As this case illustrates, a lot of trouble can be saved later on by seeking specialist advice early...
A patient who had recently attended a locum dentist for an extraction returned and was treated for a dry socket. The locum left the practice a week later to travel around the world.
Subsequently the patient returned to the practice complaining of pain. The locum had now left the country and the principal dentist, now back from holiday, examined the patient and found an oro-antral fistula at the extraction site. The practitioner felt able to treat the fistula and made an appointment to carry out the surgical treatment.
During surgery, the principal found some of the dry socket dressing material on the floor of the antrum. The area was cleaned and sutured. Unfortunately, the surgery was not successful and two further attempts were made by the principal to resolve the matter with further surgery on each occasion.
The patient subsequently took legal action against both the locum who had left the practice and the principal. The locum was cited for causing the oro-antral fistula and the principal for failing to refer the patient for specialist treatment.
The expert advice obtained by Dental Protection suggested that the locum had not been negligent in creating the oro-antral fistula although there was some question as to whether it was recognised at the time. There was also some difficulty with the placing of the dry socket medicament into the sinus floor.
The expert also felt that while the principal was experienced in oral surgery, specialist advice should have been sought particularly when the first surgical procedure failed. The matter was settled with the agreement of both the practitioners concerned.