Neuropraxia

A patient brought a claim alleging that a DDU member caused them to suffer neuropraxia during the extraction of their LR7, and either misplaced dental instruments or caused damage to the mucosa.

The scene

A patient attended a DDU member complaining of a throbbing pain associated with the LR7. This tooth had been previously root filled. The member had made the patient aware that the tooth might require extraction, and this was documented in the clinical notes.

When the patient attended the DDU member with pain from the tooth, a radiograph was taken which showed a periapical lesion. The treatment options were discussed and the patient decided to have the tooth extracted.

The DDU member numbed the area with an ID block and sectioned the roots of the LR7, before attempting to elevate them out of the socket. The mesial root was successfully removed, but the tooth was grossly carious and the distal root proved difficult to extract.

The member explained to the patient that the distal root could not be extracted and took a periapical radiograph, before referring the patient to an oral surgeon. The member also gave the usual postoperative instructions.

The patient subsequently attended the specialist and had the retained root removed. They did not return to our member after the initial extraction and neuropraxia was diagnosed by a different dentist, who treated the patient after the specialist extraction.

The claim

The patient subsequently brought a claim, alleging the DDU member caused them to suffer neuropraxia at the time of extraction of the LR7, and either misplaced dental instruments or caused damage to the mucosa. They also alleged that they suffered from prolonged pain and suffering, ongoing pain and discomfort, altered sensation, neuropraxia, upset and distress, and anxiety and loss of confidence in their dental providers.

Responding to the claim on the member's behalf, we sought independent expert opinion in order to investigate the allegations. The expert found that the member had not breached their duty of care and was supportive of their treatment. They believed that although the neuropraxia was unfortunate, it was an unpredictable event that could not have been avoided.

The outcome

On the basis of the supportive expert evidence the DDU served a letter of response denying liability. The response noted that the DDU member followed the standard practice for an extraction and that reasonable skill and care was taken in doing so. It also argued that it was through no fault of the DDU member that the patient unfortunately experienced neuropraxia, and with supportive expert evidence the allegations were denied.

The patient's solicitors did not provide a response for almost three months. When they did, they noted that they had also sought expert advice and that the DDU member was responsible for a persistent tingling sensation on the patient's lip. They made an offer to settle the claim for £2,500.

We reverted to our independent expert for their further opinion. They maintained their position and views that the member used the correct technique and used the skill and care expected of a reasonable competent dentist. We again denied liability, and the patient's solicitors returned a few weeks later to confirm that they were no longer pursuing the claim, and the file was discontinued.

Learning points

It is important that clinicians keep accurate notes, including of the discussions that take place with patients during the process of obtaining valid consent.

However, when an unexpected complication arises, it is also important that the records reflect any subsequent steps taken to manage this. These may include the initial advice or treatment provided, as well as an appropriate referral and the offer to arrange follow-up appointments if necessary.

This guidance was correct at publication 09/09/2019. 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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