Case Synopsis: A 25 year old male was referred to an oral surgeon for the removal of four impacted wisdom teeth and an extra (supernumerary) wisdom tooth on the lower right side. A panoramic radiograph was taken at the general dentist’s office and sent with the patient to the oral surgeon. The radiograph was not labeled right and left. The oral surgeon used the unlabeled radiograph and proceeded to extract the wisdom teeth including the extra tooth. The oral surgeon, as a result of the unlabeled radiograph, thought that the extra tooth was on the left side of the lower jaw. After exploring this area and finding no tooth the surgeon proceeded to the right side and removed the lower right wisdom tooth as well as the extra or supernumerary tooth. Unfortunately the surgical exploration on the left side damaged the inferior alveolar nerve that supplies the teeth, gums and lip on the lower left jaw resulting in permanent paresthesia (numbness).
Expert Analysis: Failure to appropriately label radiographs can lead to extracting or restoring the wrong tooth or teeth. The oral surgeon should never have performed the surgical procedure unless he could determine accurately which side contained the extra tooth. To make matters worse the patient had no fillings (restorations) which could have helped the surgeon determine right from left.
Conclusion: Both the referring general dentist and the oral surgeon should have ensured that the panoramic radiograph was appropriately labeled right and left. The oral surgeon assumes the majority of the responsibility because he was directly responsible for the damaged nerve and resultant permanent paresthesia.