EXTRACTING TEETH IS still a significant part of the job of a dentist.

When I qualified as a dentist in 1982, I joined the practice in Rainham (Kent) run by Julian U. He was a generally competent dentist and very skilful when it came to extracting teeth. If, as it happened from time to time, I was having difficulty removing a tooth, he would come into my surgery to apply his skill and experience to the problem at hand. Whenever he did this, he would work on the offending tooth, but would stop when he knew I would be able to complete the operation.

Julian could have easily finished the job himself, but he left it to me to do this for a good reason. He knew that if I removed the tooth, the patient would believe that it was my skill that contributed to the successful conclusion of the operation and therefore would not lose confidence in me.

Later in the day, after the patient had left, Julian would explain to me why I  had had difficulties and how to avoid repeating the problem. He was a great mentor as I began my career in dentistry.

The NHS used to pay a standard fee for an extraction. If an extraction proved to be particularly difficult, involving bone removal for example, the practitioner could write to the NHS explaining why the operation was not simple and enclosing a radiograph (xray image) of the tooth in question. In these cases, the NHS used to pay a larger fee than the standard one.

On one occasion when I had not taken a radiograph prior to an extraction because I  had assumed it would be simple, the operation proved to be very difficult. After completing it, I  applied for the supplementary fee but did not receive it because I  had not submitted a preoperative radiograph.  I was furious not only because I had not been adequately remunerated for my effort but also because my word had been doubted.

Some months later,  a distressed couple brought their infant to my surgery. The child had chewed on a keyring and it had got stuck between two teeth. Carefully, I cut through the ring and thereby removed it from the kid’s teeth.

Still smarting from my failure to convince the NHS that my extraction of a few months earlier was truly difficult, I  wrote up my keyring removal and applied for a fee for this unusual procedure.  I explained that neither had I taken a radiograph (because it was unnecessary) nor was I  able to send them any evidence, such as the remains of the keyring because the parents had wanted to keep them. I waited patiently for the NHS to reply, which they did. To my great surprise,  they believed my story without me sending any evidence and paid me a decent fee. Nowadays, it would be unwise to perform any extraction without having taken a preoperative radiograph. This is not for the purposes of seeking enhanced remuneration but to protect the practitioner should the patient decide to make a complaint against the dentist. Sad to say, but by the time I retired, preventive dentistry acquired a new meaning. In addition to preventing dental disease in patients, it has also come to mean preventing the dentist from litigation and defending him or her when malpractice is alleged.