Dentaltown January 2015 - (Page 60)

oral surgery feature SHOULD I EXTRACT THIS TOOTH? by Jay B. Reznick, DMD, MD 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 ow of their practices by e panding 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. he 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 e perienced 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 60 JANUARY 2015 » dentaltown.com 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 e pertise. he 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 ﬁ nancial 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 ﬁ nally throw in the towel and seek assistance. he 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 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown January 2015

Dentaltown.com Highlights
Howard Speaks: Why Too Much Clinical Dentistry is Bad for Business
Professional Courtesy: Coming Soon: More Denture Patients
Continuing Education
Sleep Apnea Screening and Treatment
Data Encryption: Count the Acronyms
Anterior Tooth Position in Restorative Dentistry: Applying the Chasolen Triad
Poll
Office Visit: Texas Hygienist a Diva of Dings
What is the Current Science Behind Socket Grafting to Preserve Ridge Height?
Pulp Capping: Improving the Prognosis
Industry News
New Products
Should I Extract That Tooth?
Townie Meeting 2015 Preview
Ad Index
Remembering Suzanne Mann
Diagnosis in Endodontics
Quickbooks: Ten Tips to Stay Organized and Efficient
Dentally Incorrect

Dentaltown January 2015