Holiday toothache

26 February 2009

Mrs V had booked an expensive family holiday in Thailand. Two weeks before departure a filling in a lower right molar fell out. She phoned her dental surgery and requested an emergency appointment.

The dentist examined the tooth and found a deep cavity but no exposed pulp. Mrs V said she was not in pain and felt only a little sensitivity to cold. In the limited appointment time available the dentist decided to place a temporary filling without anaesthetic. He requested that Mrs V then make an appointment for further treatment on her return from holiday.

A week later Mrs V contacted the surgery again to say part of the temporary filling had fractured. Another emergency appointment was arranged and this time the dentist applied a further temporary filling. Again the patient was advised that full treatment would be necessary at a later date.

On the flight out to Thailand Mrs V began to experience pain in the tooth. A few days later the toothache became unbearable and she had to seek local treatment. An X-ray was taken and antibiotics and painkillers were prescribed. Her holiday insurance only covered part of this treatment.

Mrs V returned to the surgery after the holiday. Her face was swollen and X-rays confirmed an apical abscess. She was angry and demanded that the dentist pay the balance of costs for her treatment in Thailand. The dentist declined on the basis that he had acted correctly on the information provided by the patient, and it could now be seen that the symptoms could have flared up at any time. A further appointment was arranged to initiate root canal treatment to the tooth. The patient missed that appointment and a letter of claim alleging negligence was received at the surgery from a solicitor acting on Mrs V behalf.

Outcome and analysis

MDDUS requested the patient notes regarding Mrs V and it was discovered that there was no record of any discussions with the patient regarding her symptoms. Had she reported pain or other symptoms, further tests including an X-ray would have been indicated and an abscess would have been diagnosed. The dentists would then have been able to discuss options with Mrs V regarding both the urgent need for treatment and her holiday plans.

The lack of any notes in the patient records regarding the discussion of symptoms meant that any legal defence would rely on the dentist’s memory. MDDUS judged that arguing the case would be risky and could involve significant legal costs. It was decided with the member’s agreement to settle the case for a modest sum with no admission of liability.

Key points

• Ensure adequate information including discussion of symptoms and treatment options are recorded on patient records.
• Emergency appointments require a high index of suspicion.