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28 February 2007
Ian McLaren, DDU lead claims handler
The dentist advised that extraction was the only viable treatment for this tooth and an appointment was made for two weeks later.
On the morning of that appointment, the patient cancelled but then three days later telephoned asking to be seen as he was now in severe pain.
The dentist saw the patient as an emergency that afternoon. The UL6 was very tender to percussion and the patient did indeed have severe pain in that area. The patient did not like injections and the dentist therefore proposed to extract UL6 and at the same time provide a filling for the adjacent UL5 while the area was anaesthetised. The patient agreed to this.
The extraction of UL6 was difficult due to the extensive breakdown of the tooth but the dentist was confident that he had removed the entire tooth. The socket was packed to achieve haemostasis and the patient given post extraction instructions, including hot saltwater mouthwashes for one week. The cavity in UL5 was restored at the same visit.
Four days later the patient again attended the surgery without an appointment and sought urgent attention as he was experiencing pain. On examination, the dentist noted an inflamed socket with exposed bone. Antibiotics were prescribed and the patient reminded of the importance of the mouthwash regime. An appointment was made for review a week later but the patient instead chose to attend the casualty department of the local hospital three days later. The notes of the oral and maxillofacial house officer referred to a healing socket but suggested that a radiograph taken at that attendance showed a retained root. Arrangements were made for further exploration of this; a week later the patient attended another dentist, although no complaints about UL6 were recorded in that dentist’s records.
When the patient did attend the hospital again the following month, the UL6 area was fully explored under local anaesthetic. No root was found but bony spicules were removed.
19 months later, solicitors acting for the patient began pursuing a claim for compensation. They alleged that there was no justification for the extraction of UL6, that a radiograph should have been taken prior to extraction, and that the procedure itself had caused unnecessary trauma. It was said that the patient had reported after the extraction that he could feel a fragment of tooth remaining and that the pain had continued to get worse since the extraction. Reference was made to the hospital records and that the extracting dentist should have recognised that a root had been left behind. Finally it was alleged that the extracting dentist should have referred the patient directly to hospital immediately following the extraction or at the attendance four days later.
Copies of the records of the hospital and the subsequent dentist were obtained. Unfortunately the radiographs taken at the hospital could not be located.
Clinical advice obtained by the DDU was that the records of the extracting dentist might not be considered sufficiently comprehensive and it would have been advisable for a radiograph of UL6 to be obtained prior to recommending that the tooth be extracted.
However, it was strongly arguable that a radiograph is only an aid to diagnosis and the notes demonstrated that the dentist was clearly willing to restore teeth where possible, because he had charted seven cavities for restoration and restored UL5 at the same time as carrying out the extraction. UR6 and LL6 had both been lost previously and the extracting dentist had asserted that UL6 was so broken down as to make extraction the only viable option.
The loss of the hospital radiographs was not material, as the record of the exploration subsequently undertaken at the hospital confirmed that no root fragment was retained. As no retained root was found, it could not have been present four days after the extraction.
The DDU drafted a full reply to the claim. It was not accepted that UL6 was, on the balance of probabilities, restorable or that the patient would have chosen restoration instead of extraction, especially as he was clearly in pain when seeking emergency treatment on the day of the extraction.
The hospital records showed that the initial impression of a retained root had not been borne out by the physical exploration, and it was contended that it was most likely that the bony spicules identified at that time were whatthe patient could feel. It was further contended that the presence of bony spicules did not indicate a lack of appropriate care by the extracting dentist.
Finally, it was not accepted that the dentist should have referred the patient to hospital because of his complaints of pain on the day of the extraction, or four days later. The dentist had correctly identified an infected socket and provided appropriate management for this recognised complication.
With the agreement of the member, the reply to the claim, denying all liability, was sent to the claimant’s solicitors. After seeking further advice and instructions, the solicitors subsequently confirmed that they were not pursuing the matter further.
This guidance was correct at publication 28/02/2007. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
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