A failed extraction handled appropriately

A patient, who had originally been seen by another associate within the same practice six months earlier, attended with a new dentist complaining of a broken tooth. The new dentist identified deep caries in the 47 and carried out further investigations on the tooth.

After review of a radiograph, the tooth was deemed to be unrestorable. After speaking to the patient it was determined that he had been aware of deep caries previously and did not want treatment of the tooth, namely root canal treatment and a crown,both of which had been offered six months earlier.The patient had been prepared to wait until the tooth broke or caused pain, after which he would agree to an extraction at that stage.

There was no pain from the tooth, however as it was broken, the patient found that he was having difficulty with eating and this had prompted a return to the practice. The radiograph indicated the 47 was grossly carious and was broken below alveolar bone level; however, there was good bone and periodontal support. There was no evidence of apical pathology. The patient was advised of the risk that the tooth could break during removal and surgical intervention may be required. The patient was offered an option of a specialist referral at this stage. The patient wished for the tooth to be extracted at the practice and so was also informed that whilst all attempts would be made to remove any broken root, if this was not possible an onwards referral would be required.

The patient was booked for an appointment three days later and as expected, the tooth fractured during removal, leaving the distal root in situ. The dentist attempted to remove the root, however was unable to mobilise it and after 25 minutes stopped the treatment. The patient was informed of what had happened and that a referral would be required. The patient was not charged for this appointment by the dentist and the referral was duly made.

Two days later the patient returned in pain and saw another associate at the practice.A diagnosis of dry socket was made and appropriate treatment provided. At this point the patient questioned why antibiotics had not been prescribed at the time of extraction and
questioned how long they would need to wait for the referral.

One week later a complaint letter arrived. The patient wanted another explanation as to why antibiotics were not prescribed as soon as the dentist knew the root had broken and expressed concern that the dentist had been aggressive and rough during the extraction process.

The dentist requested assistance from Dental Protection and was advised to send a detailed reply to the patient outlining the consent process,technique of extraction and postoperative care and management of the patient.

The patient accepted the explanation and no further action was taken.

Learning Points

• It is essential that a patient understands what to expect from treatment, both in terms of the procedure itself and any likely outcomes.
• A clear record of the consent process, as well as the pre and postoperative advice given to a patient.