Retained root fragment following extraction

The scene

A patient had been a regular attender at a practice for ten years. When he developed a short period of dull, aching pain from his LR6, he was unable to be seen by his regular dentist and instead saw our member, who diagnosed irreversible pulpitis and advised that root canal treatment was necessary.

Our member performed the root canal treatment but the pain did not subside, and the patient returned a few months later when the tooth was extracted.

Unfortunately, the tooth fractured during the extraction and the patient was left with a small fragment of the distal root in the socket. The member planned on leaving the small root fragment as opposed to removing it.

The claim

Six months later the patient instructed a solicitor to complain on his behalf, and a letter of complaint was sent to the practice. The solicitors wanted to know why root canal treatment had taken place and why the tooth needed to be extracted. They also queried why the fragment of root had not been removed and the subsequent dry socket not diagnosed sooner.

Both dentists wrote to the DDU for advice. There was no conflict between the two so the complaint was handled by the same adviser, who helped the members formulate their responses to the patient's solicitor.

Unfortunately, the responses did not stop the patient's instructed solicitor from serving a letter of claim against the dentist who had performed the extraction. This alleged the dentist had failed to tell the patient about the retained root, or how it could be treated or managed, and that if the patient had been made aware of the retained root, he would have opted for its surgical removal. He was also alleged to have experienced severe pain throughout.

Once the letter of claim had been forwarded to the DDU, the claims handler instructed an independent expert to comment on breach of duty and causation. On viewing the records and radiographs, the expert believed there was good reason for the tooth to be root treated, but ultimately that the tooth was un-restorable and did require extraction.

The expert also commented that it was reasonable to leave the small root fragment, due to its size and position.

The outcome

After receiving the supportive report, the claims handler drafted a letter of response with help from the member. This denied liability on behalf of the member, reminding the patient's solicitor that teeth can fracture during extraction, especially those that have been previously root filled.

As the member had told the patient about the retained root and given post-operative instructions, and this was clearly recorded in the patient's clinical records, there was no breach of duty.

This case therefore clearly shows the importance of keeping good notes of the discussions that take place with patients. Interestingly, the root was never surgically removed, so that aspect of the claim was also denied.

Once the letter of response had been served, the patient's solicitors confirmed that he had discontinued the claim, and the matter was closed.

This page was correct at publication on 14/08/2019. 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.