WADA Golf at Hartfield Country Club

A field of 22 players met at Hartfield Country Club in Forrestfield for the third fixture of the WADA Golf season. This event was sponsored by Insight Dental Ceramics, and we were pleased to be joined by Insight owners and ceramists, Andres Vivanco and Angus Wilshaw, for the day.

It was another glorious Perth autumn day with the recent rains providing lush but challenging conditions at Hartfield. Scoring reflected the tough conditions for some (well me really) and others blossomed.

The winner stood alone with 38 stableford Pts – Patrick Douglas, Ian McCarrey scoring 37 points came in second. David Owen was a close third with 36 points.

• 1st Patrick Douglas

• 2nd Ian McCarrey

• 3rd David Owen

• 4th Michael Whitford

The winner’s prize was presented by Andres and Angus. Andres and Angus presented Patrick Douglas with the winner’s prize. Our thanks are extended to Andres and Angus for their generous support.

Nearest the pin

4th hole Ian McCarrey Health Practice Brokers

6th hole Stu Phillips Swan Valley Dental Laboratory

12th Hole Simon Tee Dentsply Sirona

15th Hole Dean Hanson Healthlinc

18th Hole Simon Tee Longest Drive

Special mention to a new member Jun Liew who scored a great 42 Pts, and when his handicap becomes official, he should put in some challenges for the top awards.

We also welcomed our latest new member in Dean Hanson.

Our next fixture is at Joondalup Country Club on Friday, June 16. All interested golfers are welcome to join us for a game.

Good golfing, Frank Welten WADA Golf Captain Dentistgolf@gmail.com

What do you think is the most concerning procedure in so far as creating adverse outcomes in general dental practice today?

Ask yourself the question, and then read on as Dr Mike Rutherfo rd, Senior Dentolegal consultant for Dental Protection, sets it out .

The first response we often get to this question is: ‘Is it wisdom teeth?’, to which we will reply ‘Yes…. No…. Yes!’

Quite reasonably, you may then ask ‘Well is it or isn’t it?’ to which we would respond: Yes it is! But no – because it is not the number one issue we see (but it does produce some eye watering big numbered claims).

To explain this further, endodontics is by far the most common area of adverse outcome, and in particular fractured rotary files, so while that is very concerning in itself, these are contained or discreet problems. What this means is that at best a specialist endodontist removes the fractured file and there is no residual harm to the patient, or if it can’t be removed well then there may be an uneasy feeling that the tooth may fail one day but then it lasts indefinitely regardless; or worst case the tooth is lost and then remediation is required for one tooth. As a generality this is able to be done predictably, relatively simply and at not a great cost, generally.

But wisdom teeth – now there’s a can of worms. When things go wrong during general dentist third molar removal the best we can hope for is a second surgery, often under GA by an OMFS colleague. That’s the best we can hope for – so at best your patient gets to be miserable twice, require a GA and take more time off work. That’s the best. And the worst? Well everything from a fractured mandible; to a potentially life threatening compromised airway from infection, inflammation or surgical emphysema; or a permanent paraesthesia of the Inferior Dental or Lingual (or both) nerves. So, we have all just read over that last sentence and moved on, but lets just back up a moment: a permanent paraesthesia of the inferior dental or lingual nerves. Have a think about this – this is a permanent impairment to the joy of kissing, perhaps the joy and/or ease of eating, sometimes a lifetime of worry that those around us will think if we slur our words, or, if we have food on our face and don’t realise. It’s an impairment to our working life and our job prospects.

Dental Protection uses the classic case of the French Horn player as an example of when specific warnings need to be given about potential nerve damage: the professional musician French Horn player who suffered an IDN paraesthesia and lost his livelihood and his sense of self, which was devastating. But what about your patient? What about the teacher, the receptionist, the salesperson, the waiter, the barrister, the doctor – they are all impacted in their working and social lives by altered nerve function subsequent to third molar removal. In Australia, and in some states in particular, we are witnessing more frequent litigation around third molar injuries and a significant increase in general damages – what is often colloquially called “pain and suffering”. Partly the higher payments are due to the age of surgical patients. To use the same comparison, our endodontic patients are generally older and have less frequent and severe residual harm. Our third molar patients are generally young, and have to live with any incapacity for far longer. They are usually at an age when they are likely to be seeking employment, seeking relationships and social interactions. When a claim is made against a dentist it is often accompanied by an expert report – that is a report written by either a general dentist or an oral surgeon commenting on all aspects of the patient interactions and treatment that led to the adverse outcome. Unfortunately for many of our Members, the expert providing the report finds that the records and consent process are often easy. The first consideration is why? Why did you recommend the removal of this/ these third molars? Even here we often do not document and explain well. It’s obvious isn’t it? – just look at the OPG! – I am afraid today that this doesn’t wash and neither does the long gone era of you have had ortho treatment, so now you need your third molars removed. If we don’t write a history and examination findings (of pericoronitis or whatever) we can’t record a diagnosis, and if we don’t record a diagnosis, how can we have valid recorded consent from our patient? Doing this is not in itself difficult, and it is therefore incredibly frustrating for the dentist involved and for Dental Protection to not be able to defend the integrity of a Member’s treatment when the documentation around the diagnosis and consent process consists of: needs eights out or similar.

To be clear, needs eights out or similar

• Is not a history

• Is not a description of the examination

• Is not a diagnosis

• Is not options presented including do nothing and specialist referral, risks and warnings presented including personalised particular risks and considerations (university exams, friends wedding, proximity of IDN, occupation of patient), consent discussed, costs involved, description of procedure, likely post op journey and cooperative requirements from the patient (such as rest, don’t exercise vigorously).

Despite all the lectures we attend and all the articles we read, and the fact that we communicate all this to the patient we, as a profession, are still not good at writing this discussion down.

Then what about assessment of difficulty (not just proximity to vulnerable structures)? This unfortunately is where things go wrong in many instances, and again is low hanging fruit for the dental expert report. Of course it is easy to be clever in hindsight but too often it is difficult to defend a Member’s decision to go ahead themselves, to not warn patients of the difficulty and offer to refer, and secondarily – to push on when the going gets tough with no clear idea of what they are going to do next. If we miss the opportunity to refer a complex case prior to attempting removal, we should not miss the opportunity to refer when the complexity becomes apparent during surgery. Prolonged unsuccessful attempts at tooth removal is in nobody’s best interests. I am sorry if this article sounds dogmatic and prescriptive but Dental Protection is assisting with an increasing number of third molar cases that lack the required recordkeeping, consent and complexity analysis to defend vigorously. Inferior Dental or Lingual Nerve damage harms our patients but it also harms the dentist involved.