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The case of double prescribing

24 October 2018

Following a 12-year period of nonattendance, a patient visited the dentist due to recurrent pain at 37. His mouth was healthy overall with no previous restorations. There was, however, a history of recent pain and swelling associated with 37.

Following an examination, a diagnosis was made of cracked tooth syndrome at 37 with
irreversible pulpitis. The options for treatment were discussed, including attempting restoration with root canal treatment and later placing a crown, or extracting the tooth.
On considering the cost implications and the time involved with restoring the tooth, the
patient opted to have the tooth extracted.

The following day the 37 was removed under local anaesthetic without complication.
Although the extraction was uneventful, the patient was given a prescription for antibiotics by the practitioner on account of the prior history of pain and swelling from the tooth. The next day, further pain was experienced and the patient re-attended with the same practitioner. The dentist thought that he was giving a different, second antibiotic to take in conjunction with the first. Instead the patient was given a further prescription of the same antibiotic.

The dentist based the prescription on the previous day’s record, but this was inaccurate.
The record entry stated that the first prescription was for amoxicillin, when in fact,
metronidazole 400mg had been prescribed. When the patient returned the next day,
another course of metronidazole 400mg was prescribed, which he took as he was not
aware that he could not take both together. The patient became increasingly nauseous
and dizzy and subsequently attended his local hospital for blood tests. No admittance
was required, however he underwent blood testing with, arguably, associated discomfort
and inconvenience.

The patient wrote a letter of complaint and requested compensation for the avoidable
pain and suffering that he had experienced. The dentist sought assistance from Dental
Protection, and the case was able to be resolved directly with the patient without
escalation into a formal legal claim involving solicitors.

Learning points

  • Based upon the record of the clinical findings, there was no clear indication for antibiotics following the extraction. When the patient returned with postoperative pain, once again there was no evidence to suggest any sign of infection which would justify prescription of antibiotics were required. There was therefore a vulnerability in the dentist’s position from this.
  • No medication should be prescribed in the absence of clear justification. Antibiotics must only be used in accordance with in accordance with the protocols contained in the Therapeutic Guidelines Oral and Dental Version 2.
  • A further issue arose from the inaccurate record entry relating to the original prescription, and this was compounded by the effects of the second course of metronidazole. It was clear that on various levels the position of the dentist was difficult to defend and an early resolution of the case was sought to avoid a potentially problematic escalation.
  • It is important to ensure records are accurate. This can best be achieved by completing entries contemporaneously with the treatment to which they relate.

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