A dentist examined a patient who had a soft-tissue swelling in his lower jaw. Following an examination, he concluded that the swelling was an acute periodontal abscess, and treated the patient with antibiotics and local curettage. The patient's problems did not resolve over the next month, and, eventually the dentist, with the consent of the patient, extracted the offending tooth.
The socket failed to heal, and as soon as the patient presented with paraesthesia as well as pain, the dentist made an urgent referral to the local maxillofacial unit. The patient was seen almost immediately and a biopsy confirmed a non-Hodgkin's lymphoma.
The time between the initial consultation with the dentist and the subsequent biopsy was less than six weeks, but this did not prevent the patient's lawyer from writing to the dentist alleging negligence.
An expert witness was instructed and advised that this was an extremely rare tumour and that the dentist had acted properly, bearing in mind he was not a specialist. The expert felt that it was reasonable to treat the swelling as an abscess initially, but as soon as it became clear that this was not the diagnosis, a referral was properly made. Therefore there had been no breach of a duty of care and liability was denied on behalf of the dentist. This case was successfully defended, with the help of good records, which documented the presenting condition, diagnosis and treatment at each stage.
It is impossible to stop unusual situations arising; however a prompt referral and careful records can help prevent an unusually large claim from arising as a result.