goodbye oral surgery....for now

1 month i was posted in the oral n maxillofacial department. well this time we're allowed to take cases for extraction,suture removal,irrigation, etc. since we've finished with the theory portion. so far, this is the branch of dentistry i like the most. my 1st extraction case was an easy 1, a mobile tooth (26), but the experience of giving nerve block to the patient seemed scary at first but exhilarating later. my 2nd extraction case was the most challenging of all. i was ordered (yes, i mean that literally) to remove 16 (right upper 1st molar) tooth which was grossly carious. the mesial half of the tooth was already gone. well the intern who was on opd duty didnt even order an iopa before the extraction. as a common knowledge is us the dental practitioner, it is almost an obligation to get an iopa xray before any extraction of maxillay 1st molar, in case the roots extend into the maxillary sinus, which may cause complication after extraction. there are 3 legal cases against the hospital still going on now in that the roots of the maxillary molar broke during extraction,root fragments got lodged in the maxillary sinus, infection n inflammation of the sinus, invasive maxillofacial surgery to treat the complication, hence patients sue the doctors.

back to my case. under the observation from dr. rohan shah, i palpated the mucobuccal fold of the maxilla,located the landmarks for posterior superior alveolar nerve block, injected the LA solution, gave the buccal infiltration for the mesiobuccal root of the tooth n greater palatine nerve blocks. (i know, the blocks werent necessary but just for practical purposes). then i reflected the gingiva n applied the forceps onto the root of the tooth. after that, using my theoritical knowledge, i started giving the buccal n palatal movements once i had a firm grip on the tooth. well the tooth didnt seem to be moving a milimiter! i took almost half an hour to extract the tooth, that after changing the 16 forceps to cowhorn forceps. when i finally managed to take the tooth out........wow...... the 3 roots were unusually long....n diverging!! my hands trembled, thinking what would i do if the roots were broken in the process n got lodged in the maxillary sinus ....n also silently cursing the intern who didnt order for iopa n my own foolishness not to ask about iopa..

so moral of the story..i ll never forget to ask for iopa before extraction of the tricky teeth next time..after that few cases came..then end of omfs posting...n its gonna be a while till i'll be able to come back to this department again.=)