Renton Tara, Al-Haboubi Mustafa, Pau Allan, Shepherd Jonathan, Gallagher Jennifer E
Department of Oral Surgery, King's College London Dental Institute, London, United Kingdom.
J Oral Maxillofac Surg. 2012 Sep;70(9 Suppl 1):S48-57. doi: 10.1016/j.joms.2012.04.040. Epub 2012 Jul 3.
In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom.
Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery.
The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines.
The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.
2000年，英国国家临床优化研究所（NICE）发布了首份与第三磨牙（M3）手术相关的指南，第三磨牙手术在英国是一种常见的手术。在此之前，20世纪90年代的研究出版物和专业指南建议不要进行预防性手术，并为M3手术提供了具体的治疗指征。本报告的目的是总结英国有关指南对M3手术影响的现有证据。
分析了英格兰和威尔士20年期间（1989/1990至2009/2010年医院事件统计数据）基层医疗牙科服务和医院入院数据，以及私人医疗保险公司的数据。评估了随着时间推移M3手术活动的数量，并在可能的情况下评估了其性质，同时还评估了指南的附带影响，包括手术时的患者年龄和手术指征。
在NICE指南发布前的20世纪90年代，所有部门的M3拔除量均有所下降。在这20年期间，住院病例中阻生M3手术的比例从80%降至50%。此外，手术入院的平均年龄从25.5岁增加到31.8岁。年龄变化与该期间M3手术指征的变化相关，“阻生”情况减少，但“龋齿”和“冠周炎”作为病因因素的情况增加，这与NICE指南一致。
M3手术活动的显著减少发生在NICE指南发布之前。因此，M3手术的实施年龄有所推迟，手术指征越来越符合NICE指南。文中讨论了对保留的M3进行临床监测的重要性。
