Surgical emphysema during extraction

The scene

A patient attended a DDU member for extraction of a badly decayed lower wisdom tooth. During the procedure the tooth fractured, and the dentist made a buccal incision to gain surgical access and attempted to split the roots. He decided to take a periapical radiograph and used a 3-in-1 syringe to improve the visibility of the extraction site, which was bleeding profusely. Unfortunately, this caused immediate surgical emphysema of the patient's cheek and eye.

The member immediately informed and reassured the patient and accompanied her to hospital, cancelling the rest of his working day to stay with her.

The member immediately informed and reassured the patient and accompanied her to hospital, cancelling the rest of his working day to stay with her. A surgical emphysema was confirmed, and the patient was prescribed antibiotics. The swelling subsided within a week but the patient experienced ongoing discomfort and sensitivity for several weeks.

The hospital advised the patient to wait three months before extraction of the retained roots, which was eventually performed under general anaesthetic.

The claim

The patient made a claim against the dentist, who called the DDU for assistance. The DDU claims handler immediately obtained and examined the complete clinical records, carefully considered the allegations made, and instructed an independent expert to give an opinion on the case.

The expert was of the view that the dentist was in breach of his duty of care by failing to adopt an appropriate extraction technique, and that the use of a 3-in-1 syringe to aid visibility was inappropriate. It was concluded that the dentist was therefore liable for the surgical emphysema, distress, pain and the avoidable need for extraction of the roots under general anaesthetic.

The outcome

In light of the unsupportive expert evidence, the DDU obtained the member's consent to amicably resolve the matter by settlement with no admissions of liability. Our letter of response included an opening offer of £750 but the patient's solicitors rejected this, seeking nearly four times that amount. This was felt to be unjustifiably high, and we spent several months negotiating with the patient's solicitors to reduce the figure. Thanks to the DDU's efforts, the claim was eventually settled for £1,000.

This guidance was correct at publication 16/07/2018. 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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