Extraction of the wrong tooth can be prevented in sev eral ways. Obviously, the most important method of preventing wrongful extraction involves making a careful diagnosis of the patient's problem.
When a patient presents with pain, there is often more than one tooth involved that could be the source of dis comfort. Clinical and radiographic evidence to support the extraction of a tooth should be recorded in the chart. If several teeth in a quadrant need to be extracted but the patient elects to have only one tooth removed, this should also be documented in the chart. If there is no radiographic or clinical reason to suspect a dental cause for the patient's symptoms, afflictions such as tri geminal neuralgia, maxillary sinusitis or temporoman?dibular disorders must be considered.
A complete discussion with the patient prior to surgery is necessary to inform the patient which tooth is to be removed. A written and signed informed consent is essential.
Careful management of a patient's records by the den tist and dental staff is important to prevent extraction of the wrong tooth. The radiographs must be mounted cor rectly. Use of the Universal Tooth Numbering System can minimize many potential problems related to tooth iden tification. It is sometimes helpful to mark the tooth to be extracted on the radiograph.
When a patient is referred to an oral surgeon for an extraction, additional potential problems may arise in identifying the correct tooth. Many times the oral sur geon receives distorted information due to the number of people involved in the referral process. It is very helpful to have a referral slip signed by the referring dentist that is mailed or carried to the oral surgeon by the patient.
There are several other potential problems that might transpire when the patient is referred to an oral surgeon for extraction of a tooth.
These include:
1. Noting the wrong tooth on the referral slip.
2. Failure to use the Universal Tooth Numbering System.
3. When the Universal Tooth Numbering System is not used, the left side is frequently confused with the right side. This is particularly true when radiographs are incorrectly mounted.
4. Utilization of an incorrect number to identify a tooth. This situation often arises due to previous tooth loss.
5. Failure of the general dentist to confer with the oral surgeon regarding special considerations in patient management. For example:
a. A patient is referred for extraction of bicuspids for orthodontic treatment and the general dentist does not communicate to the oral surgeon that it is necessary to remove a second bicuspid in one quadrant and first bicuspids in other quadrants.
b. A patient is referred for the removal of maxillary anterior teeth and placement of an overdenture and the general dentist does not inform the oral surgeon that the cuspids need to be retained. Without proper communication, the oral surgeon may not realize that the cuspids should not be extracted.
In any unusual procedure it is important for the referring dentist to communicate to the oral surgeon any meth odology to be considered for patient management.
Claims prevention in a situation where the wrong tooth is extracted depends upon establishing good rapport with the patient pre- and post-operatively.
After an error by the dentist, litigation is often initiated by a resultant increase in treatment expenses. I believe that the dentist should attempt to mitigate the situation by assuming all additional costs for dental work now deemed necessary due to wrongful extraction. This action on the part of the dentist will frequently deter a patient's pursuit of litigation.
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