The dentist who was the subject of the claim correctly advised the patient to have the lower right third molar tooth removed, as it had been the cause of symptoms for some ten months. The tooth was removed under local analgesia and on review three weeks later, the dentist noted that the socket was healing satisfactorily.

Four months after the extraction the patient returned to another dentist at the same practice complaining of pain, swelling and bad taste from the lower right quadrant. On clinical examination a bony spicule/tooth fragment was found, and a radiograph of the area showed a retained root. The second dentist referred the patient to the local hospital, and in the referral letter made the understandable assumption that the remnant of the root showing on the radiograph was that of the third molar tooth previously extracted by his colleague.

Arrangements were made by the hospital for surgical removal of the retained root, and the discharge summary letter described that a root fragment of the lower right third molar had been removed.

Negligence alleged

The patient claimed that she had complained of a fragment remaining when she had returned to the dentist who had performed the removal of the wisdom tooth three weeks after the procedure, and that he had carried out a cursory examination before reassuring her. The patient alleged that she had continued to endure discomfort on a daily basis from then until the root was removed at the hospital some nine months later. It was contended the dentist who had removed the wisdom tooth had failed to perform an adequate examination, and this had led to unnecessary and protracted pain and suffering.

Investigation

The dentist who performed the extraction was adamant that at the review visit following the extraction the clinical appearance was of a normal healing socket, the whole of the lower right third molar had been removed, and that the retained root must have been the remnant of an adjacent molar tooth extracted years before. However, he had not taken a preoperative radiograph of the tooth, and the limited previous dental records available did not assist.

The DDU sought an expert opinion based on the records that were available. The expert stated that if a retained root is to cause problems following an extraction, usually it will do so by preventing the healing of the socket, and symptoms will be reported rather sooner than 4 months after the extraction. The expert further advised that if there was a pre-existing retained root in the position of the adjacent second molar teeth, it may have become uncovered with recession of the gingiva and bone tissue around the third molar region following the extraction of that tooth. The expert felt that this was a much more likely explanation, particularly given that the position of the retained fragment corresponded with the position of the second molar tooth rather than the third molar.

The outcome

With the agreement of the dentist who removed the wisdom tooth, the DDU issued a firm denial of liability to the solicitors acting for the patient, accompanied by disclosure of the expert report. The solicitors later confirmed that their client would not be pursing the claim.

Risk management

While it is not an absolute requirement to take a preoperative radiograph prior to any extraction, in this case and with hindsight it would have been beneficial.

Retained root

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