Friday, May 11, 2007

Who to blame?

I received a frantic call from the oral surgeon today. Patient had woken up from GA and was still experiencing severe toothache and she's accusing the oral surgeon of pulling out the wrong tooth.

Oral Surgeon: You referred Mrs G to me for extraction of 16. I've done that but now she's saying I pulled out the wrong tooth.

I could hardly remember a Mrs G so I had a look on the computer and it all came back to me.

Mrs G was presented with fractured amalgam on a root canal treated tooth in September last year. She said the tooth was "niggling". I can never understand what patients mean when they say the tooth is "niggling". Do they mean it's giving them sharp pain, dull ache, throb or what??? I tried to get her to use other words to describe the sensation but she just kept repeating "You know it's just niggly", "It's not sharp. It's niggling". DUH. Fed up I just patched up the tooth with Fuji IX. The tooth wasn't TTP, neither was there any PA radiolucency on the radiograph. I told Mrs G if she starts getting dull throbbing ache in the tooth she'll either require RCT re-treatment by endodontist or have it extracted. Mrs G doesn't like the idea of travelling 700km to go to the endodontist and would rather have extraction. I do not like the combination of big amalgam restoration + RCT + close proximity to sinus so I told her if she ever require extraction she'll have to go to the oral surgeon. To save her the trouble of waiting 2 months to get in just to obtain a referral letter to the oral surgeon when the tooth flares up I decided to write her the referral letter in case she needs it.

Mrs G also has a deep carious lesion on 14. It had been asymptomatic so I told her she'll have to come back asap to get it fixed before it starts to hurt. She didn't.

My guess is, 8 months down the track she started getting toothache and thinking it's coming from the 16 she went to the oral surgeon. The oral surgeon followed the request on the referral letter and extracted 16 when it was 14 that was giving her pain. What amazed me is that how someone can think a half broken rotten tooth cannot cause pain, especially after being warned by me that she'll experience severe dull throbbing ache if she doesn't get it treated asap.

She came in the the practice today to make an appointment and she's still telling everyone the oral surgeon pulled out the wrong tooth. I feel sorry for the oral surgeon.