Case history

A young woman, who had an irregular record of dental attendance, attended the NHS emergency dental service at her local dental practice complaining of pain around a lower premolar crown.

After clinical and radiographic assessment the dentist, a DDU member, advised her that the painful tooth was potentially restorable following root canal treatment (RCT), and explained that she would need to attend another dentist for completion of this treatment. The dentist offered the alternative option of an immediate extraction, and, following consideration of these options, the patient decided on extraction.

During the extraction under local analgesia, the crown fractured off the tooth. While the dentist was attempting to loosen the root using a dental elevator, the elevator slipped and punctured the soft tissue of the gum.

The dentist offered an immediate apology, explained what had happened and showed the patient the site of the injury. After a suitable pause he completed the extraction without further problem using a surgical approach.

Two days later the patient telephoned complaining that her lower lip on the side of the extraction was still numb. The dentist invited the patient in for an examination, after which he provided further advice regarding the healing of the extraction site.

The dentist reviewed the patient on three more occasions during the following five weeks and each time recorded, with the aid of diagrams, the extent and nature of the patient's persisting numbness.

The claim

The patient failed to attend a three-month follow-up appointment with the dentist. Eight months later the member received a letter of claim from the patient's solicitors seeking compensation in relation to alleged nerve injury.

The patient claimed she was experiencing continued numbness which was causing her difficulties while eating and speaking.

DDU assistance

As part of the investigation of the claim, the DDU claims handler sought an independent expert opinion from a maxillofacial surgeon. The expert considered the relevant clinical records and also examined the patient.

This examination confirmed some persisting numbness on the patient's skin and lower lip in the area of the extraction, although there had been a recent improvement.

The expert's view was that, when the elevator had slipped, its tip had passed over, or very close to, the mental foramen where the mental nerve exits the mandible to supply the lower lip.

The expert considered the member's advice to the patient regarding the initial treatment options to have been appropriate. Given the patient's reluctance to attend for regular dental care, the patient's decision to proceed with extraction was considered appropriate and practical.

However, in terms of the injury suffered by the patient, the expert considered the member to have breached his duty of care by failing to employ a proper degree of skill and attention, so allowing the elevator to slip and injure the soft tissues.

The expert advised that all dentists are duty bound to use appropriate methods, and modify their technique if necessary, to minimise the risk of an instrument slipping. The member's failure to do so in this case was indicative of treatment below an acceptable standard of care.

With the consent of the member, the DDU made an offer of compensation in respect of the patient's pain, suffering and loss of amenity, and the offer was accepted.

Learning points

Take care that all dental instruments are handled in such a way as to minimise the risk of inadvertent damage.
Provide adequate protection of the patient's surrounding soft and hard tissues during all dental procedures.
Modify techniques where necessary in order to ensure the above.
Be aware that inadvertent injuries during treatment may be considered evidence of a lack of proper skill and attention, and thus demonstrate treatment that is below an acceptable standard.

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