A dentist accepted a young male adult patient for treatment and saw him on three separate occasions. He was a dental-phobic patient but regularly ate a diet based around chocolate and fizzy drinks. This had resulted in the premature loss of several teeth and the need for further extractions.
Due to the severity of the patient’s phobia, the dentist decided to refer the patient so that the surgical treatment could be provided under conscious sedation. An assessment was arranged at a referral practice.
Unfortunately, there appeared to be a lack of communication and the patient had assumed they were being referred for a general anaesthetic. After being assessed for treatment under conscious sedation, the treatment was declined due to an excessive BMI and the patient was subsequently referred for a general anaesthetic. The patient was upset about the delayed treatment, but all the same, he returned to the dentist for some restorative care. Local anaesthetic was used and the patient experienced his first ever ID block, which proved to be a slightly uncomfortable experience, and an infiltration so both upper and lower quadrants were anaesthetised.
The dentist had suffered some eye damage the day before this episode so that when the operating lights were switched on; it became obvious that it would be impossible to continue working – her vision had been badly affected.
Rather than risking any harm to the patient, the dentist made her apologies and the patient returned home with a further appointment for the following week. The patient was clearly unhappy, and extremely numb. Sadly, the patient suffered several days discomfort following the ID block.
The patient’s parents then called the practice to complain about the lack of treatment that had been provided for their anxious son, only to be informed that the practice could not enter into conversation about other adult patients. The following week a six page letter of complaint was received which accused the dentist of being rude, thoughtless and patronising.
The son complained that he had not given consent for the sedation appointment, and confirmed that he had been to another dentist for an examination. He alleged that the fillings that were planned were unnecessary and that he was being subjected to excessive treatment.
Fortunately the dentist had taken good radiographs and the cavities were clearly visible, and with this in mind a written apology was sent to the patient regarding the failed treatment, but it was made clear to the patient that the cavities were visible on the radiographs and the member stood by her clinical opinion on the need for restoration.
The patient did not return and sought further treatment elsewhere.
Learning points
- Anxious patients may have exaggerated expectations and can sometimes be unpredictable. Management of these patients can be very rewarding but can also create considerable challenges.
- It is important that when referring patients they are aware of the reason for the referral and the treatment that would be undertaken.
- If treatment needs to be delayed this must be discussed with the patient. The reason for undertaking treatment or not is important and needs discussion to ensure consent is achieved.
- It is important that there is clear communication at all stages of treatment from all members of the team.