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

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

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.

Useful Articles:

J Oral Maxillofac Surg 2007.  Prevention of Wrong-Site Tooth Extraction. Clinical

Quintessence Int 2010.  Wrong Tooth Extraction.  Root Cause Analysis

BDJ 2014.  Preventing wrong tooth extraction experience in development &
implementation of an outpatient safety checklist
Last Updated 5th December 2014