The Application of Military Mandibular Third Molar Guidelines in the Operative Management of Mandibular Third Molars in United Kingdom Armed Forces Personnel Diagnosed with Pericoronitis: A Service Evaluation.

INTRODUCTION: This service evaluation (SE) sought to determine if United Kingdom Armed Forces (UKAF) personnel diagnosed with pericoronitis were treated in line with Defence Guidance and Policy documents. United Kingdom Armed Forces Policy states pericoronitis should be managed in a proactive manner and all mandibular third molars (M3M) should be considered for extraction after a single episode of infection. An additional objective was to establish waiting times for M3M referrals to both Tier 2 (practice based) and 3 (hospital) providers.

MATERIALS AND METHODS: Five hundred forty-five attendances for urgent care with the diagnosis of pericoronitis, between February and March 2019, were sampled via identification of the pericoronitis read code on the common records system used in Defence Primary Healthcare Dental. Following application of inclusion and exclusion criteria, 269 patient electronic records were assessed. Patient demographics alongside the frequency of symptoms and ultimate management of their M3M were recorded and analysed using Microsoft Excel. Trends between referral waiting times and patient history were sought.

RESULTS: Operative intervention, in line with UKAF policy, was considered for 27% (n = 73) of the patients after urgent attendance. One hundred ninety-six patients (73%) did not have a proactive approach to their pericoronitis treatment and therefore did not meet UKAF Policy. 36% (n = 96) of patients had their M3M extracted, part extracted (Coronectomy), or an operculectomy in the 5 years following the urgent attendance. 64% (n = 173) of the sample met the National Institute for Health and Care Excellence Technology Appraisal third molar guidance (NICE TA1 guidance). The waiting times were significantly (P value < .001) longer for patients referred to Tier 3 services compared to those accessing care at Tier 2. No geographic variation in services (P value .095) was noted and there was no significant difference in waiting times at Tier 3 when those hospitals with a military Oral and Maxillofacial Surgery consultant were compared to those with no military consultant in post (P value .21).

CONCLUSIONS: United Kingdom Armed Forces personnel diagnosed with pericoronitis were not treated in line with UKAF Policy. Most patients suffered recurrent episodes of pain where the M3M was left in situ, even when a conservative treatment plan adopted. Waiting times for Tier 2 care were significantly shorter than Tier 3. This SE would support a recommendation of increased access to Tier 2 services to improve the dental readiness of UKAF personnel.