Erroneous extraction

The scene

A DDU general dental practitioner (GDP) member was visited by a patient complaining of toothache. A bitewing radiograph showed that the UR6 was deeply carious distally, with the cavity margin almost level with the alveolar bone. It also showed the UR7 with a gold restoration and early distal caries.

The DDU member recommended that, following antibiotics, UR6 be extracted, and advised the patient of the options for its replacement following the extraction.

After taking time to consider the options at home, the patient returned for a subsequent appointment and the DDU member extracted the UR7. It wasn't until later that the patient noticed the tooth causing him pain was still in his mouth. He immediately phoned the practice and was asked to return the same day.

Back at the practice, the DDU member confirmed that the UR7 had been mistakenly extracted instead of UR6.

It wasn't until later that the patient noticed the tooth causing him pain was still in his mouth.

The member dressed the UR6 with Ledermix dental paste and glass ionomer cement after the decay was removed, but the patient's pain continued after the appointment, and despite later endodontic treatment by a specialist, the tooth was ultimately lost.

The claim

The patient brought a claim for dental negligence alleging that the DDU member had erroneously extracted the UR7, which would have had a good prognosis, instead of the UR6, which was irreversibly decayed. The patient also claimed for additional damages for pain and swelling at the extraction site, which required antibiotics.

The GDP contacted the DDU for help. In assessing the claim we sought evidence from an independent expert, who found a number of failings in relation to this course of treatment.

The expert stated that on the balance of probabilities, the UR7 would have had a good prognosis and should not have been extracted.

The outcome

On the basis of the unsupportive expert evidence, the GDP agreed with the DDU's suggestion to attempt to settle the claim. The patient's solicitors had originally claimed for the cost of an implant to replace the UR7, but the DDU expert had noted that the patient did not have her LR7, and the UR7 was therefore unopposed and replacing it with an implant would serve no functional purpose. The DDU was thus able to argue that this cost should not be included in the settlement amount.

The claim was eventually settled for £1,500 to compensate the patient for losing the UR7 and undergoing unnecessary procedures on the UR6, although legal costs came to more than double this amount.

Learning points

Before any clinical procedure, and especially an irreversible one such as an extraction, it is very important to carefully check that the clinical and radiographic presentation confirm the proposed treatment plan. In the case of an extraction, asking the patient to confirm the tooth they believe they are having extracted can also help reduce the risk of an erroneous extraction.

This guidance was correct at publication 16/07/2018. 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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