Expert: Mark Bornfeld DDS - 9/10/2007

Question
Hello Mark,
I had two wisdom teeth removed the last Friday and have a few questions for you regarding this. First of all I do not like having dentistry work of any kind done so I was very nervous to have two wisdom teeth pulled (at age 26) but figured my best bet would be with an oral surgeon. The first question I have is..." Is it normal for an oral surgeon/dentist to accidentally rupture a blood vessel in my cheek when he was administering my localized anesthetic..resulting in a hemotoma in my cheek and around my eye? Next question... Directly after my second tooth was pulled the Surgeon or His Assistant dropped my wisdom tooth into my throat...resulting in some yelling and then me being tilted forward with them banging on my back asking me to cough followed by the surgeon reaching into my throat with his hand and removing the tooth, Is this a common practice? Also... The surgeon said it wasn't necessary for my to be on an antibiotic but I feel like I should have been put on one just as a precaution, How do you feel about this? Any answers will be greatly appreciated.
Thanks
Patrick Davidson

Answer
Dear Mr. Davidson,

First, as to the ruptured blood vessel and hematoma-- this is a complication that sometimes occurs due to the inability to determine the precise position of deeply situated vascular channels. When a needle moves through a blood vessel, especially an artery or smaller arteriolar branch, a hematoma will form. This can happen regardless of the skills of a surgeon or the technique used. This event is a matter of pure chance; although I would not characterize it as "normal", a certain number of cases will manifest with hematoma. Unfortunately, you are in this privileged minority.

Dropping a foreign body down the throat is something that can happen due to the imprecise way that an extraction forceps sometimes grips the tooth, which is smooth, convex in contour, and slippery from blood and saliva. Although dropping a tooth down the throat is a human error, courts have held surgeons to a higher standard. In other words, although almost any dentist who has performed many extractions can and has done something similar to what you describe (myself included), the consequences of losing such an object in the respiratory tract are grave. As a result, any injury that results from aspiration of a tooth, bone chip, or other foreign body is considered professional negligence. Fortunately for both you and your dentist, the tooth was retrieved. Had it not been, both you and your dentist would be facing considerable difficulties now.

The use of antibiotics has come under increasing scrutiny by many authorities. Current thinking is that the pervasive over-use of antibiotics presents considerable risk to both the individual patient and society at large. It has resulted in the emergence of bacteria and other microorganisms that are increasingly resistant to these once powerful drugs, necessitating more complicated antibiotic regimens in situations that were once more easily managed. Current conventional wisdom maintains that antibiotics should only be used when there is compelling reason to do so. The philosophies that using antibiotics because "it couldn't hurt" or "just to be safe" are flawed because it could hurt and it doesn't always make things safer. A review of any hospital morbidity and mortality report will quickly show just how prominent C-Dif, MRSA, and other new bacterial threats are-- these are major problems that didn't exist just a few short years ago.

For more information on the CDC's initiative to promote responsible antibiotic use, see the following web site:

http://www.cdc.gov/drugresistance/community/

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY