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NICE Third Molar Guidance — MFDS Part 1 MCQ

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ModerateOral Surgery PrinciplesNICE Third Molar GuidanceMFDS Part 1

A 21-year-old patient has an asymptomatic, mesioangular impacted mandibular third molar identified incidentally on radiography. Clinical and radiographic examination shows no caries, pulpal or periapical disease, infection, resorption, cystic change or other associated pathology. According to NICE TA1, what is the most appropriate management?

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Reveal the answer and explanation

Correct answer: D — Retain under routine dental care and consider removal only if a NICE-defined indication develops

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as D · D = shown as E

A is correct. NICE TA1 states that prophylactic removal of pathology-free impacted third molars should be discontinued and that these teeth generally require no alteration to routine dental care. Surgical removal is reserved for defined indications, including unrestorable caries, non-treatable pulpal or periapical disease, abscess, cellulitis, osteomyelitis, resorption, fracture, follicular disease such as a cyst or tumour, or interference with planned surgery. Mesioangular orientation alone does not justify extraction, so C is incorrect. Similarly, impaction, failure to erupt or reaching a particular age is not independently an indication, excluding B, D and E. A first episode of pericoronitis is also not normally an indication unless particularly severe; recurrent episodes may justify removal.

Reference: National Institute for Health and Care Excellence. TA1: Guidance on the extraction of wisdom teeth, section 1 Recommendations. 2000. https://www.nice.org.uk/guidance/ta1/chapter/recommendations