Section 7Dental Dilemmas
The heart of the matter DDU advice
A patient alleged that he developed infective The DDU obtained expert advice from a microbiologist,
endocarditis, requiring emergency heart surgery, who confirmed that the bacterial endocarditis was not
as a result of negligence during a dental causally related to any dental treatment provided by the
procedure. member, because the infecting organism was not of
The patient in question had been born with a congenital
dental origin. In addition, a general dental practitioner
heart defect that had required childhood surgery on his
expert was supportive of the member’s clinical
aortic valve. He alleged that the dentist had carried out a
management, and agreed that antibiotic cover was not
scale and probing of the gums, ‘and other invasive
recommended at that time for the procedures
procedures’ without the necessary antibiotic cover.
undertaken.
The guidance, in widespread use in the UK at the time of Other medical experts instructed by the DDU also
the treatment (the recommendations of a Working Party concluded that the patient’s endocarditis was unrelated
of the British Society for Antimicrobial Chemotherapy), to the dentistry, given the organism that was cultured
advised that dentists should ensure patients who had and confirmed at the hospital, and the time interval
undergone previous valvular surgery should be given between the dental treatment provided by the member
prophylactic antibiotics shortly before undergoing and the hospital admission.
specific dental procedures.
The experts also cast doubt on whether there was any
Some weeks after the dental visit in question, the patient proven causal link between dental treatment and
had attended the Accident and Emergency department infective endocarditis, and whether there was any firm
of his local hospital feeling unwell, but was discharged. evidence antibiotic prophylaxis was effective in
Three days later, he returned and was admitted, at which preventing endocarditis - views now reflected in the
point a diagnosis of infective endocarditis was made. current NICE guidelines on antibiotic prophylaxis
The patient later underwent emergency surgery to (Ref: CG64. Prophylaxis against infective endocarditis,
replace both his aortic and mitral valves. NICE 17.3.08).
The dentist contacted the DDU for assistance explaining In light of the members’ account of the treatment
that only non-invasive dental treatment had been provided, and the supportive expert evidence obtained,
provided to the claimant on the date in question, and a robust defence to the claim was served by the DDU and
thus there was no requirement for antibiotic cover. the patient’s claim against the DDU member was later
dropped.
“…the patient’s endocarditis was
unrelated to the dentistry…”
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