Dental Procedures and Practices Concerning Extractions.

[Arealperson]

Hi,
I've spent time trying to form these questions so I could get a response. So, thanks in advance. I've also tried to keep it on point or it would be a book.

Overview:
This extraction was on #31 (#30 and #32 were previously pulled years ago). I’ve never had any issues with any extractions. This is concerning a complex extraction by my new career Dentist (25+ years) (a non OS) on the first visit. 98% of the tooth was removed. The top of the tooth snapped off at the very start of the extraction process with the Dentist continuing. The process took 45 mins. This extraction was a needed maintenance extraction, there was no pain in the tooth, there was no infection. And, no explanation was given by the dentist as to why the extraction was performed the way it was.

Scenario:
My #31 complex molar extraction.

After the 45min. extraction, I was given stitches over the gum area of #30 and told to be careful not to spit the blood clot out. This was a joke as the entire socket had been cut out in a “V” shape and there was no socket or area to produce a blood clot (Much tissue was removed on top and sides from 30 - 32). Only the exposed white bone over a three tooth area. Also, all the gums over this 3 tooth area had been pretty much stripped off and removed via suction. The dentist had created a “V” shaped Jack O'Lantern cut (the correct term is unknown) in order to remove the molar.

After about 3 months, the healing seemed to stop. And every sense (its been about 6 months now) I’ve have very little feeling (some feeling remains) in that lower quadrant of my mouth. It’s sensitive in that area also, and I have pain, kinda like a toothache also. Tissue has finally covered the area(s) but it feels like a goose egg in my mouth (Like only part of the novocaine wore off). Also the Sublingual Space of my cheek/mouth was opened and remained open for a long time.

I’ve had a hard time getting answers on my questions. If you feel the questions are to vague or whatever, please just answer them on their own level of abstraction, the best you can, and provide your assumptions.

Questions: (Some may seem redundant, but please, try to answer if in anyway you can.)

1) Is the V” shaped Jack O'Lantern cut (correct term unknown), a type of valid or approved method, procedure or technique that is taught in dental school ? If yes, can you explain ?

2) Is the “V” cut accepted as a practice for Dentist in extracting a molar but is not specificity taught as a method, procedure or technique (or other). Please explain if you can ?

3) What is the criteria (if any) for determining when a patient should be sent to an OS (Oral Surgeon) ? This question asked within the scope of the scenario.

4) On the actual extraction itself (removal of the tooth). Can a dentist (non OS) generally choose/do whatever they want, OR, are they required to use specific approved procedures.? Example, just cut the tooth out, you should try to be careful, maybe use this procedure if you can (or want to), but the way you choose to remove it, is up to you as a dentist.

5) Is there a specific method, procedure or technique to perform Sectioning during a complex extraction ? If yes, what is it ?

I’ve been suffering, and it’s really been hard to get answers.
So if you can, please have pity on me and try to answer and/or help, because, I’m suffering and need some answers.

Thank You for your help,
Arealperson

 

[MattKW]

1. Hard to say what you're trying to describe. It is not unusual to "raise a flap" with "relieving incisions" into sulcus for a surgical extraction.
2. Again, not sure what you had done, just guessing.
3. No specific criteria; some general dentists are just more experienced than others and will do all themselves. Others refer at first sign of trouble. Others get into trouble (maybe unexpected), and then refer to OS to complete treatment.
4.Different methods can be used. Some methods might be judged better than others, but some techniques are preferred by dentist due to experience. There are some basic surgical do's and don't's in flap design to ensure minimal damage.
5. Again, "different strokes, different folks". The end result is the main aim, as long as basic principles are applied, and no unreasonable treatment is undertaken.
If you're not sure about degree of healing, go back to dentist and ask questions, and perhaps ask for referral to OS for higher opinion.

 

[Arealperson]

Ok, I'll clarify...
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Clarifying Questions 1 & 2

For Halloween many people choose to use a classic Sawtooth cut for the mouth of the pumpkin.
I'm uploading two images bellow. On the jaw cross section I've colored it red so you can see it.
The cut is deep and flush with the bottom of my mouth.

If you used this pattern around the whole mouth it would be a classic Jack O'Lantern pattern
Thats what I meant in my question.
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Question 3
"some general dentists are just more experienced than others and will do all themselves"
So your saying that a general dentist can legally preform any or most, or some surgical procedures.. as in.. "will do all themselves" ?

They will do a surgery they feel they can ? That seems illegal to me. Is it ? Am I correct ? Or did I missunderstand.
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I may be misunderstanding, so in the U.S, As long as a general dentist feels the can do an oral surgery
they may legally do it ?
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Thanks for your answers,

 

[MattKW]

I'm not from the US, hence I'm not a Halloween follower and the sawtooth didn't make sense to me.
1. and 2. It's still not possible to understand quite what you're talking about, as you don't have a post-op pic. That said, it is not always possible to close a flap up completely after an extraction - it would be ideal, because this would be healing by "primary intention", but quite a lot of dentistry healing is by "secondary intention".
3. I don't know quite the situation in US, but it's prob similar to here in Australia. There is no single point at which a dentist needs to refer to an OS; all dentists are qualified to do oral surgery. When I worked in a country area, I did more oral surgery. Now that I in a city, I have access to an OS down the street, I choose to give him most of my difficult cases. Why should I try and do everything as a general dentist when he's doing OS all day, every day, and has a better setup? It's similar to Root Canal Therapy - all dentists are trained, some are better than others, some prefer and actively do more than others, and some refer all cases to specialists.