Deviation in the Standard of Dental Care During Tooth Extraction

Evaluate breaches in the standard of care

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following indications for tooth extraction did the patient present?(Choose all that apply)
    Loose teeth
    Decayed tooth
    Broken tooth which cannot be retained
    Tooth interfering with artificial teeth set
    Retained milk tooth
    Mal-positioned tooth causing problems in teeth alignment
    Patients requiring oral radiation/chemotherapy
    Tooth responsible for local sepsis
    Impacted teeth
    Supernumerary teeth
    Teeth associated with pathologic lesions
    Teeth involved with jaw fractures
    None of the above
    Answer unknown
    Why is this important?
    Extraction of a tooth is a procedure that combines the principles of surgery and elementary physical mechanics. When these principles are applied correctly, a tooth can usually be removed from the alveolar process even by someone without great strength and without untoward force or sequelae.
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  • Was a medical history obtained prior to the tooth extraction? Why is this important?
    Answer this question
    
Patients can have a variety of health problems that require treatment modification or medical management before the oral surgery can be safely performed. Special measures may be needed to control bleeding, lessen the chance of infection, or prevent a medical emergency.

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  • Which of the following contraindications did the patient possess? (Choose all that apply) Why is this important?
    Answer this question
    
Tooth extraction without prior medical management is contra-indicated.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process.

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  • Did the clinician perform a pre-operative evaluation of the tooth to be extracted? Why is this important?
    Answer this question
    
In the pre-operative assessment period, the tooth to be extracted should be examined carefully to evaluate the level of extraction difficulty. A variety of factors must be specifically examined to make a thorough assessment.

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  • Were imaging studies of the affected tooth performed? Why is this important?
    Answer this question
    
It is essential that proper radiographs be taken of any tooth to be removed. In general, periapical radiographs provide the most accurate and detailed information concerning the tooth, its roots, and the surrounding tissue. Panoramic radiographs are used frequently, but their greatest usefulness is for impacted teeth as opposed to erupted teeth.

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  • Were prophylactic antibiotics administered? Why is this important?
    Answer this question
    
Antibiotic prophylaxis for dental procedures is advised only for patients with cardiac conditions associated with the risk for endocarditis.

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  • Did the clinician explain the planned procedure to the patient? Why is this important?
    Answer this question
    
Anxiety control begins with a proper explanation of the planned procedure.

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  • Was an informed consent obtained prior to the procedure? Why is this important?
    Answer this question
    
The laws of most states require that the dentists obtain informed consent before providing any treatment.

    (2011) 23 EOMSCA 3 475-484 



  • What type of anesthesia was administered? Why is this important?
    Answer this question
    
Profound local anesthesia is needed if the tooth is to be removed without sharp pain for the patient. Dense local anesthesia results in the loss of all pain, temperature, and touch sensations, but it does not anesthetize the proprioceptive fibers of the involved nerves.

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  • With which of the following indications for surgical removal of tooth did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
Conditions such as advanced caries, abnormal root morphology, or difficult anatomic locations can make the extraction of a tooth complicated and necessitate a surgical extraction.

    (2012) 56 EDECNA 1 245-266 



  • Was a sterile environment maintained? Why is this important?
    Answer this question
    
The principle of universal precautions states that all patients must be viewed as having bloodborne diseases that can be transmitted to the surgical team and other patients. To prevent this transmission, surgical gloves, surgical mask, and eyewear with side-shields are required.

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  • Were all the components of the affected tooth removed completely? Why is this important?
    Answer this question
    
If a root fracture is noted, the socket should be irrigated copiously with normal saline, and an attempt should be made to directly visualize the retained root or root tip. If there is associated disease with the tooth pre-operatively, it is imperative that the root fragment be removed.

    (2012) 56 EDECNA 1 75-93 



  • Was finger pressure applied to the socket after extraction of the tooth? Why is this important?
    Answer this question
    
The expanded buccolingual plates need to be compressed back to their original configuration. Finger pressure is applied to the buccolingual cortical plate to compress the plates gently, but firmly, to their original position.

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  • Which of the following complications did the patient develop during the extraction procedure? (Choose all that apply) Why is this important?
    Answer this question
    
A common postoperative complication is persistent bleeding several hours after the extraction, accompanied by a poorly organized clot formation.

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  • Were the complications during the extraction procedure managed? Why is this important?
    Answer this question
    
Despite the utmost care, a tooth may break during the extraction procedure.

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  • Was a debridement of the extraction site performed? Why is this important?
    Answer this question
    
At the termination of the procedure, the extraction socket and the space under the soft tissue flap should be generously irrigated to remove bone dust and tooth particles that may be present. Leaving bone dust and clotted blood below the flap could result in an infection.

    (2012) 56 EDECNA 1 245-266 



  • Were post-extraction radiographs obtained? Why is this important?
    Answer this question
    
Aggressive attempts to remove portions of roots that are in precarious positions cause more damage than benefit, when radiographic follow-up may be all that is required.

    (2012) 56 EDECNA 1 75-93 



  • Were sutures applied on the patient’s extraction wound? Why is this important?
    Answer this question
    
Proper healing requires proper positioning of the soft tissues closest to their original position in a stable fashion, with the least amount of tension.

    (2012) 56 EDECNA 1 281-303