Welcome wisdom.

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS e-mail: bdj@bda.org Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online. Sir, it is good to see further discussion and debate recently in the BDJ and Faculty Dental Journal with regard to the NICE guideline on the extraction of wisdom teeth.1 The guideline has not been updated in 13 years and was originally developed for cost saving reasons as third molar surgery is one of the most commonly performed surgical dental procedures in the NHS. The SIGN guideline, management of unerupted and impacted third molar teeth,2 published the same year, provides greater information about the levels of evidence available for each guideline statement and is more detailed. NICE have classified their guideline as 'static' since March 2010 but even if there is a lack of new evidence for the guideline surely it is prudent to update and re-evaluate the national guideline at timely intervals? The Cochrane collaboration update their reviews regularly and SDCEP update their guidelines regularly to allow further discussion of topics in a multidisciplinary setting and to ensure improvements in the quality of patient care. More information on the decision making process needs to be implemented into guidelines for the management of impacted wisdom teeth. Guidelines should be patient centred, individualised and take into account the multiple dental and patient factors involved when making a decision on the extraction of an impacted wisdom tooth. This should include degree of impaction, patient age, position and location of the tooth, patient risk assessment for oral disease, patient medical history and most importantly patient preferences, not just simply whether the tooth is disease free or not.