I extracted a wrong tooth and I had a iatrogenic pulper, I must be the winner of them all! My pulpal exposure case, she was only 21, I was prepping for a OL recurrent caries under a large existing deep amalgam on #31. Removed the existing amalgam without event, it was chasing the caries that I pulped it. The pt was already warned about the possibility of pulpal involvement so I was covered. Well, after exposure, the faculty suggested we pulp cap it with Fuji glass ionomer to see if the tooth responds and heals. A week post, the pt was in extreme pain and came back in the clinic with palpable submandibular swelling. We took a posterior PA radiograph, sure enough, the pulp capped tooth had a periapical radiolucency.
Since it was a 2nd molar, I had to refer the pt to PG Endo because Predoc can only do 1st molar endos. Pt had the endo done and sent home with analgesics and antibiotics. Post-op follow up calls showed pt healing well, resolving swelling, and without pain.
My wrong tooth extraction case:
Happened in my 3rd year, 2nd semester on OMFS rotation. Pt is a mid 40s AA woman who had treatment planned for both upper and lower RPD. At that appointment, the pt was scheduled for extraction of #17 and #16 (3rd molars). I did the consent forms and the paper work all while I was looking at the Panorex. The pan showed #18 and #17 only teeth left in the LL quadrant. Both #17 & #18 had furca involvement, but #17 more than #18. In my head, I knew I was going to extract two teeth at that appointment and then I concentrated on the pan for #17 & #18 so much that I end up extracting both of those teeth.
#18 was treatment planned as an abutment for the lower RPD.
Extractions were without complications and I was closing practicing suturing. A faculty member came in as I was suturing:
Faculty: Hey Andy, what's up?
Me: Things are going great, I'm just closing.
Faculty looked at my work for a second and then exited the operatory
Faculty entered the operatory a minute later
Faculty: Andy, why don't you close up and clean up the patient and come see me.
Me: sure!
I finished suturing and stepped out to see that faculty
Faculty: Tell me where is #16 and #17?
Me: (confused as to what he's refering to) What do you mean?
Faculty: (again said) Tell me where is #16 & #17?
Me: #16 is the maxillary.....
As soon as I said the word "maxillary" from what I was going to say "maxillary 3rd molar", my world and time had stopped and it was right there and then I realized that I didn't extract any maxillary tooth at all and I extracted a wrong tooth on this patient! I remembered that hall way got longer and the ceiling got taller, everything was quiet and I started to sweat! The faculty and a resident asked to see the panorex and informed me to informed the patient of my mistake.
To make matter worse, I had to go back in and anesthetize the patient again in upper left quadrant to extract #16 that the patient had came in for that appointment. I explained to the pt what had happened and how sorry I was, luckily for me, this particular patient was extremely warm and empathetic. I was very lucky. We offered the patient a free implant and crown, but the pt wanted RPDs and didn't want to wait for osseointegration time of 8 weeks.
So there's my wrong tooth extraction story. Since then, I've extracted hundreds of teeth and never again extracting the wrong tooth. I carelessly knew that I had two teeth the extract and looked at the pan and stared at #17 & #18 because they were the only teeth left in that quadrant with poor periodontium, I extracted a wrong tooth.
The wrong tooth incident and my recent pulpal exposure due to caries are the only "bad" events happened to me in dental school. (knocking on wood)
Any one else brave enough to share their blemishs?
