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 1990s 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.