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Only fools rush in

15 July 2014
Failure to listen properly to the patient can result in unnecessary treatment or worse, as this case illustrates…

A patient attended a maxillofacial surgeon complaining of pain from the upper incisor region but was a little vague as to its exact location. In the hurly-burly of a busy clinic, the surgeon was rather hasty and immediately referred the patient for an x-ray, without spending sufficient time listening, observing and examining.

The x-ray revealed that both the central and lateral incisors had been root-filled and fitted with post crowns. The upper left central incisor showed a slight widening of the periodontal membrane, but no periapical lesion, whereas the lateral incisor displayed a radiolucent area at the apex of the root.

The surgeon arranged an early appointment for surgery and an apicectomy on the lateral incisor was carried out under general anaesthetic without any problems. When the patient came round, he immediately gestured with his finger to the central incisor and explained that now he had had that tooth apicected as well, he was sure that he would have no further pain!

When the patient had fully recovered from the general anaesthetic, the member asked some more pertinent questions and on this occasion spent a considerable period of time listening and observing.

It soon became clear what had happened. Following an episode of pain after the root canal treatments and crowning, the patient’s previous practitioner had recently carried out an apicectomy on the lateral incisor using a flap technique that had left no scarring on the buccal mucosa.

The x-ray appearance of the periapical radiolucency was in fact a healing apicectomy area. The member’s failure to listen effectively and observe at the initial consultation had resulted in an unnecessary operation being performed.

Admitting liability

The patient initiated a claim through his lawyers against the surgeon and Dental Protection had little alternative but to admit liability on his behalf and to settle the claim accordingly. The settlement consisted of a refund of fees for the unnecessary surgery and a substantial amount for general damages covering pain and suffering and loss of earnings. The patient was an opera singer who had to cancel a short tour of singing engagements at the time of the second surgical procedure!

Learning Points:
Apart from the obvious need to check that the correct tooth is about to be treated before starting any dental procedure, it is also worth remembering that a patient’s occupation can significantly influence the significance of a sub-optimal result.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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