Jaw dislocation

A patient brought a claim alleging that a DDU member had failed to appropriately use a mouth clamp during a crown preparation, leading to a dislocation of the jaw and the need for treatment under general anaesthetic to relocate it.

The scene

A patient with a lingually fractured LL6 attended a DDU member, who advised that a crown was needed.

At the crown preparation appointment the member took a periapical radiograph to assess the tooth. They discussed the restoration options with the patient, before agreeing on a gold crown. The DDU member numbed the patient with an ID block and started the crown preparation.

However, around halfway through the preparation the patient experienced a locked jaw and the member noted that a dislocation had occurred on each side. Their attempt to reposition the jaw was unsuccessful, so they attempted to contact the local oral surgery department.

Unfortunately the department was closed, and the member therefore recommended the patient attend A&E and volunteered to accompany them. The clinical notes were therefore completed retrospectively so the member could assist the patient.

The A&E consultant also attempted to reposition the jaw but was unsuccessful too. A radiograph was taken which showed that both the patient's temporo-mandibular joints had dislocated. The patient required treatment under general anaesthetic in order to relocate the jaw.

Around four days later the patient returned to our member, who decided it was best to refer the patient for the completion of the crown at a local maxillofacial unit; as the dislocation had never occurred before, this would provide the best environment if it did so again. The crown preparation was subsequently completed uneventfully at the maxillofacial unit.

The claim

The patient brought a claim against the DDU member almost a year and a half later, alleging that the DDU member failed to appropriately use a mouth clamp and to position it correctly during the crown preparation. The claim also alleged that due to this, the patient suffered the dislocation and the subsequent need for hospital treatment under general anaesthetic. As well as this, the patient claimed for continuing pain and suffering, a clicking in the jaw, a dull ache if opening too wide and distress at the thought of the jaw dislocating again because they believed it was now weakened.

The member turned to the DDU for advice and support in dealing with the claim, and we sought an independent expert opinion in order to investigate the allegations. The expert was supportive of the member's treatment and found that they had not breached their duty of care. It also emerged that the member did not use a clamp during the procedure, so the claim in itself was incorrect.

The outcome

The DDU served our letter of response, informed by the independent expert's opinion and denying liability on behalf of the member. The independent expert produced supportive material, which demonstrated that there are only certain occasions where a dentist would be found to be negligent in causing a bilateral dislocation - these being when the patient has a predisposition to dislocation or if the jaw is left forcibly open by clamps for a prolonged period of time.

This scenario did not meet those criteria. The patient had never experienced a dislocation before and there was no clinical indication that this could be a concern. Also, the DDU member did not use clamps to open the patient's mouth and it was not open for a prolonged period. There was also no evidence or suggestion by the patient that they had been in pain or discomfort while the preparation was carried out.

The DDU held that although it was unfortunate, the situation did not inherently equate to negligence. The procedure was carried out in the way any normal and reasonable dentist would have. Although it is likely that the normal and common dental procedure performed by our member may have caused the jaw dislocation, there was no evidence that the DDU member could or should have anticipated this.

In response the patient's solicitors maintained that the DDU member used a tool to keep the patient's mouth open and that it was continually made wider until the dislocation occurred. However, the DDU member refuted this and confirmed that they had only used a fast handpiece during the procedure.

The DDU therefore advised the patient that there was no evidence to suggest their allegation was correct, as shown by the clinical records. In light of the DDU's robust response, the claim was discontinued with no settlement paid.

Learning points

It is important to keep clear and accurate clinical notes at all times. Before any procedure is undertaken, the risks should be discussed with the patient and this should be documented in the clinical records.

In the case of a dislocation such as this, important notes such as whether a clamp was used or not can offer vital information to the successful defence of the claim.

This guidance was correct at publication 08/10/2019. 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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