Section 7Dental Dilemmas
An anxious patient The outcome
A man in his thirties presented for his first The DDU claims handler sought a copy of the clinical
consultation at a new dentist with very poor and records from the dental access clinic and the hospital.
neglected teeth. Following his examination, the Based on these, a DDU dento-legal adviser, expressed the
dentist explained to the patient the poor prognosis view that the dentist’s actions were appropriate, given
of many of his teeth and discussed the treatment the clinical presentations over the relevant five-month
options, depending on whether he wanted to try period. With the member’s approval, a response was sent
and save some teeth or have them extracted. to the solicitors denying liability. When this response was
The patient expressed a wish to have all the treatment
not accepted, the DDU asked a general dental practitioner
carried out in one appointment to ‘get it over with’ but
expert for an opinion.
also indicated he was anxious about the prospect of such The expert considered that the patient had neglected his
extensive work. The dentist suggested sedation, but dental health and this had led to numerous teeth
explained that he did not provide this at his own practice becoming grossly decayed. The radiographs indicated
and the patient would require a referral. It was left to that extraction of teeth was a wholly appropriate form
the patient to decide how he wanted to proceed. of treatment. The records showed that the patient was
The patient returned to see the dentist approximately
anxious with regard to receiving dental treatment. It was
two months later. He was complaining of pain associated
also clearly noted that the patient had acute pain
with his UL6 and antibiotics were prescribed. The patient
associated with his carious LL5 and/or UL6 at the time of
asked to be referred to the local hospital for treatment.
the second consultation and at the subsequent
A letter of referral was sent the following day.
consultations with our member.
Two weeks later, the patient returned complaining of
The expert considered that there was no evidence to
pain associated with his LL5. It was recorded that there
suggest that the dentist had failed in his duty of care to
was no swelling apparent. Antibiotics were prescribed,
the patient. The record keeping was satisfactory and
and it was again recorded that the patient requested
indicated that when the dentist initially saw the patient
treatment to be carried out in one go.
he had no complaints regarding pain or other symptoms.
While it may have been possible to carry out a routine
The next day, the patient visited a dental access centre in extraction of LL5 and the other teeth requiring extraction
the area because he had a swelling in the lower left under local anaesthetic, the expert accepted this would
quadrant of his mouth. The swelling was incised to drain have taken numerous appointments and would probably
and he was referred to a hospital where this procedure have been inappropriate for an anxious patient.
was repeated.
Additionally, the expert considered that, while it may
The patient had no further trouble until six weeks later have been possible to initiate root canal treatment for
when he again attended the practice with pain and the patient’s LL5 at the third consultation, on the basis
swelling associated with his LL5. On this occasion, the that the dentist had already referred the patient to the
dentist incised the swelling to drain the infection and hospital for extractions, it was appropriate to treat the
prescribed another course of antibiotics. developing infection with antibiotics. The fact that the
antibiotics failed to control the infection, resulting in the
Soon afterwards the dentist received a letter from the
jaw becoming swollen and painful, was unfortunate but
patient’s solicitors claiming £1,500. This was for increased
was not the fault of the dentist.
pain and suffering due to delays in treatment. It was
alleged that the delays caused the extractions to become Finally, the expert pointed out that the dentist who
more difficult. The patient claimed that the LL5 was treated the patient at the hospital approximately ten
causing problems at the first consultation and that it weeks after the initial consultation decided not to extract
would have been reasonable to extract that tooth in LL5 in spite of the fact that she administered local
isolation. His solicitors alleged that if extraction of LL5 anaesthetic. Indeed, the tooth was still present by the
was not considered appropriate, then there should have time of examination by the claimant’s expert some two
been a referral at the time of the initial consultation. months after the patient’s final visit to the dentist. This
suggested there was no urgency to carry out the
extraction.
The DDU drafted a detailed letter of response to the
claimant’s solicitors, once again denying liability and
setting out the expert’s opinion, and in the light of this
letter the patient’s solicitors agreed to discontinue their
claim.
“…it was appropriate to treat the developing infection with antibiotics. ”
39
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