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A failed extraction handled appropriately

09 January 2019
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.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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© 2019 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association. “Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”).

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