A DDU GDP member had been treating a patient for over 10 years, although the patient also attended a dentist in New Zealand, where she spent several months of the year.
When the patient attended the member’s practice for the first time in nearly two years, she complained of tenderness in the LL7 molar. The dentist took a periapical radiograph and tested to find that the nerve of the tooth was vital. The patient was not in any particular pain at the time and the dentist considered that the most likely cause of the tenderness was trauma.
Five months after the initial consultation in the UK, the patient attended a dentist in New Zealand who recorded in the patient’s history that the LL7 had been bothering her for several months but more so in the last four weeks. The dentist found the tooth was mobile and that behind the tooth was a fluctuant swelling. An OPG radiograph showed a significant monolocular lucency associated with LL7. The patient was referred to an oral maxillo-facial surgeon who removed LL7 and the buried third molar behind it. The associated lesion was diagnosed as a dentigerous cyst. The patient sought compensation from our member, alleging that he should have identified the cyst at the consultation five months before, enabling the patient to have NHS treatment in the UK. The patient asserted that the failure to do this had led to five months of unnecessary pain and suffering and then having to pay for private treatment in New Zealand.
The member sought the assistance of the DDU and submitted his original clinical records. The DDU obtained clinical records from the dentist in New Zealand and sought an independent opinion from a GDP expert witness. That expert confirmed that the original radiograph taken by the member was of very high quality and showed LL7 with a good area of tissue around the tooth. A large proportion of the buried third molar tooth could be seen behind and below the LL7. The mandibular bone around LL7 was clearly depicted.
In the opinion of the expert, the most common radiographic appearance of a dentigerous cyst features a clearly delineated margin, and the appearance of the lesion on the OPG taken in New Zealand five months later did show this. However, this feature was not present in the periapical film taken by the DDU member. Consequently, the DDU expert considered that there were no clear features on that periapical film which should prompt further investigation or imaging.
The DDU provided a detailed letter of response in which it was accepted that, given the nature of the ensuing surgery, it is likely that there was a degree of pathology associated with the buried third molar tooth. However, even if that pathology could have been found at the first consultation, it was not accepted that the dentist’s management of the patient was below the standard expected of a reasonable practitioner and therefore we denied any liability on the part of our member.
The claimant accepted the explanation and did not pursue the claim further.
This page was correct at publication on 01/08/2010. Any guidance 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.