A patient had not attended her dental practice in 14 years. On examination she was found to have a neglected dentition with numerous missing and broken-down teeth as well as an over-erupted upper right molar. She was advised on oral hygiene with specific instruction regarding the use of appropriate brushes for maintaining the upper right molar region, and asked to attend routine examinations every six months.
More than two years passed before she attended again, now as an emergency appointment with pain in the upper right area, necessitating an extraction. The patient again failed to attend regularly and next contacted the practice some 20 months later, complaining of pain from UR6 and UR7.
The dentist updated the patient's medical history, recording that she was diabetic and that acute back pain made it difficult for her to sit in the dental chair for long. He carried out an examination which revealed that both UR6 and UR7 were tender to percussion. He found the teeth heavily restored with interdental spacing and marked over-eruption of UR6 due to the absence of the opposing teeth.
Unfortunately, the member did not record his working diagnosis in the contemporaneous notes, but did record that the patient 'would like XLA UR67'.
He took a periapical radiograph and asked the patient to return the following day when he extracted UR6 and UR7.
Solicitors acting for the patient subsequently brought a claim alleging that the dentist had not obtained the patient’s valid consent to the extraction of the teeth, as he had not offered the option of preserving UR67 through endodontic treatment and crowns. It was asserted that, if this treatment had been offered, the patient would have undergone root canal treatment as opposed to the traumatic extraction of both the molar teeth. Compensation was sought for the 'unnecessary' loss of the two teeth and anticipated future remedial treatment. Once the DDU had obtained all the relevant clinical records, a GDP expert opinion was sought. The expert did not agree that the periapical radiograph indicated the presence of periapical pathology, and found the limited contemporaneous notes made by the dentist at the key consultation did not describe the nature of the patient’s pain. The expert considered that, whatever the correct diagnosis, it is likely that the teeth were amenable to restoration.
The dentist asserted that he did offer the option of root canal treatment and even though he had not recorded that part of the discussion in the contemporaneous notes, he did specifically record that the patient 'would like XLA UR67'. The expert considered that the patient’s history showed dental disinterest, low dental aspirations and at best , symptomatic attendances in response to complaints of pain. The patient had hitherto shown no interest in even replacing missing anterior teeth and therefore, on the balance of probabilities, at the time of the extractions she did not have an unprecedented desire to preserve her painful UR67.
On the basis of the expert opinion, the DDU denied liability on the member's behalf, maintaining that he did have the informed consent of the patient to extract UR67, even though the clinical notes were not as full as they might have been.
Subsequently the solicitors confirmed that they were no longer instructed to pursue the claim.
This case demonstrates whilst it is possible to draw inferences from the previous history, it is important for a dentist to investigate the nature of the pain being complained of, record a working diagnosis and then specifically note the treatment options discussed with the patient. If the patient's notes, in particular for the key consultation, had been fuller the claimant may have been advised not to bring a case at all.
This page was correct at publication on 01/08/2012. 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.