Knowing when to ask for help and refer

Fresh out of dental school — I can do anything! Quadrant dentistry — I got this! A molar root canal — no sweat! Crown and bridge — I can do this with my eyes closed! But that third molar distally impacted tooth #17 — ummmm…they didn’t cover that well in my oral surgery class.


With student debt, bills to pay and other financial considerations — this situation certainly puts me in a bit of a pickle! What to do? Do I attempt a procedure that I have little confidence in and just hope for the best? The answer is an undoubted — no! Even if you’ve been instilled a “can-do” spirit and the feeling of invincibility, it is important to recognize the lesson from David Allen, the creator of the personal management method of “Getting Things Done,” that “you can do anything, but not everything.”

During our dental school training, we always had the safety net of working with our professors. They, indeed, assumed a lot of risk in helping us graduate from ivorine teeth to full-fledge enamel, dentin and pulp. However, in the professional world, there is rarely a safety net. There is no proverbial “knight in shining armor” to ride in and help us extract tooth #25. We, dentists, must be fully aware and realistic about our own abilities, as we have to be able to weigh the pros and cons during the treatment planning phase of patient care. Can we really take out tooth #32 without damaging the IAN? Can we find the MB2 canal of #14 easily and readily? And of most importance, with respect to malpractice insurance, can we offer dental treatment by avoiding as many possible subsequent treatment complications and putting our patients at risk?

In my six-year career, I believe I found the answer — it is knowing when and how to refer.

“But doc, [you say], aren’t you going to lose so much productivity as the patient walks out the door?”

Alas, I may not have that $1,200 molar root canal — but knowing my skill set, is it worth the chair time, lost productivity with other patients, loss of patient’s trust and care (negative word of mouth is never a practice builder) and especially, if a file were to break in the canal, would it be worth the possible lawsuit for both time and money? I think not!

Unfortunately, some of these situations have happened to me personally — as with all dentists. These days, I head off these potential headaches by referring from the start. It must be made clear to all dentists that knowing your own personal limits is not a sign of weakness, but rather an innate strength that comes with experience. It is OK to refer to an oral surgeon when the tooth is impacted. It is okay to refer to the endodontist when the distal canal is too calcified. Plus, it does not hurt that the patient will have the procedure done effectively and efficiently, resulting in a nice easier post and core with a crown that presents much less risk.

Taking the COVID-19 pandemic into consideration, we are all working together to help promote proper oral health care through our own professional networks. Remember, it is not a failure to admit the challenges of extracting that distally impacted #17. It is a failure, however, to attempt something you know will not end well for either the patient or for you. As the adage states, “No man is an island entire of itself. Every man is a piece of the continent.”

Dr. Amir Kazim was born in Toronto, Ontario, Canada. He completed his DDS at Howard University in 2014 and an Advanced Education in General Dentistry Program in the subsequent year at Yakima Valley Farm Workers Clinic in Spokane. During his time in Washington State, Dr. Kazim took on roles in many varying capacities such as working in Federally Qualified Health Centers, private practice as well as insurance audits and adjunct professor of restorative dentistry. To this end, Dr. Kazim played an integral role in bringing the merits of teledentistry to Washington by being one of the founding members of their established task force. While keeping busy with dental–related issues, Dr. Kazim enjoys traveling and experiencing new cultures and foods. Having recently moved to California, Dr. Kazim is excited to continue his efforts into this exciting new aspect of dentistry. He is a member of the ADA, the California Dental Association and the Harbor Dental Society.

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