Expert: Mark Bornfeld DDS - 9/23/2007

Question
Is it legal in the state of Georgia (or anywhere) for a general dentist to attempt to extract wisdom teeth that have not errupted from the gum?

Can it be seen in panaramic xrays that upper wisdom teeth are fused to the jawbone/sinus bone?

Is it legal for a general dentist to attempt to extract unerrupted wisdoms without me being asleep at the time?

If it's not legal, and if it can be seen, can you help me find an attorney that can help me, and that can practice law in the state of Georgia, even though I did not sustain permanent injuries?

Answer
Dear Suzie,

I am unfamiliar with the specifics of the dental laws in Georgia, but the laws that deal with specialization are, to my knowledge, fairly uniform across the country.

In fact, a dental license grants the legal ability to offer any service that may be considered dental, including the extraction of impacted wisdom teeth. Dental licenses do not confer specialty status, and it is not legally required to specialize in order to offer services that would be considered within the scope of any of the recognized specialties. So, strictly speaking, any dentist (that is, either a general dentist, or a dentist who has limited his practice to a specialty and is certified as a specialist in ANY specialty) may legally extract impacted wisdom teeth. In other words, an orthodontist could legally extract an impacted wisdom tooth if he wanted to.

However, your question deals not with legal questions, but with ethical matters. While this may seem to be a small distinction, the laws that govern dentistry detail what a licensed dentist can and cannot do, while the dental codes of ethics detail what a dentist SHOULD and SHOULD NOT do.

In terms of when a patient SHOULD be referred to a specialist, the consensus is that a general dentist should make a specialty referral when it is in the patient's best interest to do so. The code gives the general dentist the discretion to make the decision, based on several factors. For example, if a general dentist is clearly untrained and inexperienced in wisdom tooth extraction, or if he has only limited experience, he would be subjecting a patient to risk by undertaking a task that he may not be able to successfully implement. On the other hand, if the patient were located in Juneau Alaska, and the closest oral surgeon was 300 miles away, there may be justification for that general dentist to assume that responsibility, especially if treatment was a matter of urgency and the patient could not travel to a specialist. Ethics always must be viewed in the context of the situation as it presents.

As for determining whether a wisdom tooth is ankylosed (fused to bone)-- no, it is usually not possible to determine this fact from a panoramic or any other type of radiograph. Ankylosis is determined, unfortunately, at the time of surgery, when the tooth does not yield to efforts at extraction.

And yes-- it is perfectly legal to extract an impacted wisdom tooth without general anesthesia; in fact, a good proportion are extracted using nothing but local anesthetic. The use of sedation or anesthesia is based mostly on the patient's level of anxiety; a calm patient does not need general anesthesia, and the use of general anesthesia adds significantly to the cost and the inconvenience (abstaining from food pre-operatively, the necessity of bringing another adult along to accompany the patient, and the possibility of adverse side effects). For this reason, general anesthesia is used selectively for those patients who would benefit, and not used for those who would not benefit.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY