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By not extracting, are you under-prescribing?

15 July 2014
An experienced oral surgeon received a referral from a general dental practitioner colleague requesting that he remove a painful and impacted lower right third molar....

Radiographs supplied by the GDP indicated that a surgical approach with bone removal and root division was necessary and the oral surgeon noted that at the time the corresponding lower left third molar was in a similar, if not worse, impacted situation.

As surgery was to be carried out under general anaesthetic at his hospital, the surgeon initially recommended that both be removed at the same time – in accordance with his usual custom in such cases. 

However, mindful of recent guidelines issued by his ‘College of Oral Surgeons’ criticising the extraction of asymptomatic impacted teeth, he wrote to Dental Protection asking if it would be prudent to only remove the one symptomatic tooth and if he did so, could he then be accused of under-prescribing?

The dilemma also brought up consideration of the necessity of a second general anaesthetic with its concomitant risks, as, and inevitably when, the other wisdom tooth became symptomatic and also needed removal.

Practical and ethical

This was a practical as well as ethical dilemma, and one in which Dental Protection was prepared to support the dentist’s clinical opinion, relying on his own expertise and experience.

Learning point:
Every jurisdiction has a standard of duty appropriate to a clinical negligence action. It is important to be aware of the local standards. Interestingly most standards reflect reasonable skill rather than perfection.
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