Surgical Extraction w/ high speed handpiece and air embolism??

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Exodontia

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So for the OMFS residents out there, what are the occurance rate of air embolism via high speed handpiece for surgical extraction?

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Bitters, you're such a dick. Leave the kid alone.

BTW, the term "air emphysema" is redundant. The term is subcutaneos emphysema.
 
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You mean like this....






I'm not sure anyone knows the incidence, but I doubt you would have a leg to stand on in court because it's a known risk.
 
Well if you use the handpiece that is specifically desgined for surgical procedures, you won't have to worry about emphysema happening because that handpiece has air coming out away from the operative field.
check it out:http://www.palisadesdental-llc.com/products.asp
 
toofache32 said:
The point is that some GP's are too cheap to buy those.
But they're perfectly willing to fork over malpractice premiums after the settlements. For being as smart as we are, dentists can be a pretty dumb lot sometimes.
 
Exodontia said:
So for the OMFS residents out there, what are the occurance rate of air embolism via high speed handpiece for surgical extraction?

Not sure about everyone else, but it seems like it happens every time I use that damn thing.
 
I've always used the Stryker for a surgical handpiece, but I've also worked with 3 or 4 faculty who claim if you turn the air down all the way, they have, in 500 years of practice, never had a problem, blah blah blah....
 
LarryBobDDS said:
I've always used the Stryker for a surgical handpiece, but I've also worked with 3 or 4 faculty who claim if you turn the air down all the way, they have, in 500 years of practice, never had a problem, blah blah blah....

I hear this works great at LSU-NO since they practice OMFS under water and don't have to irrigate to prevent the bone from burning up.
 
Extraction said:
I hear this works great at LSU-NO since they practice OMFS under water and don't have to irrigate to prevent the bone from burning up.

Natural copious irrigation for every procedure.

Like the OP, I'm also curious as to how many of these incidents occur.
 
In school we hear about it through the grapevine... most dentists get away with it throughout their careers. the malpractice is just one of the things that can happen. Could be worse if the regulatory body decides to suspend your license and audit your charts.
 
I hear a dremmel works wonders :D
 
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LarryBobDDS said:
I hear a dremmel works wonders :D
You kid, but I know several people who have taken them on mission trips. Of course, they aren't being used to remove impacted thirds...
 
I've been wondering about this. Does the air that comes out of a dental handpiece have enough pressure to force itself along and dissect fascial planes? I always see the Hall drilll used when a drill is needed. It's pretty frickin loud. That'd scare the crap outta me if I was a Pt.
 
drhobie7 said:
I've been wondering about this. Does the air that comes out of a dental handpiece have enough pressure to force itself along and dissect fascial planes? I always see the Hall drilll used when a drill is needed. It's pretty frickin loud. That'd scare the crap outta me if I was a Pt.
That's why TX sings show tunes to his patients while treating them...
 
drhobie7 said:
I've been wondering about this. Does the air that comes out of a dental handpiece have enough pressure to force itself along and dissect fascial planes?
Refer to my xrays posted earlier in this thread.
 
I am not trying to hijack this thread but the last three chiefs who graduated from here and are in private practice have all gone to electrical handpieces. We use Hall drills exclusively in the clinic and strykers in the OR. While the Halls are really great drills, they are loud. I think it is a little disconcerting to a patient who is having a consult to hear the Hall drill blaring in the back ground. Especially with the new regulations that discourage anything but solid floors in the office... nothing to muffle the sounds of a Hall "screamin like a demon". I think that the electric drills for office use are essentially the same as the stryker right? If so, I don't think they are nearly as fast as the Hall....
 
But they're perfectly willing to fork over malpractice premiums after the settlements. For being as smart as we are, dentists can be a pretty dumb lot sometimes.


tell me about it. i have been fighting with my employer for over a month now trying to get the surg hand pieces. i finally had enough and told them that i will not be doing any more surg extractions until i have the right equipment.

Can anyone find any good articles on this topic?
 
tell me about it. i have been fighting with my employer for over a month now trying to get the surg hand pieces. i finally had enough and told them that i will not be doing any more surg extractions until i have the right equipment.

Can anyone find any good articles on this topic?

Here's one. I have more that I can't get to upload, but here are some citations:

J Emerg Med. Cervicofacial and mediastinal emphysema as the result of a dental procedure. 1996 Jan-Feb;14(1):9-13

Heyman SN, Babayof I. Emphysematous complications in
dentistry, 1960–1993: an illustrative case and review of the literature.
Quintessence International 1995; 26; 535–543.

Monsour PA, Savage NW. Cervicofacial emphysema following
dental procedures. Aust Dent J 1989; 34: 403–406.

Davies JM, Campbell LA. Fatal air embolism during dental
implant surgery: a report of three cases. Can J Anaesth 1990; 37:
112–121.

By the way, your "employer" cannot force you to commit malpractice, just because they sign your checks. The lawyers will come after YOU and not your employer. And "...but I told my boss but he wouldn't listen...." is not a valid excuse.
 

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tell me about it. i have been fighting with my employer for over a month now trying to get the surg hand pieces. i finally had enough and told them that i will not be doing any more surg extractions until i have the right equipment.

Can anyone find any good articles on this topic?

Aren't subcutaneous air emphysema( if they happen during exos ) usually insignificant, nonfatal, and self-resolve without any major interventions?

I *know* that surgical exos are best done under surgical handpieces but I know so many GPs who even treat impactions using regular handpieces. I even work in one of their offices right now. When I asked them about using surgical handpieces, they were all like "what? What's the point?" From my experiences, only oral surgeons use surgical units for exos.
 
By the way, your "employer" cannot force you to commit malpractice, just because they sign your checks. The lawyers will come after YOU and not your employer. And "...but I told my boss but he wouldn't listen...." is not a valid excuse.

Not absolutely true. In one office I'm currently at, last year, an ex-patient started a lawsuit that named the dentist that treated him AND the owner dentist, who doesn't clinically practice dentistry there. I don't know why this occurred but I don't think the lawsuit was for anything serious, as the treating dentist settled for $10k. No word yet regarding the actions from the owner.

Your chances of being sued for crown, bridge, and rct work ( due to a prick dentist saying all sorts of bad things about your work, even if it is clinically acceptable if not ideal, so he can re-do the treatment and charge the patient ) is significantly higher than seeing even one case of air emphysema from a lifetime of surgical exos under a regular handpiece.
 
Aren't subcutaneous air emphysema( if they happen during exos ) usually insignificant, nonfatal, and self-resolve without any major interventions?

I *know* that surgical exos are best done under surgical handpieces but I know so many GPs who even treat impactions using regular handpieces. I even work in one of their offices right now. When I asked them about using surgical handpieces, they were all like "what? What's the point?" From my experiences, only oral surgeons use surgical units for exos.

Not absolutely true. In one office I'm currently at, last year, an ex-patient started a lawsuit that named the dentist that treated him AND the owner dentist, who doesn't clinically practice dentistry there. I don't know why this occurred but I don't think the lawsuit was for anything serious, as the treating dentist settled for $10k. No word yet regarding the actions from the owner.

Your chances of being sued for crown, bridge, and rct work ( due to a prick dentist saying all sorts of bad things about your work, even if it is clinically acceptable if not ideal, so he can re-do the treatment and charge the patient ) is significantly higher than seeing even one case of air emphysema from a lifetime of surgical exos under a regular handpiece.

Look at the bright side. When you're sued out of the profession and the boards strips your license, at least you'll be able to stop complaining about how awful your career as a dentist has been.
 
Look at the bright side. When you're sued out of the profession and the boards strips your license, at least you'll be able to stop complaining about how awful your career as a dentist has been.

My friend, I think your posts are pushing the boundaries just too much.

On the topic of getting sued, just a few nights ago, I did an awful lower 3rd molar exo. I did this exo together with another dentist. We ended up incising distally and then superiorly up and thru the pterygomandibular raphe( or so it seemed. Sometimes it's hard to tell with all that soft tissue impaction ). Even though the other dentist is partly to blame, the patient was completely assigned to me, and I ended up writing the chart and with production credit.

I wouldn't be too surprised if the patient returns for this followup with paresthesia and sues me for $300k. On top of my 250k+ student loans and personal financial problems, I'm practically SOL.
 
My friend, I think your posts are pushing the boundaries just too much.

On the topic of getting sued, just a few nights ago, I did an awful lower 3rd molar exo. I did this exo together with another dentist. We ended up incising distally and then superiorly up and thru the pterygomandibular raphe( or so it seemed. Sometimes it's hard to tell with all that soft tissue impaction ). Even though the other dentist is partly to blame, the patient was completely assigned to me, and I ended up writing the chart and with production credit.

I wouldn't be too surprised if the patient returns for this followup with paresthesia and sues me for $300k. On top of my 250k+ student loans and personal financial problems, I'm practically SOL.


How come no referral to OMF? It isn't worth doing this to yourself.

Hopefully it all works out for you (and your patient doesn't have any paresthesia) and you can put that in the "i'll never do that again pile".
 
Why put anyone at risk in the first place?

If it is a known risk, why do it? I would rather fork over the extra cash for the proper handpiece than risk causing the patient any problems and risk all the hard work and sweat equity I put in to getting the privilege of doing the procedure in the first place.

Duh.
:D
 
I recently purchased surgical handpieces for both of my practices. It's just not worth the risk.

Thanks for the articles Toofache...great info.
 
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