Less-than-desirable results can occur despite the dentist’s best efforts in diagnosis, treatment planning, and surgical technique. A poor result does not necessarily suggestthat a’ practitioner is guilty of negligence or other wrongdoing. However, when complications occur, it is mandatory that the dentist immediately begin to address the problem in an appropriate fashion. In most instances the dentist should advise the patient of the complication. Examples of such situations are loss of or failure to recover a root tip; breaking a dental instrument, such as an endodontic file, in a tooth  ferforation of the maxillary sinus; damage to adjacent teeth; or inadvertent fracture of surrounding bone. In these instances the dentist should dearly outline proposed management of the problem, including specific instructions to the patient further treatment that may be necessary, and referral to an oral and maxillofacial surgeon when appropriate . It is advisableto consider and discuss reasonable treat merit options that may still produce reasonable results. • For example, when teeth are extracted for orthodontic purposes, the first premolar may accidentally be extracted
when the orthodontist preferred extraction of the second premolar. Before removing any other teeth or alarming- the patient and parents, thedentist should call the orthodontist to discuss the effect on treatment outcome
and available t reatment modifications. The patient and parents shOlilct be notified that the wrong tooth was extracted but that the orthodontist indicated that the · treatment can proceed without significantly  compromising  the result The lack oi reasonable modifications of the original treatment plan is more’ challenging. The dentist may have to consider a more expensive plan, such as implants, and should also consider funding additional treatment. Another common complication is altered sensation following third molar removal. The chart should reflect the existence and extent of the problem. It may be useful to use a diagram to document the area involved. The density and severity of the deficit should be noted after testing, if possible. The chart should reflect the progress of
the condition each time the patient returns for follow-up. .Ultimately the patient may require a referral to an oral and maxillofacial surgeon with experience in diagnosing and treating nerve injuries. In most cases the referral · should occur within approximately 3 months after the injury it no significant improvement is seen. Excessive delays may limit the effectiveness ‘of future treatment, Documentation of the patient’s progress helps justify the decision to delay the referral.

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