A patient attended her dentist complaining of pain in one of her upper left teeth. On examination, the UL6 was noted to have irreversible pulpitis, and a periapical x-ray showed some evidence of apical periodontitis. The treatment plan recommended root canal treatment or extraction. The patient elected to have the extraction. After administering appropriate local anaesthesia, the dentist found he was unable to achieve any movement of the tooth on applying forceps. He asked for assistance from a colleague. His colleague also had difficulty moving the tooth until the crown fractured off in the forceps. The roots were then separated with the use of a high-speed dental drill and each root was elevated separately.
The palatal and disto-buccal roots were successfully removed, but the mesio-buccal root was apparently displaced upwards when the dentists tried to remove it using root forceps. Post-operative OPG and PA radiographs were taken and although neither dentist could identify whether the missing root had been displaced into the maxillary sinus, they were aware that this was a possibility.
Following the extraction an opening was noted into the maxillary sinus. The dentist applied a dressing to the socket, sutured it and asked the patient to avoid blowing her nose. He gave her a prescription for an antibiotic. Copies of the post-operative radiography were sent to the local hospital, along with a referral letter, marked urgent. The letter was sent first class on the day of extraction.
The following week, the patient was seen by another dentist in the same practice, who reviewed the socket and removed the sutures. No abnormality was noted at that time. The patient contended that she had been told to await an appointment from the hospital, but that as none was forthcoming she telephoned the hospital to ask about her referral and when she could reasonably expect an appointment. The patient further contended that she was told by the hospital that they had no record of her referral letter or radiograph having been sent. There was no record of her call in the hospital notes.
Six weeks after attending the third dentist (during which period the patient also attended her GP, who recorded an infected nasal sinus and prescribed antibiotics), the patient re-attended the dental surgery, explaining her continuing symptoms of pain, bad taste and foul odour. It was recorded that the patient’s antral lining was ‘very prolapsed’ and the patient reported pus leaking from around this area.
The practice principal was consulted about the patient’s problem and personally telephoned the hospital and spoke to a consultant oral and maxillo-facial surgeon, who requested a faxed copy of the initial letter, which was sent that day. The patient’s care was provided by the hospital thereafter. Several months after the hospital assumed control of the patient’s care, the patient brought a claim against the dentist. The allegations included failure to obtain valid consent to the extraction of the UL6 on the basis that the significant risk of creating an oro-antral fistula and root displacement into the maxillary sinus during the procedure was not explained. Furthermore, there was an alleged failure to offer the patient the option of a referral to a specialist oral surgeon for the operation. A further major allegation was a failure to use reasonable care and skill in relation to the extraction in that the dentist should have used an atraumatic transalveolar surgical approach, rather than extraction forceps and elevators.
The patient claimed more than £2,500 for past and future expenses, including an implant at the site of the extraction. The DDU claims handler obtained a factual report from the member. The patient was then asked to attend an examination by an independent maxillo-facial surgeon, who provided an expert opinion on the claimant’s condition and prognosis, as well as on the liability of the member.
The expert considered that the treatment provided by the member was entirely appropriate and that all the allegations could be refuted. He further considered that the hospital had dealt with the dentist’s instruction in an inappropriate fashion in designating the referral ‘routine’.
On the basis of the expert report and after discussion with the member, the DDU sent a letter of response to the claimant’s solicitors denying liability and refuting all the allegations. Nothing further was heard from the claimant’s solicitor for 14 months. The time lapse meant the claim became statute-barred; the claim had been successfully defended.
This page was correct at publication on 01/08/2010. 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.