22 October 2014
Although the nature of this patient’s medical condition is not described, some patients trawl the internet seeking a remedy for what they consider to be an untreatable chronic condition.
Historically, amalgam has been considered to be a safe restoration although there have been developments of global plans to control mercury pollution that could see amalgam being phased out over the next few years.
When deciding how to respond, you obviously have to advise her on what is considered current best practice and to offer her treatment which would be considered to be in her best interests.
There would clearly be a dilemma for the patient if there was no improvement whatsoever in her medical condition after you removed the tooth. Even if you did insist on this patient signing a disclaimer, it would be of little help should she decide to make a claim in negligence against you unless there was a cogent reason for you acceding to her request. You could also be asked to justify the reason for the extraction if an adverse incident occurred when extracting the tooth.
You may wish to consider obtaining a second opinion from a Specialist in Oral Medicine or Oral Surgery, and if necessary with the patient’s permission, to liaise with her general medical practitioner before carrying out any irreversible treatment. It may also be worth discussing your concerns with this patient on the efficacy of the treatment she suggests and perhaps trying to persuade her to have the amalgam removed (which in itself can be a source of morbidity), and to restore the tooth on a temporary or semi-permanent basis to see whether it does have any effect on her underlying medical condition.
Further information is available in Dental Protection’s Risk Management Module on Amalgam-free Practice.