Extraction of the Wrong Tooth

Extraction of the wrong tooth is an avoidable error which can easily be prevented by ensuring that proper identification of the patient and tooth to be extracted, is made.

Teeth commonly extracted in error are upper canines instead of upper first premolars, lower permanent premolars simultaneously with lower deciduous molars and upper second molars instead of upper third molars. The latter is particularly liable to occur if the upper third molar is partially erupted and difficult to visualise.

Being aware of the possibility of these errors and “counting out” the tooth to be extracted will go some way to minimising their occurrence.

A common source of confusion is the correct identification of one of 2 molar teeth when the other molar is missing or absent. Although a naming convention exists for just this situation, longhand notation such as “the first standing lower right molar” instead of the lower right 7 may help avoid confusion where the third molar is erupted and the first molar is absent.

A similar situation occurs when only one of 2 unerupted and adjacent teeth are to be extracted. Again, this is commonly requested as part of an orthodontic treatment plan and as such should be avoided at all costs.

If the wrong tooth is extracted, the oral surgeon should proceed with removing the correct tooth unless the extractions are for orthodontic purpose when it may be better to seek the advice of the patients’ orthodontist first.

The tooth extracted in error, particularly if it is otherwise healthy, should be immediately replaced in its socket. If mobile, it should be held in place with a custom made vacuum-formed splint for approximately 4 weeks. It is likely that it will subsequently require to be root-filled and if there is any doubt about its prognosis, the advice of a consultant restorative dentist should be sought.