I recently attended a continuing education class about oral surgery with speaker Karl R. Koerner, DDS. It was a great class and I really enjoyed it. One thing he said really stuck with me. He was very thorough about describing all of the potential errors that can occur during treatment and showed cases where such things did go wrong. One dentist “slipped” and cut the facial artery during an extraction. The bleeding stopped at the site with pressure; however, the blood found a new place to go and ended up causing a Ludwig’s angina. The patient took legal action against the dentist. Dr. Koerner said, when describing that case, “This is why we don’t slip.”
That sentence stuck with me. Teeth are slippery, especially when they are covered in plaque, blood, and saliva. We are using a lot of pressure with our instruments and it seems inevitable that, from time to time, minor (and major) things are going to happen. I have been thinking about what he said and I have been trying to implement a few of the techniques he showed to us to ensure that slips don’t happen. It seems the more skilled you are and the more practice you have, the chances of “slipping” decrease, but to say “never” seems bold. There are things we all can do to be more confident and minimize risks.
- Use the proper instrument for the right area of the mouth. When you are trying to use an instrument that doesn’t fit the space, the chances of bumping adjacent teeth or sliding off the tooth is much greater. Dr. Koerner demonstrated some narrow beaked forceps that he prefers in certain situations.
- Luxators and elevators are different and should be used accordingly. This is something I am guilty of not following; luxators go apically and elevators go interproximally.
- Take your time and think through what you are doing. The hygienists are waiting on you for exams and your next two patients are in the waiting room. Still, take a deep breath and really think through your procedure—it can make a big difference.
- Don’t be afraid of flaps and sectioning. If you aren’t getting movement, it is time to make things easier on yourself and take some interseptal bone. I saw a technique in which you collapse the roots into the socket after using a No. 700 bur to remove part of the tooth all the way around.
- Patient selection is key. Patients who are taking blood thinners and who have complex medical histories can be managed, but if you haven’t had the training, it might be best to refer until you get the proper training on how to manage these patients.
We all are human and we will never be able to able to practice without any risk, but the more we learn, the more we can take steps to improve and minimize risk whenever possible.
Sarah Meyer, DDS