ORAL SURGERY :
By Jay B . Reznick , DMD , MD Reprinted with permission from DentalTown Magazine
Should I extract this tooth ? This is the thought that frequently goes through the minds of many general dentists when a patient of theirs is in pain with a non-restorable tooth . In the old days , most general dentists were so busy doing crown and bridge , bleaching , veneers and cosmetic dentistry , that doing anything that caused bleeding was not on their clinical radar . But things have changed in the last few years . A major economic downturn affected dentists throughout the country . Those same dentists began looking for ways to maintain the cash flow of their practices by expanding their services to include procedures and treatments that have traditionally been done mostly by specialists .
These included orthodontics , endodontic therapy , periodontal procedures , surgical extractions and dental implants . Advances in dental technology and materials helped facilitate these changes by making these procedures simpler and more predictable . Now that the economy seems to be improving slightly , many practitioners are continuing to use their new skills and equipment to boost the profitability of their practices .
THE ORAL SURGEON
The typical oral surgeon spent four years of his or her life after dental school learning surgery from senior surgical residents and faculty . The first two years are spent becoming proficient at dentoalveolar surgery and anesthesia . The second two years focus on medical management , advanced surgical techniques and exposure to various medical and surgical specialties . One thus graduates very experienced at every-day office oral surgery before they are allowed to go into private practice . The other thing the surgical resident learns , in addition to the surgical skills , is that which I can simply call surgical judgment . In a nutshell , that is being able to make a surgical diagnosis , know the treatment options , decide on the best treatment option for that particular patient and plan for that option .
The surgical resident is also taught to mentally walk through each procedure , knowing what the steps are , what instruments and materials will be needed , and more importantly , how to avoid trouble and how to get out of trouble if it happens . Having a plan A , plan B , and plan C is crucial , no matter how simple the procedure . The surgical resident is also taught when not to do surgery , and when it is better to refer the patient to a colleague with greater expertise . The welfare and safety of the patient always comes first .
These concepts are not generally taught in the course of undergraduate dental education . So , unfortunately , when faced with a patient who needs specialty treatment , some dentists look at the financial benefits of the case to their practice , look at the patient , and say to themselves " I think I can do that ," even when the procedure is beyond their training and experience .
I have devoted a significant portion of my time to educating general dentists in the art and science of oral surgery . My approach is to emphasize proper education and training for each procedure before it is attempted on a live patient . This includes teaching general dentists to " think like an oral surgeon " when contemplating a surgical procedure . As I was taught in my residency , always do what is best for the patient and " above all , do no harm ."
I am becoming concerned because , in my private practice , I am managing an ever-increasing number of complications from procedures done by dentists ( both GP and other specialties ) who were not able to successfully complete the intended surgical procedure . Many times , they have had the patient in their dental chair for an hour or more before they finally throw in the towel and seek assistance . The patient usually arrives in my office in pain , anxious , upset and exhausted . If I decide it is appropriate for me to complete the procedure that day , I usually work more slowly than I usually do , so that I do not make it look too easy and further the patient ’ s frustration at their dentist ’ s misadventures . I hate being put into this situation , because nobody wins in the end . I am sure that all specialists feel the same way .
COMPLICATIONS
Here are a couple examples from the past few months . A healthy 19-year-old college student went to his family dentist complaining of pain in the right maxilla . In Fig . 1 , you see a periapical radiograph of a bony-impacted tooth # 1 which his dentist diagnosed as the source of his pain . Since the patient was in town for a few days , and the procedure looked easy , his dentist decided that he should take the tooth
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