A disputed extraction - Dental case study

DAY ONE

Mrs S attends her dentist, Mr G, complaining of considerable pain in her upper left 6 molar. Mr G examines the tooth and diagnoses an infection, advising that the tooth will likely need to be extracted but that antibiotics should first be prescribed to clear the infection.

DAY TEN

Mrs S returns to Mr G with continuing pain in her UL6. Mr G prescribes a further course of antibiotics and advises a hot salt water mouthwash. He schedules a follow-up appointment for the following week.

DAY FOURTEEN

The pain in UL6 worsens but when Mrs S attends her practice she finds it is closed. She knows there is another dental practice nearby and attends there, requesting an emergency appointment. She sees Mr R and tells him she is in a lot of pain, but fails to mention the treatment she has recently received from Mr G. Mr R examines the tooth and recommends immediate extraction. He administers anaesthetic and asks Mrs S to wait for it to take effect. When she returns, Mr R removes the tooth, but not without some trouble as the molar fractures half-way through. He eventually completes the extraction and Mrs S is sent home with post-operative instructions on how to minimise complications and aid healing.

LATER THAT DAY

The pain worsens and Mrs S experiences some bleeding. She seeks treatment at her local dental hospital where small fragments of bone are removed from the socket. She states that she is unhappy with the care provided by Mr R.

ONE year later Mr R receives a letter of claim from solicitors representing Mrs S. It alleges that Mr R’s treatment was negligent in that he failed to carry out any investigation (i.e. radiographs or vitality testing) to determine the cause of the pain. It is claimed he also did not sufficiently examine the tooth to see if alternative treatment options were available and failed to sufficiently numb her mouth before extraction. Bone fragments were left in the socket, a flap of skin was left loose next to the extraction site and the patient was sent home while still bleeding heavily. Because of the lack of investigation, it is alleged the extraction was carried out without informed consent.

Mrs S is seeking damages for avoidable pain and suffering and claims she would have chosen an alternative treatment had it been offered.

MDDUS advisers and solicitors review the claim and commission an expert report. Having consulted dental records from Mr G, Mr R and the dental hospital, the expert is largely supportive of Mr R’s treatment, although his record keeping is poor. The expert believes the extraction was most likely justified as both Mr G and Mr R agreed that it was indicated. In light of this, the expert believes consent was informed.

However, there is no note showing the extent to which Mr R examined the tooth and whether he had discussed other treatment options with Mrs S.

The dental hospital notes support the claim that bone fragments were left in the socket, but not that there was heavy bleeding, nor a loose flap of skin following Mr R’s extraction. Mr R refutes the claim that the patient’s mouth was not sufficiently numbed and states that she would only have been sent home once the bleeding had stopped. He said the patient had made no mention of wanting to save the tooth and seemed happy to proceed with extraction. However, there are no notes to support this.

While the extraction did appear to be justified, due to Mr R’s poor record keeping and apparent lack of investigation, MDDUS believes the case could be difficult to defend in court. The matter is closed with a small settlement.

Key points

• Ensure full and contemporaneous records are kept of the treatment given and of discussions with patients.
• Consider all alternative treatment options and discuss these with patients to ensure consent is valid.