Oral Surgery

oral surgery

The extraction of a tooth can be a low stress event for the chronic perio patient having had several done before, a blessed relief of pain for an unrestorable inflamed tooth, or a terrifying event as a first experience in a new patient. Your pre-op explanations will be heard twice as carefully as your post-op instructions and that is why those are written!
The surgical extraction of a tooth is one of those dental encounters that occasionally calls for not giving too much information during the procedure!

Mrs Johnson, we plan to remove that bad tooth this morning and I expect we’ll have no trouble but I wanted to reassure you that we will make sure you are perfectly comfortable and that if anything really bothers you, you just raise your hand to let me know. This tooth is badly broken (decayed, impacted) and we may need to remove it in a couple of sections (not “pieces” or “roots”) which is very routine so don’t be alarmed about that. All you should ever feel is a pressure in that area or a clicking sound (root tip!)

The secret of a glowing patient after an extraction is to work skillfully and quickly and do not “narrate” the procedure. Patients seem to have the most trouble if you allow them to:

1.) see the extraction forceps which appears huge compared to most dental instruments
2.) lead them to believe it is over when you’ve just begun to reflect tissue or elevate by mumbling “there we go” or “almost, almost”. (Better to say “OK, this is coming along.”)
3.) By ever saying “uh-oh” or “oops” (or worse) when we hear that dreaded “snick” of root tip fracturing (and you all will.)
4.) Asking the assistant out loud (in front of a conscious patient) for a “root tip pick”, “bone file” “scalpel” or “drill”. How about a “tip instrument”, “edge smoother” “Bard-Parker” or “Stryker”.

If complications arise, try to behave as if you were totally prepared for these consequences (as you indeed should be) and stay calm and efficient. Don’t narrate with an I’ve almost got it when you might not have it. Only say the magic OK, just bite down on this gauze after you are completely done with the procedure. Many times the patient will be amazed and extremely grateful at how quick and painless it was “You mean that’s it?” How wonderful!” Make this the kind of oral surgery you decide to do and know your skill level. After all, that’s what Oral Surgeons are for!

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In my many years of practice I have heard literally dozens of horror stores about extractions from patients; from “both he and the assistant got a hold of the pliers and it still wouldn’t come out” to “he even put his knee on my chest trying to get it out” to “he worked on getting that tooth out for three hours”. Now one might think that these were exaggerations but I have heard such horrible descriptions so many times over the years that I suspect there is a sad element of truth to them. Just don’t go there. Know when to hold ’em and when to fold ’em.

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Don’t let such things ever happen to you. Match the clinical presentation, potential complications, and your current level of clinical skill to the situation at hand. If complications arise beyond your expertise, patients are far more appreciative of a wise decision than foolhardy continuance: Mrs. Johnson, we have had an unexpected occurrence in which one of the root pieces of that badly broken down tooth has gotten into your upper sinus and your safety and comfort are always the rule I go by. This situation requires the additional skills of a specialist, an oral surgeon, who we will contact right now to resolve this.

Most patients, while maybe being a bit frustrated at having a prolonged procedure, will sincerely appreciate your knowing your clinical limits, being honest with them, and personally arranging a resolution of the problem. And, by being upfront, truthful, and helpful, you have just reduced any subsequent legal issues by about 99%.

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