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To prescribe or not?

05 June 2020

Mr T, a 57-year-old male and a long-standing patient of the practice, attended an emergency appointment with pain from tooth 14. The tooth had a deep MOD restoration which had been placed six years ago and had been symptom-free for that time. The medical history was updated at the time and it was clear. The patient was a non-smoker and took no medications.

Mr T complained of pain for two days, which had kept him awake at night, and he was taking painkillers. He reported no other symptoms and was not pyrexic. Upon examination the tooth was very tender to percussion and did not respond to vitality testing. There was no observable inflammation or swelling and a periapical radiograph revealed that the tooth had periapical periodontitis. The dentist Dr F discussed the options to manage the situation and these included doing nothing, which was unsuitable as the patient had symptoms, RCT and the extirpation at that appointment, and the last option was extraction. Pros and cons were explained for every treatment option. Mr T opted for RCT and extirpation and Dr F proceeded with that. After completing extirpation of the diseased pulp, advice was given about further painkiller usage and an appointment was made in two weeks’ time to complete the RCT.

Mr T failed to attend that appointment and two months later the dentist received a letter of claim from solicitors. From the letter it was apparent that Mr T attended hospital a few days after the extirpation appointment with facial swelling, which was treated with IV antibiotics. Unfortunately, he clearly considered that his experience was the result of poor treatment at the emergency appointment.

The solicitors alleged that Dr F failed to provide adequate emergency treatment and prescribe systemic antibiotics; had these been prescribed, the solicitors alleged, the outcome could have been avoided.

After comprehensive assessment of the records and discussions with Dr F, the case was successfully defended by our claims team who argued that the emergency appointment was thorough and was well documented. The cause of the symptoms was correctly identified and appropriate advice and treatment had been provided. It was argued that there had been no indication based on Mr T’s presentation that systemic antibiotics were required.

Learning points

The law on consent provides a framework that protects patients’ rights to decide about their treatment. In this case all treatment options were explained with their associated risks and benefits.

The full symptoms of the patient were assessed and recorded in the notes, where it was clearly indicated that the lack of systemic involvement meant that local measures were indicated, and not systemic use of antibiotics.

Had the records not been as thorough, then defending the claim could have been much more difficult.  

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