• Real Outcomes

    The following are real examples of outcomes when oral surgery is performed by non-trained clinicians

     

    A female college student becomes aware that her wisdom teeth are trying to come in and are causing her pain. She consults with her dentist who advises that he can remove the wisdom teeth in his office under local anesthetic. He attempts the removal of the wisdom teeth with local anesthetic. The patient is in the chair over an hour at which time the dentist advises the patient that he cannot get her numb enough to complete the treatment and refers her to an oral and maxillofacial surgeon. She arrives at the oral surgery office in pain, still bleeding, tearful and trembling. The oral surgeon sedates the patient, administers an IV antibiotic, and completes the removal of the wisdom teeth in 10 minutes. The patient awakens from the surgery without pain and is comfortable. Her follow-up care is uneventful.

     

    A female high school student is diagnosed with impacted wisdom teeth by her family dentist. The dentist advises that that the wisdom teeth should be removed to prevent future wisdom tooth-related problems. He recommends lower wisdom tooth removal under local anesthetic in his office, stating that the upper wisdom teeth are “too high” to be removed at that time. He starts the procedure, and after an extended period of time, is unable to complete the surgery and refers the patient immediately to an oral and maxillofacial surgeon. When the patient arrives at the oral surgery office she is tearful, trembling and has open oral wounds with a partially exposed wisdom tooth. The oral surgeon x-rays the patient and determines that all of the wisdom teeth can be removed safely. The patient is sedated, and the treatment is completed in 20 minutes. The patient heals uneventfully.

     

    An adult female with grown children presents to an oral and maxillofacial surgery office complaining of ongoing pain associated with wisdom tooth extraction that was performed by her family dentist. She relates that the tooth removal appointment was “traumatic” and that near the end of the procedure that the dentist advised her that the roots of the wisdom teeth could not be removed. The dentist advised that the bone and gum tissue would grow over the roots and not cause the patient any problem. The oral and maxillofacial surgeon x-rays the patient and determines that the roots of the wisdom teeth are still present and likely responsible for the patient’s ongoing pain. The oral and maxillofacial surgeon sedates the patient and completes the removal of the tooth roots in 15 minutes. The patient heals without difficulty and her pain concern resolves.

     

    An adult female presents to an oral and maxillofacial surgery office, referred by her family dentist, who is unable to complete the removal of an upper molar tooth. The oral and maxillofacial surgeon examines the patient and finds that the molar roots are still present and that there is a large opening around the roots that extends from the mouth into the sinus cavity in the upper jaw. The surgeon completes the tooth removal and then closes the sinus opening by developing a local tissue flap from adjacent gum and cheek tissues. The surgery takes 45 minutes to complete. The surgeon charges for tooth removal, but does not charge for the sinus closure to avoid inflaming the patient toward her dentist. The patient heals uneventfully.

     

    A retired male patient is missing a lower molar tooth. His family dentist recommends a dental implant. The dentist places the implant under local anesthetic. The patient returns 1 week later complaining of persistent numbness of the lower jaw, lip and chin. The patient seeks the advice of an oral and maxillofacial surgeon. An x-ray is obtained and reveals that the dental implant has violated the main sensory nerve in the lower jaw. The oral and maxillofacial surgeon recommends removal of the dental implant, which he carries out. The patient returns for monitoring and sensory nerve testing to determine whether or not the nerve is permanently injured.

     

    An adult male patient is having upper posterior teeth removed by his family dentist. During the procedure, part of a molar tooth is displaced into the sinus cavity in the upper jaw. The dentist is unable to retrieve the tooth fragment and refers the patient to the oral and maxillofacial surgeon. The surgeon obtains a 3-D scan of the sinus which demonstrates the location of the displaced tooth fragment. The surgeon sedates the patient, retrieves the tooth fragment from the sinus and performs a sinus closure by developing a local tissue flap from adjacent gum and cheek tissues. The surgeon reduces his fee to ease the financial burden on the patient who has already paid his family dentist for an extensive treatment plan, including the removal of several teeth.

     

    A young adult female decides to have her wisdom teeth removed by a dental practice that limits its services to tooth removal. She is sedated in the office, the procedure is completed and she is discharged home. A few weeks later, she develops pain and swelling at one of the wisdom tooth sites. She returns to the practice that removed the teeth but becomes uncomfortable with the proposed treatment and seeks the advice of a family physician. The physician orders a CAT scan that reveals a cystic mass at the wisdom tooth site. He refers her to an oral and maxillofacial surgeon for evaluation and treatment. The surgeon suspects that there is a bone infection and performs a debridement and finds that a full thickness bone defect has developed as a result of infection. He thoroughly cleans the area, administers an IV antibiotic and places the patient on a long -term oral antibiotic. The patient eventually recovers from the infection.

     

    A high school student is advised by their general dentist that there are 4 full bony impacted wisdom teeth that should be removed. The dentist advises the patient that the upper wisdom teeth should be removed in a procedure separate from removal of the lower wisdom teeth. The patient undergoes removal of upper full bony impacted wisdom teeth in the dentist’s office with local anesthetic and laughing gas. The patient starts to swell post operatively. One side swells and then resolves, but the other side swells and keeps swelling without resolution. Two weeks after the original surgery, the patient is referred to the oral and maxillofacial surgeon for evaluation. The oral and maxillofacial surgeon diagnoses a severe fascial space infection with abscess formation. In addition, the patient has severe loss of jaw mobility due to the infection. The surgeon sedates the patient, administers an IV antibiotic, and performs an incision and drainage of the abscess cavity, which contains nearly 20 cc of pus, and places a drain. The drain is removed 4 days later. Two weeks later the patient re-gains normal jaw mobility and demonstrates resolution of the infection.