We frequently deal with complaints that members have received from patients who allege that a root canal treatment carried out several years earlier has now ‘failed’ and as a result the tooth needs to be extracted. Usually, the patient has transferred care to another dentist along the way and the ‘failure’ may become apparent due to symptoms arising or a radiological finding. While occasional failures to fully clean and obturate the root canal system can indeed render a tooth unrestorable, the assessment made by a second dentist – often without access to the full clinical history – may be flawed.

In many cases, the apparent failure is not the result of any breach in the member’s standard of care. It is often the case that small details noted in the records at the time of treatment can be crucial in defending the member’s position and proving that there was no fault in the care provided.

Case study 

A dentist contacted us seeking assistance after receiving a complaint from a former patient regarding treatment carried out several years previously. It concerned a root canal treatment on a lower molar and subsequent swelling the patient had developed beside the tooth. Another dentist had taken a radiograph and advised the patient that they had an infection and that the root canal treatment was faulty. He advised that the patient needed to have the tooth extracted.

Both the clinical records from the member’s practice and the patient’s clinical records were reviewed. There was evidence of detailed record keeping at all stages of the root canal treatment, which had been carried out over two visits. As well as detailed records of consent, warnings given, instrumentation and process, there were also high-quality working radiographs and evidence of obturation to the working length in three canals. The records showed that the patient was advised on both visits that a crown would be needed on the tooth and additionally, a hard night guard, as the dentist noted some occlusal and bruxism issues. The records showed that the patient was specifically warned of the risk of root fracture. 

The patient’s new clinical records included a recent radiograph that showed infection around one of the roots, despite evidence of a well-executed earlier treatment. The tooth had not been restored with a crown as had been advised by the treating dentist. The pattern of infection suggested that a structural issue, such as a root fracture, was as plausible as any problem with the original treatment.

An independent specialist opinion was sought and confirmed a vertical root fracture and noted that the patient had not followed earlier advice regarding a night guard.

The dentist’s position was successfully defended on the basis of clear documentation showing that the patient had been informed of the risks associated with the procedure, the need for a crown, and the importance of protective measures. The failure of the tooth was therefore attributed to factors outside the practitioner’s control, and no liability for further treatment costs arose. 

This outcome was possible only because the records contained detailed postoperative advice and evidence that appropriate warnings had been given. Without such documentation, the patient could have credibly claimed that no advice had been provided – claims that, in similar cases, often escalate to allegations of prolonged symptoms or distress, significantly increasing potential exposure. 

The point should also be made that dentists reviewing treatment carried out by a colleague should be careful of criticising previous treatment where they may not have the full picture and all the relevant information. Negative comments can often stir up a completely unnecessary complaint, or worse, claim – which may have very significant repercussions and impacts on the previous dentist. 

Learning points 

• Evidence of preoperative warnings and that they have been provided to the patient is essential. 

• The ‘particular patient’ warnings, i.e. if there are warnings that are relevant to this particular patient for this particular tooth, it is essential to capture that they have been given, even if noted briefly. 

• Preoperative and postoperative radiographs indicate the need for treatment and the treatment as it was at the time it was provided.

• Be cautious in making judgements on work carried out in the past by other colleagues. It is often wise to seek further information and possibly seek another opinion before alleging that the treatment carried out was ‘substandard’ or ‘faulty’ in some way.