There is a comfort zone that most general dentists have regarding their abilities. In order to expand those abilities it is necessary to study and educate themselves. Specialists are available for referral but this involves an inconvenience for the patient plus loss of income for the general dentist. There are also ethical considerations regarding what is best for the patient. Ultimately, by pursuing a life long quest for knowledge and improvement, the general dentist will expand his abilities, provide a better service to his patients and be rewarded financially. There is also a feeling of confidence ( and less stress ) that a motivated dentist can acquire when when he sees the results of his efforts.

This patient came to me with a chief complaint of pain under her denture on the lower left. The etiology was a partial eruption of an impacted wisdom tooth. Since medicaid was going to cover the surgical expense of therapy ( a disputed claim later on caused problems ) we went ahead with the procedure. The technical aspects of performing this procedure involved the following:

Local anesthesia was administered ( topical plus Carbocaine 3% via a mandibular block along with infiltration of the adjacent soft tissues with Septocaine ). A mid crestal incision was made and a buccal flap was elevated. Osseous resection was performed to expose the crown portion of this tooth. The crown was then separated and the remaining root elevated out.The flap was closed with gut sutures.The patient was given ice packs to control swelling.

Analgesics were dispensed and written post operative instructions were reviewed. In this surgery, careful dissection ( with high powered lenses. Designs for Vision ) allowed for minimal surgical trauma and therefore faster post operative healing. The location of the mandibular canal was noted initially and there was no Paresthesia or other nerve damage post operatively. It was noted initially on her medical history that she had been taking Fosamax (Alendronate).

With the minimal dosage she had been taking, I didn’t think this would be a problem. Unfortunately, this did result in delayed healing and continued moderate pain. Following a brief course of antibiotics ( Amoxicillin, 500 mg # 22 tabs ) with minimal resolution I referred this patient to an oral surgeon. The oral surgeon referred to another oral surgeon ( the director and chief of a major hospital ) who eventually resolved the problem via a minor surgical procedure (reentry and cleaning out the wound ).