BJOM-108.
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2. Allwright J, Cooper RA, Shuter B, Painter DM, Henry RG,
Norman JEdeB. SPECT in the diagnosis of hyperplasia of the
mandibular condyle [Abstract]. J Nucl Med 1988; 29: 780.
3. Cooper RA. Bone scintigraphy. In: Norman JEdeB, Bramley P, eds.
Textbook and Color Atlas of the Temporomandibular Joint:
Diseases, Disorders, Surgery. London: Wolfe Medical Publications
Ltd, 1990; 108–109.
4. Norman JEdeB, Mitchell RD, Shnier RC. Temporomandibular
crepitus: imaging of the temporomandibular joint: radiology, CT
scanning, MRI and arthrogram video, and nuclear scintigraphy with
SPECT. Brunei Int Med J 2000; 2: 429–437.
5. Norman JEdeB, Painter DM. Hyperplasia of the mandibular
condyle. A historical review of important early cases with a
presentation and analysis of twelve patients. J Maxillofac Surg
1980; 8: 161–175.
6. Painter DM. Pathology. In: Norman JEdeB, Bramley P, eds.
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Diseases, Disorders, Surgery. London: Wolfe Medical Publications
Ltd, 1990; 52–68.
doi: 10.1054/bjom.2000.0542, available online at http://www.idealibrary.com on
Re: Webster K, Wilde J. Management of anticoagula-
tion in patients with prosthetic heart valves undergoing
oral and maxillofacial operations. Br J Oral Maxillofac
Surg 2000; 38: 124–126
Sir,
We were interested to read the opinion of Webster and Wilde1
on the management of anticoagulation in patients with pros-
thetic heart valves undergoing oral and maxillofacial surgery.
They recommend the use of tranexamic acid mouthwash post-
operatively for patients who have had minor oral surgery proce-
dures. We would like to point out that at this time tranexamic
acid does not have a licence for use as a mouthwash in the UK,
despite its proven benefit.2
Webster and Wilde also refer to a publication by Souto
et al.3 ‘… in which the dose of warfarin was not modified …’.
The anticoagulant used by Souto et al. was, in fact, aceno-
coumarol and not warfarin.
Yours faithfully
Luc Evans
Medical Student; previously Senior House Officer
Adrian W. Sugar
Consultant Oral and Maxillofacial Surgeon
Morriston Hospital
Morriston, Swansea SA6 6NL, UK
REFERENCES
1. Webster K, Wilde J. Management of anticoagulation in patients
with prosthetic heart valves undergoing oral and maxillofacial
operations. Br J Oral Maxillofac Surg 2000; 38:124–126.
2. Sindet-Pederson S, Ramstrom G, Bernvil S, Blomback M.
Hemostatic effect of tranexamic acid mouthwash in anticoagulant-
treated patients undergoing oral surgery. N Engl J Med 1989; 320:
840–843.
3. Souto JC, Oliver A, Zuazu-Jausoro, Vives A, Fontcuberta J. Oral
surgery in anticoagulated patients without reducing the dose or oral
anticoagulant: a prospective randomized Study. J Oral Maxillofac
Surg 1996; 54: 27–32.
Letters to the Editor 245
doi: 10.1054/bjom.2000.0553, available online at http://www.idealibrary.com on
AUDIT ON IMPACTED WISDOM TEETH
Sir,
Such audits appear still both trendy and continuing. All wisdom
teeth referrals to Whipps Cross Hospital throughout a three-
month period commencing on 1 February 2000 were recorded
and examined individually by one oral & maxillofacial surgeon
(B.L.).
A total of 146 patients were referred specifically for removal
of their impacted wisdom teeth. These could be categorized as
follows:

56 patients had sufficient clinical and radiographic evi-
dence to justify an inpatient waiting list entry for surgi-
cal removal of the wisdom teeth;

20 patients had sufficient information for addition to the
daystay waiting list;

3 patients had sufficient clinical and radiographic infor-
mation to warrant removal of wisdom teeth under local
anaesthesia.
In 54 of the patients, there was insufficient evidence to jus-
tify any surgical intervention at that time and the cases were
placed ‘on probation’ this with clinical review six months later,
followed by a further radiographic check at one year.
Patients were advised to bring these review appointments
forward, were there to be significant clinical deterioration. Also
that if surgical intervention became unavoidable, then it would
be appropriate to ‘backdate’ a waiting list entry.
Forty-two patients had symptoms of temporomandibular
joint pain dysfunction, the wisdom teeth were ‘red herrings’,
therefore not requiring removal.
In only five cases was it deemed appropriate to return the
patient to the referring practitioner after their initial consulta-
tion, without any follow-up.
In summary, over half of the patients referred for removal of
their wisdom teeth was justified and correct. Where there is
inadequate clinical information to make a valid judgement, then
placing ‘on probation’ can be a useful tool.
Finally, the third largest category referred to temporo-
mandibular joint pain dysfunction symptoms to which the wis-
dom teeth were non-contributory. I would suggest that this
possibility should always be considered before making a deci-
sion to surgically remove wisdom teeth which may merely be a
chance finding on a rotational tomograph.
Mr B. Littler MBBS, BDS, FDSRCS
Consultant Oral & Maxillofacial Surgeon
Whipps Cross Hospital
Leytonstone
London E11 1NR, UK