Reasonable care and skill

A dentist was not liable for the loss of tooth, but did fail to refer the patient

A 50-year old male patient attended as an emergency complaining of pain at the LR7. The tooth had fractured. The dentist, who had been treating the patient for over five years, restored it with a mesio-occlusal amalgam filling.

The tooth remained sensitive and at a routine examination a month later, a fluoride varnish was applied. A periapical radiograph of the LR7 revealed that the filling was deep and that the periodontal ligament was intact. The use of interdental brushes was recommended.

Over the course of the next year the patient returned for a replacement crown at LR6. Once this treatment had been completed he attended complaining of discomfort at LR7. On examination a buccal sinus was noted to be present. Following a course of antibiotics, root canal treatment was started at LR7.

Unfortunately, access to the LR7 was difficult and compounded by a fracture to the lingual cusp of the tooth shortly after the first stage of RCT had been completed. By the time successful working length measurements of the mesial and distal canals had been taken almost four months had passed with nine visits to the dentist.

The patient became unhappy with the length of time the treatment was taking and sought treatment elsewhere. His new dentist referred him to an oral surgeon for extraction of the LR7.

The patient instructed solicitors to pursue a claim against the first dentist for failing to perform root canal treatment of the LR7 when it had first fractured. Based on radiographic evidence, it was alleged the dentist had placed the mesio-occlusal amalgam filling into the pulp chamber. It was also alleged that once he had started RCT, he had then failed to use reasonable care and skill or consider a referral to an endodontist. It was claimed the dentist was responsible for the loss of the LR7 and its replacement by way of an implant-retained crown.

The independent expert instructed by the DDU examined the tooth together with photographs and radiographs and found that the LR7 would in fact have been amenable to root canal treatment at the time of extraction. However, given the difficulties the claimant had experienced, it may have been that he had decided to opt for extraction by then.

The expert found that while on the initial radiograph it did appear the amalgam restoration was in contact with the pulp chamber, it could not be inferred from a two-dimensional image that the filling actually contacted the nerve. He confirmed that the dentist did not cause any damage to the tooth during the initial root canal treatment, did not give up on the patient and may well have succeeded in saving the tooth in time.

The DDU expert did find, however, that the dentist had not referred or offered to refer the claimant to an endodontist at an appropriate time.

Liability for loss of the tooth was therefore formally denied, but a compromise of £1,500 compensation was offered in view of the failure to refer. Legal costs amounted to £7,000.

Samuel Hedges
Lead claims handler

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