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Difficult and deceitful dentistry

15 July 2014
Keeping patients informed of any negative developments in their treatment is always a better policy than trying to hide something for whatever reason...

A 56-year-old male patient attended his dentist complaining of pain. Widespread gingival recession in the upper left quadrant made the diagnosis difficult, but the dentist decided to root-treat the upper left first molar.

The treatment was carried out at a single visit during which a rotary file separated in the mesio-buccal canal. The patient was not informed as the dentist was confident that the canal was clean and the instrument would not cause any harm. The palatal canal was sealed using a low-temperature thermal obturation technique and there was significant extrusion of gutta-percha into the apical tissues. The practitioner was unable to access the distal canal.

The patient was in considerable discomfort the evening after the treatment and sought emergency care from a duty rota dentist. After taking an x-ray, the second dentist advised the patient that:

• There had been an overfill of the palatal canal

• The distal canal had not been treated

• There was a separated instrument in the mesial canal, which was also protruding through the apex

The patient received remedial treatment from a specialist and subsequently brought an action for negligence against the first dentist who had failed to tell the patient about the separated instrument and the untreated third canal. Although there was an overfill of the palatal canal, this was not treated by the specialist as it did not appear to compromise the long-term prognosis of the tooth at the time. The practitioner had used ultrasound with copious sodium hypochlorite and it was thought that further intervention of the palatal root was not necessary.

Learning point:
Information about a ‘difficult’ treatment should always be presented to the patient at the time of treatment together with suitable suggestions for its management. When the facts come to light in retrospect, at best they suggest bad dentistry, at worst a deceitful dentist.
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