THIRD MOLAR PROJECT DATA ENTRY

Dentists and surgeons that treat patients with third molars should participate in this study. All data for the Third Molar Project is submitted directly via the RedCap platform. Users can register to access the RedCap platform by clicking on the registration link. (Registration can take up to 1-2 working days.) Once registered, users can access the RedCap database to enter data here: https://trials.nforc.co.uk/

This is the first national study on third molars examining the incidence of problems from third molars, the treatment decisions made and the long-term outcomes of those decisions.

Please download the consent form for each patient to sign. This can be stored in your patients notes.

We recommend that you print a batch of Patient Information Sheets and Consent Forms in advance.

Once you have completed a clinical form you can download the data to use as your operation notes.

Study Background

The surgical treatment of the third molar (wisdom teeth) is one of the priority areas identified by The British Association of Oral and Maxillofacial Surgeons (BAOMS) for research. 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 (Technology Appraisal No. 1 – Guidance on the Extraction of Wisdom Teeth, issued March 2000) recommends the removal of impacted third molars which have caused these pathological changes.

This study 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 (PROMs) 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.

FINDINGS

We have already found that there is uncertainty over the best way to treat common condition as wisdom tooth infection. Our recent study on the current perspectives of the surgical management of mandibular third molars highlights surgeons’ views that there is a gap in evidence and knowledge to support coronectomy. (Click here to read.) As a result, further studies are needed to determine the effectiveness and safety of coronectomy. Fortunately, this study will help to answer these questions. We will use the data to assess which treatment option has the best outcome to determine the optimal approach to use in a clinical setting. This study will specifically collect data on high risk lower third molars treated with either coronectomy or complete surgical removal.

Aims & Objectives
Aims
  • To determine the extent of morbidity caused by third molar pathology in the UK
  • To determine whether patients are referred with relevant problems related to their third molars
  • To determine 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)
  • To determine whether patients are benefiting from their treatment
  • To determine whether innovative treatments such as coronectomy are safe in the long-term
  • To determine any significant longer-term clinical or economic implications of following the current NICE guidance for third molar treatment
Objectives
  • 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
What data is the third molar project collecting?

Data collection has been designed to be quick and efficient. Most of the data entry is a tick box exercise.

The project is collecting data on the elective and non–elective management of third molars. The clinical form should be completed immediately after treating the patient. You should have all the information available to complete entry for that episode.

Elective Management

Questions will be asked on:

  • Location of procedure
  • Reason for removal
  • Relevant medical history
  • Clinical/Radiograph position of third molar
  • Planned procedure
  • Untoward events
  • Use of peri-operative adjuncts

Non–Elective Management

This section is to be completed if patients have presented with issues after having a third molar procedure or presented with an acute infection from a third molar that has not been treated before.

Follow up

At 1 and 9 months, patients who had treatment for third molars will be contacted by email to complete a follow up questionnaire. Your participation is not required at this stage, but please ensure their email address or telephone number is entered correctly.

Snapshots of the data collection database and operation notes
How to register

To ensure we meet the strict information governance requirements we are using the Redcap database, which is run by The Barts and London along with Queen Mary University of London.

Registration is a three-step process

  1. Please register by filling out your details here. You will be sent a username and temporary password from a member of the NFORC team. This can take up to 1-2 working days.
  2. Go to the Barts & QMUL Helpdesk webpage and login with your details. Change your password to one more practical for you and enter your security questions.
  3. Go to RedCap https://trials.nforc.co.uk/ and log in with your username and new password. You’ll be sent a confirmatory email.
How to use REDcap

Click here to find out How to use REDCap

Who manages the study

The project was instigated by the Council of BAOMS and has been developed and approved by its Clinical Effectiveness Sub-committee. It is 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.

NFORC Director
Prof Iain Hutchison

Consultant in Oral and Maxillofacial Surgery & Sub Specialist Interest Group Lead for Dento-Alveolar & Oral Surgery – BAOMS
Mr Geoff Chiu (Chief Investigator)

Professor of Oral and Maxillofacial Surgery & Honorary Consultant in Oral Surgery with Barts Health NHS Trust – BAOS
Prof Paul Coulthard (Co-Chief Investigator)

Clinical Research Manager
Fran Ridout