Mandibular third molars: 'naughty' or NICE?

The 20-year anniversary of the implementation of NICE TA1 - Guidance on the Extraction of Wisdom Teeth - arrived in March 2020. Since its implementation, impaction of erupted or partially erupted mandibular third molars and the associated increased caries risk in second molars has been a topic widely debated in both general practice and hospital settings. This has led to significant variation in the management observed. Radiographic examination of carious second molars with an associated impacted third molar is not routine and is commonly a coincidental finding following routine bitewing examination in an otherwise symptom-free, healthy mouth. Caries in mandibular second molars is a clear oversight in NICE guidance, with management decisions influenced by personal philosophy, clinical judgement and experience. NICE guidance is exactly that; guidance, an aid to help our and the patient's decision-making. Consideration should be given to caries risk assessment and the judicious use of radiographs as well as clinical expertise, taking account of patient values on a case-by-case basis when deciding if teeth should be kept or removed.