Transcript RE-EVALUATION OF NICE GUIDANCE COMPLIANCE FOR THE

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
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.
CRITERIA FOR EXTRACTION
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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
AUDIT OUTLINE
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AIM
To improve local adherence to NICE guidance
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STANDARD
100% of extracted wisdom teeth should fulfil
the NICE guidance criteria
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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.
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
RESULTS
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.
NON-COMPLIANT CASES
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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.
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 23rd 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.
COMPARISON
PREVIOUS AUDIT
CURRENT AUDIT
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%.
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.
THANKS
• Amanda Sadler and her audit team at the
Countess of Chester Hospital.
• Miss Katharine Fleming.
Thank you for listening.