I'd hate to say … I told you so!

Nearly 4 years ago, I co-authored a paper with my colleague Naeem Adam¹ entitled ‘NICE guidance … time for a rethink?’ This paper alluded to the misplaced therapeutic advice from NICE (TA1) in 2000, that partially erupted lower third molars that were apparently disease free, should not be removed.

This guidance was based upon the fact that there was no reliable research to suggest that the removal of asymptomatic wisdom teeth benefits the patient. While this statement about the ‘evidence’ is undoubtedly true, it is almost certainly also true for a large percentage of the medical and dental procedures that are carried out on a daily basis. This is a reflection upon the level of research evidence to which we all, of course, aspire rather than the value of the clinical procedures performed. Sadly, so many Cochrane reviews conclude ‘there is insufficient evidence to determine …’ meanwhile clinical practice continues unabated. It is vital to understand that lack of evidence of an effect is exactly that … a lack of evidence, not as many people mistakenly conclude, a lack of effect.