Case study - A ruined holiday

Dental case study concerning the missed diagnosis of a dental abscess

DAY ONE Mrs B attends her dental surgery having made a quick appointment for a broken filling. She informs the dentist – Mr K – that her family will soon leave for a holiday in New York and she wants to get the tooth taken care of before going away. Mr K examines the patient and notes a missing filling in a lower right molar. The cavity is deep but there is no exposed pulp or undue sensitivity. In the limited appointment time available Mr K decides to place a temporary glass ionomer filling with Dycal in the base. Two appointments are made for Mrs B for after her return from holiday to treat the tooth with a bonded crown.

DAY FIVE Mrs B attends the surgery again for an emergency appointment two days before she is about to fly out on holiday. Mr K finds that the temporary filling has fractured. Mrs B makes no mention of any pain according to Mr K (though she will later dispute this). The dentist replaces the fractured part of the filling with a Cavit dressing. He is confident this will tide her over until further treatment can be carried out on her return from holiday.

DAY TWENTY Mrs B returns to the surgery for another emergency appointment. She reports her holiday was a disaster. She began to experience pain in the tooth on the flight out. Within a few days the toothache had became unbearable and her face grew swollen. She attended the emergency department at a hospital near her hotel and was told she had a dental abscess. A doctor prescribed antibiotics and strong pain killers. Mrs B is angry and states that her travel insurance only paid a portion of her emergency treatment and she demands that the dental surgery pay the balance of costs. Mr K advises Mrs B to contact the local PCT in respect to re-payment of her holiday expenses. Mrs B leaves the surgery and later fails to turn up for the previously booked appointments.

DAY TWENTY FOUR Mrs B registers with a new dentist and attends that surgery where radiographs reveal an abscess in the suspect molar. Root canal treatment is undertaken to resolve the infection along with the fitting of a metal crown.

 

A FEW weeks later a letter of claim alleging negligence is received at Mr K’s surgery from a solicitor acting on behalf of Mrs B. The letter charges that Mr K failed to recognise the infection in the tooth on two occasions and that X-rays should have been taken to confirm the condition of the tooth before undertaking the temporary fillings. It would have then been obvious that immediate root canal treatment was required.

Mr K contacts MDDUS and a dental adviser requests copies of the patient records for review. It is discovered that there is no record of any discussions with the patient regarding her symptoms. Had it been true that Mrs B did report pain in the tooth on her second appearance at the surgery, further investigation including an X-ray would have been warranted and an abscess would have been diagnosed. The need for urgent treatment would have been discussed and options explored given Mrs B’s impending holiday.

The MDDUS dental adviser discusses the case with Mr K pointing out that it is clear that the dentist twice missed the opportunity to diagnose the abscess. 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 judges that arguing the case in court would be risky and could involve significant legal costs. It is 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 is recorded on patient records.
  • Less haste in emergency appointments can prevent missed diagnoses.