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A delayed postoperative healing following an extraction

15 July 2019
Mrs C attended her dentist for an extraction of an unrestorable, fractured 37. The procedure was uneventful and postoperative instructions were provided in the usual way.

She returned a few days later in discomfort and the dentist diagnosed alveolar osteitis. The socket was irrigated and the dentist placed a medicated dressing in the socket.The dentist explained the diagnosis, advised Mrs C to take painkillers and offered to book a review appointment the next day.

Mrs C seemed surprised about this and declined the appointment as she had already taken two days off work to attend the clinic for the extraction and the emergency appointment. As there were no signs of infection, antibiotics were not prescribed and she left fairly disgruntled.

Her husband returned to the clinic the next day shouting and being very raucous in his behaviour. He complained to the receptionist that his wife was still in considerable pain following the extraction of her tooth, and stated that this was down to the poor standard of treatment provided by the dentist. He threatened to report the dentist to the press and contact a lawyer and said that he had already posted negative comments about the dentist on various social media sites.

The dentist in question was working in another clinic that day, so did not have an opportunity to provide an explanation to Mrs C’s husband. He did however contact Dental Protection for urgent advice as he was concerned about the impact of any social media criticism. He discussed the case with his dentolegal adviser and explained that although he was unaware of any press coverage to date, there were a handful of comments on social media attempting to undermine his credibility and professional reputation.

The press team at Dental Protection was asked to assist the member and advised that if the dentist was contacted by a newspaper for a comment, he should find out:

• the journalist’s name
• the name of the publication
• the aspects of the care and treatment they were seeking comments on
• the deadline for a response
• the journalist’s contact details – phone number and email address.

The press team also provided the following helpful advice:

• Do not respond to any questions immediately – instead take some time to consider a response or to seek advice.
• Maintain your professionalism at all times and do not be tempted to discuss a patient’s treatment in a public domain. If you cannot discuss the patient’s treatment for confidentiality reasons then you should say so.
• Avoid saying 'no comment’ as it sounds defensive. Ensure you come across as co-operative and inform the reporter that you will come back to them.
• Contact the Dental Protection press office for advice and liaise with your employer/practice where appropriate.

The dentist was reassured that the press team could liaise with journalists if necessary and provide a statement on his behalf. 

Steps were also taken to address the negative comments made on social media; the administrator of the social media page was contacted and the unfair and inappropriate comments were asked to be removed.

Dental Protection recognises that patients increasingly use social media channels to highlight concerns about their treatment and care where previously this would have been privately communicated to the practice. We would encourage members to respond to both positive and negative online feedback. Responding to online comments demonstrates you are listening and care about feedback; however, you should always express a willingness to address any concerns offline where confidentiality can be respected.

The situation was amicably resolved by arranging for another dentist to review Mrs C. This dentist confirmed the diagnosis and explained to the patient that dry socket was a recognised complication and that the pain would subside within a few days and the socket would heal.

It is always advisable to request Dental Protection’s assistance from the outset when faced with unexpected clinical outcomes and/or complications that may lead to a patient complaint. In this situation,the dentist was able to identify a strategy to manage the adverse social media coverage and potential harm to his reputation by contacting Dental Protection immediately.

Learning points

• The dentist failed to warn the patient about the possibility of alveolar osteitis at the outset. Consequently, when the patient developed a recognised postoperative complication she became alarmed and blamed the dentist.
• An opportunity was also missed when the dentist realised that the patient left the clinic unhappy. It may have been worthwhile considering contacting the patient later on that evening to enquire how she was and provide further support and advice.
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