Having Oral Surgery at a General Dentistry Office

Last month, I saw three patients referred for management of complication from oral surgery done at general dentistry offices. The first patient suffered chronic infection and numbness of her tongue following removal of her wisdom teeth. The second patient had root fragments from a wisdom tooth that were left in place because the dentist could not remove them. In fact, one of the roots was pushed through the bone into the throat area. The third patient had an infected dental implant that had been watched inappropriately over a couple of months only to result in more infection and loss of bone. In all three cases, patients and parents did not know anything about the qualifications of the person doing the surgery. They simply went along with the recommendation of their dentist to have it done in their general dentistry office. The first two patients were treated by a general dentist, and the third case, the patient with the failed implant, was treated by a part-time periodontist. Such incidents are not rare. On the average, I see four to five patients a month with complications that could have been avoided if the patient had been seen by a trained specialist in a more appropriate environment. If you need an oral surgery procedure such as wisdom teeth extraction or dental implants, it is appropriate for your general dentist to refer you to an oral surgeon for treatment. These types of oral surgery procedures are best performed by an oral surgeon at his or her office, not only because of their experience, but also to ensure that the physical office is properly equipped and staffed to manage such treatments efficiently and safely.

Some general dentists may choose to perform oral surgery procedures in their office in order to increase practice production and profits. The general dentist may elect to do the procedure or may bring in a periodontist or an oral surgeon to do the procedures in their general dentistry office. Patients may be told that there is no need to see an oral surgeon outside the general dentistry office because “I do this myself” or “We have a guy who does those procedures here,” emphasizing that it will be easier and faster to have it done at their office. Either way, it is important for patients to know a few facts before accepting such recommendations:

General dentist doing the surgery: Patients should be aware that general dentists are not trained for surgical procedures and, while a general dentist may have taken a course or two, an oral surgeon is the specialist of choice for safe and predictable results with teeth extractions, wisdom teeth surgery, or dental implants with minimal complications.

General dentist hiring another general dentist with “experience” in oral surgery: In group practices, another general dentist may be designated to perform surgeries since they may have some experience or just choose to dive into the surgical world and try it. A general dentist, even with some experience, is still not qualified to perform surgical procedures and can be quite risky.

General dentist hiring a periodontist to do oral surgery procedures: While some periodontists may do simple extractions or dental implants, they are ill experienced in the extraction of impacted wisdom teeth and complex bone grafting and dental implant procedures. Just because they are proficient in management of gum diseases and related surgical procedures, it does not qualify them for oral surgery procedures.

General dentist hiring an oral surgeon to do oral surgery procedures: I actually did this for a few months during my first year of practice about 16 years ago. I realized quickly that a general dentistry office is poorly designed for such intricate procedures. Lack of proper instrumentation, equipment, staff knowledge, and support makes a general dentistry office risky and even dangerous in spite of the surgeon’s training and experience. A general dentistry office has an entirely different focus and is set up differently than an oral surgery office. It simply does not meet the criteria for surgical procedures.

No option for IV sedation (being asleep): Whether it is an oral surgeon, periodontist, or the general dentist doing the surgery at a general dentistry office, you won’t be able to receive proper IV sedation. Your dentist may say you don’t need it, but it is the most comfortable and recommended way to have surgical procedures done. A general dentist can only offer local anesthesia, which means you will be awake for the procedure.

So, when you are making decisions about these types of procedures, remember you always have the option of requesting that a board-certified oral and maxillofacial surgeon at a specialty office provide your treatment. The treatment will be safer, shorter, and more successful with minimal complications.