioners and/or paraprofessional staff, need be no different, in general, for pathology free impacted third molars (those requiring no additional investigations or procedures).
Surgical removal of impacted third molars should be limited to patients with evidence of pathology. Such pathology includes unrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abcess and osteomyelitis, internal/external resorption of the tooth or adjacent teeth, fracture of 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.
Specific attention is drawn to plaque formation and pericoronitis. Plaque formation is a risk factor but is not in itself an indication for surgery. The degree to which the severity or recurrence rate of pericoronitis should influence the decision for surgical removal of a third molar remains unclear. The evidence suggests that a first episode of pericoronitis, unless particularly severe, should not be considered an indication for surgery. Second or subsequent episodes should be considered the appropriate indication for surgery.
Permanent molar teeth normally erupt from the age of six onwards, with the third molars (wisdom teeth) being the last to erupt, usually between the ages of eighteen and twenty four years. Wisdom teeth may erupt normally into correct dental alignment and function or conversely develop in non- 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. Wisdom teeth can also be impacted, either erupting partially or not at all. Impaction may be associated with pathological changes including pericoronitis, an increased risk of caries and periodontal disease in adjacent teeth, and orthodontic problems in later life.
Removal of wisdom teeth is one of the most common surgical procedures performed in the UK. Current practice includes both the removal of impacted third molars causing pathological changes as well as the early prophylactic removal of pathology-free impacted third molars. Wide variations in the rates of this latter procedure across the country, which suggest that in the past, up to 44% of wisdom teeth removals and prophylactic surgery may have been inappropriate, have been reported. However, in recent years, changes in the practice of removal of wisdom teeth may have taken place in response to Faculty of Dental Surgery, Royal College of Surgeon's guidelines. Even so, some 22% of procedures may still be inappropriate. In 1994/95 there were approximately 36,000 inpatient and 60,000 day case admissions in England. More recent figures (1998/99) for Wales indicate that there were up to 3000 procedures. It is estimated that the total cost to the NHS in England and Wales of wisdom teeth extractions is up to £12 million per year.
There is no reliable research evidence to support a health benefit to patients from the prophylactic removal of pathology-free impacted third molar teeth.
Every procedure for the removal of an impacted third molar carries risk for the patient, including temporary or permanent nerve damage, alveolar osteitis, infection and haemorrhage as well as temporary local swelling, pain and restricted mouth opening. There are also risks associated with the need for general anaesthesia in some of these procedures, including rare and unpredictable death. Such patients are therefore being exposed to the risk of undertaking a surgical procedure unnecessarily.