The patient visited her dentist complaining of pain in the upper left quadrant. The dentist examined her and obtained an OPG radiograph. This showed the occlusal surface of the crown of the upper left third molar protruding behind the level of the bone and covered only in soft tissue. There was a relatively thin layer of bone separating the roots of the impacted molar from the cavity of the maxillary sinus. The dentist advised the patient that the tooth needed to be extracted. He prescribed amoxcillin and referred her to the local general anaesthetic clinic, enclosing the radiograph.
A month later the patient attended the general anaesthetic clinic for surgery. The anaesthetic was given via a nasal mask but once the procedure was underway there were difficulties in maintaining a satisfactory airway. The anaesthetist decided to switch to a laryngeal mask to secure the airway. The operative site was packed with gauze while the airway was changed. On removal of the pack, the dental surgeon realised that the third molar had been displaced from the socket and could no longer be seen. He abandoned the procedure.
The patient was given an intravenous injection of ampicillin to guard against infection and a full explanation of what had happened. A postoperative radiograph was taken to confirm the position of the displaced tooth but this was inconclusive. The dental surgeon advised the patient that the best course of action was to wait and see whether she had any problems.
Over the next few months the patient visited her GP several times complaining of tonsillitis, sore throats and sinus problems. She did not tell the GP about the problem with the third molar.
At a routine dental appointment a further radiograph was taken. This showed the upper left third molar in an aberrant position within the maxilla. The dentist immediately referred her to a consultant oral and maxillofacial surgeon. He noted that the radiograph showed the upper left third molar in the antrum. Further radiography of the maxillary sinuses showed the left sinus was opaque with infection. A course of amoxicillin and nose drops were prescribed. The patient was admitted for exploration of the left maxillary sinus and a Caldwell-Luc procedure was undertaken to remove the tooth. The patient recovered well but continued to complain of residual pain and numbness of the left side of her face.
Negligence alleged
The patient alleged that the dental surgeon negligently pushed the UL8 into the antrum and then failed to advise her of the situation or refer her for further treatment and that as a result she suffered chronic sinus infection for several months.
Expert opinion
The DDU approached an expert witness who felt that the dental surgeon was vulnerable to criticism for failing to refer the patient to have the misplaced tooth removed immediately. In his opinion: "Foreign bodies such as teeth or roots of teeth which are free within the sinus cavity virtually always cause symptoms in this way and therefore need to be removed. In my opinion it was not a sensible treatment option to wait and see whether this tooth caused problems."
Outcome
With the dentist's agreement the patient accepted an out-of-court settlement of £5,050, plus costs.
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