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CASE STUDY: The case of double prescribing

08 January 2019

Following a 12 year period of non-attendance, a patient visited the dentist due to recurrent pain at tooth 37. His mouth was healthy overall with no existing restorations. There was however a history of recent pain and swelling associated with tooth 37.

Following an examination, a diagnosis was made of cracked tooth syndrome at 37 with irreversible pulpitis. The options for treatment were discussed. These included attempting restoration with root canal treatment and later placing a crown or extracting the tooth. On considering the cost implications and the time involved with restoring the tooth, the patient opted to have the tooth extracted.

The following day tooth 37 was removed under local anaesthetic without complication. Although the extraction was uneventful, the patient was given a prescription for antibiotics by the practitioner on account of the prior history of pain and swelling from the tooth.

The following day, further pain was experienced and the patient re-attended with the same practitioner. The dentist thought that he was giving a different, second antibiotic to take in conjunction with the first. Instead the patient was given a further prescription of the same antibiotic.

The dentist based the prescription on the previous day’s record, but this was inaccurate. The record entry stated that the first prescription was for amoxicillin, when in fact, metronidazole 400mg had been prescribed. When the patient returned the next day, another course of metronidazole 400mg was prescribed, which he took as he was not aware that he could not take both together.

The patient became increasingly nauseous and dizzy and subsequently attended his local hospital for blood tests. No admittance was required, however the he underwent blood testing with, arguably, associated discomfort and inconvenience.

The patient wrote a letter of complaint and requested compensation for the avoidable pain and suffering that he had experienced. The dentist sought assistance from Dental Protection, and the case was able to be resolved directly with the patient without escalation into a formal legal claim involving attorneys. 


Learning points

  • Based upon the record of the clinical findings, there was no evidence of infection and no clear indication for antibiotics. The patient did report postoperative pain, however there was nothing that would justify the use of antibiotics given the clinical presentation and history. There was therefore a vulnerability in the dentist’s position from this.
  • No medication should be prescribed in the absence of clear justification. Antibiotics must only be used in accordance with accepted guidance.
  • A further issue arose from the inaccurate record entry relating to the original prescription, and this was compounded by the effects of the second course of metronidazole. It was clear that on various levels the position of the dentist was difficult to defend and an early resolution of the case was sought to avoid a potentially problematic escalation.
  • It is important to ensure records are accurate. This can best be achieved by completing entries contemporaneously with the treatment to which they relate.