June 5, 2017
by Bruce R. Pynn, BSc, MSc, DDS, FRCD(C)
As I gathered the submissions to this month’s Oral Surgery issue, I could not help but notice that most of the papers submitted dealt with complications following extractions or a related procedure. I did a search of the world literature in PubMed on “complications and dental extractions” and to my surprise, there were more than 5000 articles that had been published between 1935 and 2017 on this topic. Focus of the articles was noted to be the more common complications and then secondarily on those complications that are rare in nature.
Even though most extractions proceed without any complications, the general practitioner (GP) and/or specialist should fully understand and be prepared to deal with any of the various consequences of the procedure. Dealing with complications is at the core of our four to six years of specialty training. This October, the American College of Oral and Maxillofacial Surgery has organized a two day review course exclusively dealing with complications!
Each extraction case is unique and the thought process should start during the initial consultation, whether it be a one tooth extraction case or a set of wisdom teeth that need to be removed. The pros/cons and risks/benefits of the procedure are discussed with the patient. It is at this point the general practitioner should decide whether they have the skills and experience to deal with the case and potential consequences, or subsequently refer to a specialist.
The common practice of the oral surgeon is to analyze each case prior to proceeding with implementation of the actual care plan. The oral surgeon develops a mental plan of any potential complications which can occur and how they could be rectified. Some of these complications can be treated in the office environment while others require more complex management in the hospital setting.
What is frustrating to specialists and patients is the general practitioner that carries out a procedure and then they are not able to follow-up with the patient once they have an issue or simply instruct the patient to go to the local emergency room if they have complications. These situations often put the patient and the on-call specialist in a difficult situation. It is always best if a GP is having a situation or complication to contact the specialist directly – that’s our job–we are here to assist you with your case for the best care for the patient. Communication and teamwork is the key to success.
As my friend and past president of the Ontario Dental Association, Dr. Gerald Smith stated, “If the potential risk factors may complicate treatment and jeopardize a successful outcome – it’s best to refer as it’s in the best interest for the patient and GP as well!” OH
About the Editor
Dr. Bruce Pynn is Oral Health’s editorial board member for oral and maxillofacial surgery. He maintains a private practice in Thunder Bay, ON. He is an Associate Professor, North Ontario School of Medicine, Lakehead University, and Chief of Dentistry, Thunder Bay Regional Health Sciences Center. President, Ontario Society of Oral and Maxillofacial Surgery.