Lip trauma

 

BACKGROUND

Mr Y attends his dental surgery for a regular check-up. The dentist – Dr G – notes that a distal composite filling on the lower right canine needs to be replaced. The patient re-attends a few weeks later and Dr G administers local anaesthetic and uses cotton wool rolls to isolate the tooth and also reduce the risk of moisture contamination and to protect the soft tissue.

Clinical notes indicate nothing remarkable about the procedure and Mr Y leaves the surgery without complaint. Three days later he returns to the practice complaining of a large ulcer on the lip adjacent to the tooth that was filled. He claims to have become aware of “some injury” within an hour of having left the surgery when he tried to eat a bacon roll. Dr G suggests that the most likely cause was trauma from biting his lip before the anaesthetic had worn off. The dentist advises Mr Y to clean the ulcer with warm salt water and apply Corsodyl gel. He arranges to review the patient in a few days.

On the next visit the ulcer has completely healed. Mr Y states that he has sought the opinion of another dentist who suggested that the ulcer was caused by the tooth being pushed up against the lip and the spillage of acid etch gel. Dr G expresses his regret over Mr Y’s suffering and explains the procedure that had been followed, including the measure to protect against soft tissue damage. He also reassures the patient that he would have informed him of any trauma that had occurred during the procedure and the likely consequences.

Mr Y is not happy with this explanation and demands a refund for the cost of the treatment. Dr G later forwards a cheque as a gesture of good will.

A few months later the dental surgery receives an injury claim from solicitors acting on behalf of Mr Y. It alleges that Dr G acted negligently by not adequately protecting the patient’s lower lip during the procedure. The letter claims that the lip was punctured and acid etch used in the procedure came into contact with the wound. Mr Y further claims that after the procedure he had to attend his GP for antibiotics and now suffers from dental phobia.

OUTCOME

MDDUS commissions an expert report from an oral surgeon, who notes numerous conflicting details in the patient’s account of the treatment. Mr Y claims there was lack of protective measures to ensure against damage to the soft tissue yet in latter statements he claims to have felt a burning sensation to his lip when the cotton wool was removed without first being moistened.

The expert assesses the clinical photographs of the lesion noting that the wound is of uniform depth with an area of ulceration corresponding in size and shape to an injury from the incisal edge of a tooth. Detailed analysis of the images further leads the expert to discount the possibility of a burn, skin adhesion to cotton wool rolls, dental drill injury or rough treatment as the cause of the lesion. His view is that the ulceration adjacent to the incisal edges of the teeth suggests that the patient bit the inside mucosal surface of his lip – possibly when eating while the lip was still anaesthetised.

MDDUS writes a letter of response to Mr Y’s solicitors repudiating the claim and the case is eventually discontinued.

* Details have been changed to maintain anonymity