No endodontic referral - The DDU
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No endodontic referral

22 May 2017

During almost 20 years' attendance at his dental practice, a 60-year old patient had received a number of treatments, including fillings and crowns. He had also received consultations for periodontal care and root canal treatment.

On one occasion, the patient attended for a crown to be fitted at UR5. The dentist did not take a radiograph, but noted a deep periodontal pocket associated with UR5, and that the tooth should have root canal treatment if problems developed.

Over the course of several further consultations, the patient continued to complain about pain in the upper right quadrant and the member planned to monitor this but no treatment was provided. A radiograph showed the UR5 had a large periapical area. However, the dentist did not record the results of the radiograph, or provide any advice or treatment at UR5.

The patient moved to another practice where the UR5 was extracted. He later rejoined the dentist's practice.

When the patient re-attended the dentist's practice as an emergency, a periapical radiograph was taken of the UR6 but no detail recorded. A month later the UR6 was root treated without any recording of working length or the root canal procedure and no report of the radiographs taken. The patient was referred for a crown for the UR6.

For several months afterwards, the patient complained of a permanent bad taste in his mouth and viscous saliva. It was noted that there was periapical pathology associated with the UR6 and apicectomy was advised. A radiograph showed interdental bone loss between the UR6 and UR7.

The patient sought a second opinion from another practice, complaining of swelling and pain in the upper right quadrant of his mouth. Examination revealed a discharging sinus visible between the UR6 and UR7.

The patient brought a claim against the dentist, alleging negligence in that he:

  • failed to perform root canal treatment to UR5 at any stage before extraction
  • failed to establish adequate contact between UR6 and UR7 when placing the crown at UR6
  • took no steps to address the gap at UR5 such that UR6 was able to drift mesially, exacerbating the gap between UR6 and UR7
  • failed to record adequate details of examinations and treatment.

The patient contended that but for the alleged breaches of negligence he would not have suffered the avoidable loss of the UR5. With the UR5 in place, the crown at UR6 would have maintained contact with UR7, and would not have drifted mesially. A gap would therefore not have opened up, allowing food-packing causing a continuous bad taste and leading to interdental bone loss at UR6-UR7.

The DDU expert was critical of the dentist's management, including failure to provide appropriate and timely endodontic intervention for the UR5, which could have avoided loss of the tooth. He also criticised the dentist's poorly documented or missing records.

The expert stated that if the UR5 had been in situ then the UR6 would have remained in position. He noted the presence of a perio-endo lesion on the UR6, possibly contributed to by a periodontal pocket on the tooth and poor plaque control, and the UL6 defective crown margins.

With the member's agreement the claim was settled for £9,500 and costs of £19,900.

This guidance was correct at publication on 22/05/2017. 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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