14 • Case Study


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TREATMENT Mea culpa


DAY ONE A 57-year-old patient – Ms T – attends her local dental surgery complaining of pain in UL7. Dr M examines the tooth and takes a radiograph which shows significant decay encroaching on the pulp. Dr M discusses all treatment options with the patient including root canal treatment, subsequent crowning or extraction. Ms T opts to have the tooth extracted. She suffers from dental phobia and agrees to referral to a private dental clinic for extraction under sedation.


DAY SEVEN Ms T attends the clinic for a sedation assessment. The dentist charts the tooth needing extraction and confirms UL7. The radiograph sent by the referring GDP is reviewed and an appointment is made for the next week.


DAY 30 Ms T returns to Dr M who then refers her to the local dental hospital for extraction of UL7 under general anaesthetic, as Ms T is too distressed to have the extraction carried out under conscious sedation.


NEXT DAY That morning Ms T returns to reception claiming that Dr P has removed the wrong tooth. The patient had not noticed until the LA had worn off later at home and she is now very distressed. Dr P calls her back into the consulting room and checks the original referral. There she discovers that UL6 had been removed some years ago and the gap had closed. This has led to the mistaken identification and extraction of UL8. Dr P acknowledges her error to Ms T and apologises.


DAY 10 Another dentist – Dr P – carries out the extraction. She goes through the medical history provided by Ms T and explains the procedure to be undertaken with input from the dentist providing the sedation. IV sedation is started following recognised protocol, and Dr P administers local anaesthetic. The dentist then extracts the seventh tooth back from the midline in the upper left quadrant. The procedure is uneventful and Ms T is given a swab to bite down and haemostasis is achieved. The patient is escorted to the recovery room and post- operative instructions are provided to her partner who is there to take her home.


A


LETTER of claim is sent to Dr P alleging clinical negligence in her treatment of Ms T. This included a failure to accurately


chart the upper left quadrant, leading to wrong-site extraction. The dentist also did not carefully reassess the radiograph which clearly demonstrated no treatment was required at UL8 and that UL7 exhibited obvious decay and required extraction. The letter also claims that Dr P failed prior


to sedation to double-check with Ms T the tooth requiring extraction.


In regard to causation (consequences of the


breach of duty of care), the letter claims that the operative error has now left a two-unit gap in the upper left quadrant. This has made it difficult for Ms T to eat properly. She also endured unnecessary infection and pain in UL7 prior to later extraction, and the experience has exacerbated her dental phobia, leading to anxiety and depression at the prospect of future treatment. MDDUS drafts a letter of response in


agreement with the member admitting liability.


A modest settlement is negotiated and the case is closed.


Key points • Ensure charting is correct and review notes to ensure nothing is missed.


• Be sure to double-check with patients their understanding of any teeth to be extracted to ensure valid consent.


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