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When doing nothing is an option

11 July 2014
Acting outside of one’s level of experience is one thing but failing to explain all treatment options, or the possibility of having none at all, is quite another...

A young patient attended her general dental practitioner complaining of pain. The diagnosis of pericoronitis was made and the practitioner advised removal of the tooth which had a history of three previous infections.

The practitioner was inexperienced in oral surgery and unfortunately the wisdom tooth fractured upon removal. In the surgical process that followed, the patient ended up with permanent lingual paraesthesia.

Among the allegations in the ensuing case were:
• The practitioner should have advised the patient that it was possible to make a referral to a specialist
• The patient was not offered the option of leaving the tooth in place, i.e. no treatment

The dentist felt that she was not under an obligation to advise the patient about referral to a specialist as she felt capable of performing the procedure herself. She did not feel that it was right to offer an alternative course of treatment, or even no treatment, as it was in the best interests of the patient to have the tooth extracted.

Possibility of paraesthesia

Although the patient had been warned of the possibility of paraesthesia, had she known of the inexperience of the practitioner or the possibility that the tooth could be left in place and the infection treated symptomatically, she might not have allowed the treatment to go ahead.

On the advice of counsel, a small settlement was made since a court was likely to find that the patient should have been advised that no treatment was an alternative. It was also considered that the difficulty of the extraction was beyond the practitioner’s experience.

Learning point:
An over-paternalistic approach by a practitioner may prevent the patient from taking a decision based upon the full facts of the case.
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