A bleeding socket after tooth extraction

Dear Editors

I am writing in response to Dr Thomas' rapid response, where he is lamenting the soon-to-be-passing generation of "simpletons" (his phrasing) who were used to manage gum bleeding from teeth extraction, pulled elbow of tots, ingrown toenail (you may call it onychocryptosis or unguis incarnates but it will only be helpful in scrabbles or trivia pursuit - medical edition).

During the course of my orthopaedic training in Australia, I have been asked to see all the conditions Dr Thomas listed: sports injuries, bleeding noses, ingrowing toe nails, boils on bums, and childrens’ ‘pulled elbows, bleeding gums*

* no, not from tooth extraction, but mandible fracture. Why, you may ask? I don't know how the referring doctor seemed to think a fractured jaw should be managed by an orthopod, but then I was also once asked to see a patient with a fractured penis (not a joke): such is the state of medicine in current times.

The reflex "referring on" behaviour is particularly sad considering Prof John Murtagh's (relatively recent) classic text described the practical management of all these conditions. Entitled "General Practice" now in its 6th Edition, it is one of the more helpful and practical books GP trainees in Australia can use to learn and manage what used to be bread and butter primary care conditions.

It is even more distressing if you know that until recently Sports Physicians in Australia are mostly fellows of Royal Australian College of General Practitioners (for purposes of billing with Medicare) with special interests and training in sports conditions; now there is a separate direct pathway to Fellowship of the Australasian College of Sport and Exercise Physicians which allows Medicare billing.

I cannot speak on behalf of my orthopaedic colleagues in Mother England or Down Under, but for myself I am very happy for the competent GP (and even the competent emergency physician) to manage uncomplicated sports injuries, bleeding noses, ingrowing toe nails, boils on bums, and childrens’ ‘pulled elbows, bleeding gums without my involvement.

And on the subject of sports injury, for the record, I consider most acute isolated ATFL ruptures (often found on ultrasound for unknown indication) part of the spectrum of a common condition known as "a bad ankle sprain"; many of which can be appropriately managed non-operatively with RICE therapy with or without physiotherapy over 2-3 months.

(I apologise for misusing this platform for my soapbox stance)

Unless it is an emergency situation such as the patient actively haemorrhaging post-dental extraction, medical professionals should not manage dental problems. Patients often present to their GP in order to avoid their dentist because of dental anxiety or perceived risk of cost; however, this does not mean that GPs are trained or indemnified to provide dental care and care of this kind is not within the sphere of GPs competence. Suggesting otherwise in a '10 minute consultation' is unsafe and risks giving the false impression that GPs ought to be managing this dental problem, and can do so within ten minutes. Any post-operative dental problems should be managed by a dentist, ideally the dental surgeon responsible for the operation.