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National Third Molar Audit

This is the first national audit examining the incidence of problems from third molars, the decisions made in treating them and the long-term outcomes of those decisions.

The surgical treatment of the third molar is one of the priority areas identified by The British Association of Oral and Maxillofacial Surgeons (BAOMS) for a national audit. Wisdom teeth may erupt normally into correct dental alignment and function. Sometimes they develop in non-functional or minimally functional positions. Impaction occurs when there is prevention of complete eruption due to lack of space, obstruction or development in an abnormal position. This may result in a tooth erupting partially or not at all. Impaction may be associated with pathological changes including infection in the overlying tissues, an increased risk of caries and periodontal disease in adjacent teeth, and cyst formation. Current best practice according to the National Institute for Health and Care Excellence (NICE) guidelines recommends the removal of impacted third molars which have caused these pathological changes


What does it measure?

The audit aims to determine:

· the extent of morbidity caused by third molar pathology in the UK

· whether patients are referred with relevant problems related to their third molars

· whether patients are offered treatment that is in accordance with relevant guidelines (NICE Technology Appraisal  No 1 - Guidance on the Extraction of Wisdom Teeth, March 2000)

· whether patients are benefiting from their treatment

· whether innovative treatments such as coronectomy are safe in the long-term

· any significant longer-term clinical or economic implications of following the current NICE guidance for third molar treatment


Benefits

This audit will record patients' symptoms and allow comparison of practice to the current NICE guidelines. It will also assess if the referral letter is an accurate reflection of the symptoms. Using patient-reported outcome measures will help to determine whether the treatment was of benefit and will record any treatment- related problems. Ultimately, higher case submission rates will lead to a more comprehensive picture of patient care and help improve patient care in the future.

The audit's long-term objectives are:

· To support clinicians in satisfying revalidation requirements relating to participation in clinical audit and improvement activity

· To ensure that surgery resolves the patients' problems with minimal morbidity

· To provide clinically meaningful information for comparative purposes and to help explain variations

· To confirm best practice and provide an opportunity to share this

· To provide a basis for the development of local action plans


Who manages the audit?

The project has been instigated by the Council of BAOMS and been developed and approved by its Clinical Effectiveness Sub-committee. It is being funded by Saving Faces - The Facial Surgery Research Foundation and co-ordinated by the National Facial and Oral Research Centre (NFORC), a branch of Saving Faces. NHS Digital is providing the IT infrastructure and data management support.


How to participate

To participate in the audit, users need to first register with NHS Digital to create single sign on (SSO) account by visiting https://login.hscic.gov.uk/Register.aspx. An SSO account allows you to use one set of log-in details to access a range of online NHS Digital services, including any clinical audits you register for. To register for the N3MA complete the NFORC Audits User Registration Form available on this webpage. The completed form needs to be signed by the trust Caldicott Guardian, who emails it back to the contact centre at NHS Digital for processing.

Once the contact centre has confirmed registration, users can access the data collection system by logging onto https://clinicalaudit.hscic.gov.uk/ with their SSO credentials. 


Feedback of the audit results

The current system design allows clinicians to download raw data extracts for cases they have treated and to compare rates of occurrence of nerve damage to the lips and tongue with other participants. The audit's managers expect to develop plans for more detailed analyses as the data accumulate.


Get in touch

If you have a clinical question or a general query about the audit, please contact NFORC on 020 8223 8049 or savingfaces@mail.com

If you have a question about the data collection system, please contact the HSCIC on 0300 303 5678 or enquiries@nhsdigital.nhs.uk

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