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You can read this if you’re not a dentist, you just have to pay attention, because it applies to everything in life.

Recently a very good friend of mine – a very knowledgeable and capable clinician – was lecturing on the subject of Oral Surgery. He discussed the situation where a GDP breaks a tooth (let’s say a lower right first molar) and in order to try and facilitate a straightforward and simple removal of the remaining part of the tooth uses a high-speed hand piece (air turbine) to section through the roots to allow them to be elevated in several parts.

Before I go on, let’s be clear that this is happening every single day in dental practices around the world and not least in the UK. You only need to do a quick straw poll on any General Dental Practitioner’s course to find out that that’s being done (providing that you are reasonable and approachable and are not going to criticise the group for their answers)

So, my friend presents this and suggests that that happens regularly and, if done carefully, is acceptable and is then ‘set upon’ by several Oral Surgeons and some of them suggested to him that this is worse than burning people at the stake for alleged witchcraft!

This has been a thing for as long as I can remember, an urban myth and an old wives’ tale that’s told by Oral Surgeons to frighten GDPs (and I am an Oral Surgeon). It’s part of the “that’s too complicated for you and it should be sent to me because I’m better” mindset.

I have been teaching people how to take teeth out for 25 years and in particular teaching GDPs to do minor Oral Surgery in one form or another. While I am aware that the effects of Surgical Emphysema can be terrible, I am also aware that it is an extremely rare condition which can happen for many possible reasons.

So, let’s stop here just in case there is anybody reading this who’s not a dentist. Surgical Emphysema is basically air which enters into the tissues under the skin and in its worst possible form can lead to pressure, choking and even death, and it can happen as a result of dental procedures where the hand piece blows air out (like an exhaust)

So, there is no doubt that a front exhausting air turbine hand piece can blow air under the tissues in freak circumstances leading to Surgical Emphysema and significant complications for patients. That’s what the Oral Surgeons were telling my friend as he was presenting.

They were using the “if you’d seen a case of Surgical Emphysema then you would know you can’t do that” line.

So, we searched the literature (well actually Nish did)

I have a Dropbox folder full of Surgical Emphysema literature if anybody would like me to share it with them, you only need to ask. The best systematic review we have examines 64 cases; 32 of which are attributed to dental hand pieces and of that 32 only 16 of them were during surgical extractions.

The most fascinating part of this is that Surgical Emphysema can happen when a patient has a cavity cut in the outside of the tooth (Class V) Some of the cases in the systematic review had come from that particular circumstance. That means that if we’re going to tell dentists that they can’t carefully section the roots of teeth that break without getting air in the tissues, they can’t cut cavities either.

Dentists are allowed, by law, to use sharp and dangerous instruments inside patient’s mouths, that is in fact their job. They need to be trained and then trusted to use them appropriately and if they don’t use them appropriately then they will get into trouble.

The use of a high-speed diamond to carefully section the roots of a lower first molar tooth before separating it with an instrument and extracting it without the trauma of a full surgical extraction is completely valid for a skilled practitioner, and certainly should not be discouraged on the basis of confirmation bias from Oral Surgeons.

The clever surgeon, the clever clinician and the person that sees themselves as a physician first might suggest other alternatives to this, other routes to solve the problem.

Instead of barking at dentists to not do something, why not encourage them to invest in electric air rotors, which don’t exhaust through the front of the drill, then we would eradicate Surgical Emphysema from dentistry altogether, from extractions or from cavity cutting.

Blog Post Number: 1711