Investigation Looks at Actual Qualifications of Dentists to Extract Teeth
(HEADLINE NEWS guru 5/22/2016) It is important that all the potential risks, benefits, complications and alternative treatment options of tooth removal be reviewed with a patient prior to any surgery.
In the eyes of a dental professional, such as a general dentist or a board certified oral and maxillofacial surgeon, the definition of a “routine procedure” is objective. Most all professionals would argue that there are extractions which are more complicated than others, and this is the area that appears grey.1.
These more complex oral surgical procedures are often performed by non-oral surgeon (general dentist) professionals and yet there are no real stats to determine how many of these cases have a higher post-operative complication rate, versus if the patient would have gone to an oral surgeon.
WebMD recommends that patients research the education and training of their dentist under “recommendations for choosing a dentist.” This makes it appear that for a top visited website such as Web MD, a website that must be rather neutral and apolitical; they put significant weight on this topic’s importance. In fact, it is in their top three suggestions: advising patients to find a qualified professional when it is recommended to have a tooth extracted. WebMD even references the educational institutions from where the dentist graduated.2
So what does this tell us? It appears they are indirectly conveying an associated risk with choosing a professional that does not have the proper training or experience.
So how can patients safeguard and assure their best chance for a successful procedure? Headline News asked the top reviewed oral surgeon in Newport Beach, CA (according to Yelp, Health Grades, Google plus, and a list of other medical review authorities) for his opinion. 3
Dr. Thomas R. Michaelis (www.DentalSurgery.guru) stated, “I see a lot of mistakes from general dentists who attempted procedures that were possibly above their training level. Today’s medical field has become so specialized; it is in the best interest of a patient to be treated by a team of dental specialists instead of a single “generalist”. In fact, I reverse refer a lot of my patients back to my team of general dentists for restorative work once surgery has been completed. The general dentists are extremely well trained in these restorative procedures and they are much better at it that I am. Even though I am also a dentist, I know that any patient of mine will be far better off having a general dentist perform their restorative work than me. However, my additional 6 years of medical education and surgical training beyond dental school has helped me perform procedures such as dental implants and wisdom tooth removal at the highest level, with proven success. I mean, if you were told you needed a hip replacement, would you prefer the board certified orthopedic surgeon or the family practioner who went to a weekend course? It’s the same principle. “
Dr. Michaelis went on to tell us that removing teeth, while not a particularly pleasant experience for patients, is a routine and uncomplicated procedure in the hands of a well-trained expert. For most oral surgeons, wisdom tooth removal is the mainstay of their practice and the 4 to 6 years of additional training beyond dental school helps minimize the complication rate and make the procedure as routine as possible.
What keeps a tooth in place in its native bone is a membrane or ligament that surrounds the tooth root called the periodontal ligament (“peri” – around; “odont” – root). The main fibers of the ligament surround the tooth at a slanted angle similar to a hammock and attach it to the bone. By carefully manipulating the tooth and with qualified training, these fibers can be fairly easily dislodged, allowing the tooth to be removed quite simply. Believe it or not, there is a real art and “feel” involved in tooth removal, making it both routine and relatively simple.2
To ensure the extraction is “simple” in the professional sense is not so simple. It involves proper assessment and diagnosis beforehand, in particular of the shape and status of the tooth or teeth to be removed, and the surrounding bone in which they are encased. Routine radiographic (x-ray) examination will allow that determination. In addition, the oral surgeon should also take a thorough medical and drug history, to both ensure that you are healthy enough to undergo this minor surgery, and that you have normal blood clotting and wound healing mechanisms.
Our investigation concurs with WebMD and the seemingly vast amount of other online resources whereas proper homework should be executed prior to choosing a dental professional for complex and noncomplex “routine” procedures. It is also important to realize that oral surgeons have an additional 4 to 6 years of medical education and surgical training compared to a general dentist. This fact is what really separates the specialist from the generalist and the importance of that difference should not be overlooked.
On a final note, it is important to understand that there is only one standard of care for dental surgery. This standard is always established by the specialists in the field. Just because a general dentist has 4-6 fewer years of education and surgical experience than an oral and maxillofacial surgeon, does not mean they are allowed to practice at a lower standard of care. They are held to the same standard as the specialist, but with less training.
4. W. Jerjes, T. Upile, F. Nhembe, D. Gudka, P. Shah, S. Abbas, E. McCarthy, S. Patel, J. Mahil & C. Hopper. Experience in third molar surgery: an update British Dental Journal 209, E1 (2010)
Published online: 2 July 2010 | doi:10.1038/sj.bdj.2010.581
_____________________________________________________________________Henry Thomas Whittikar – Medical Specialist Journalist
IJR News Assistant Editor in Chief Newport Coast, CA 657-222-7074