RCT hazard

The patient complained of pain in the lower right first molar. On examination the dentist found the tooth tender to percussion with clinical and radiographic signs of acute periapical abscess. The dentist prescribed antibiotics and another appointment was made to carry out root canal therapy.

At the next appointment the pulp was extirpated and root canal therapy begun. During this procedure the first endodontic file placed in the tooth became loose and the patient swallowed it before it could be retrieved. The dentist explained the situation to the patient and offered to arrange for him to attend the A&E department of his local hospital. The patient appeared unconcerned and refused further assistance.

The dentist telephoned the patient at home later that evening and he reported slight discomfort and feelings of nausea. The dentist urged him to seek medical advice and reiterated his offer to make arrangements for the patient to attend hospital. Again, the patient refused.

The following afternoon the dentist received a telephone call from the A&E department at the local hospital seeking confirmation of what the patient had ingested. Radiographs showed that the ingested file had passed into the intestine. The patient discharged himself and re-presented the following day for further examination by radiograph.

Negligence alleged

The patient alleged that owing to negligent treatment on the part of the dentist he had swallowed a metal object. This resulted in him having to attend hospital, take a day off work and return to hospital. Despite having suffered no injury, the patient claimed to have experienced significant trauma.


The DDU adviser felt that the dentist might be vulnerable to criticism as it could not be established whether either a rubber dam had been applied to the tooth, or the file had been attached to a piece of floss or a parachute clip. In the light of this concern, the dentist agreed to an out-of-court settlement of £1000 without liability, which was accepted by the patient.

This page was correct at publication on 02/05/2002. 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.