Best of a bad job - Dental case study

Dental case study

  • Date: 01 July 2007

A young VDP saw a 42-year-old female patient who had received root canal treatment to her lower left premolar the previous day. The patient had lost faith in her previous dentist as it had taken seven appointments to complete the treatment at a cost of £275. The patient was experiencing constant throbbing pain, had not slept all night and was taking non-prescriptive analgesics. The patient's medical history showed she was taking Warfarin following the development of a DVT. Her INR had been checked prior to the root canal treatment and was at a level of 2.1. The VDP examined the patient and found the LL5 to be very TTP. No associated swelling was noted but the patient described the left side of her lower lip to be 'tingly'.

The VDP took a radiograph and noted that the root filling material had perforated the apex by 5mm and appeared to have entered the ID Canal running distally along the canal by about 2mm. Treatment options were discussed.

The VDP telephoned the oral surgery department at the local dental hospital who advised removal of the tooth or an attempted removal of the attached extruded gutta percha and retrograde root filling. The INR value was sufficient to carry out the extraction. Treatment options were discussed with the patient and the tooth and attached root filling material successfully extracted. The patient, when reviewed the next day reported a great improvement in symptoms.

The VDP was surprised to receive a letter of complaint from the patient stating that she had not been provided with sufficient treatment options including immediate implant placement.

Analysis and outcome

The MDDUS discussed the complaint with the VDP and his trainer. The contemporaneous notes taken by the VDP clearly stated that the patient had been given a full list of treatment options and had chosen extraction of the tooth. The cost implications in this case were in excess of £5,000 as the ideal replacement for any tooth lost through negligence is a dental implant. The MDDUS drafted a letter of response pointing out the facts of the case, stressing that the VDP had acted entirely correctly. The patient accepted the explanation and raised a claim against her former dentist.

Practice points

Dental records in such cases should confirm that a thorough and comprehensive assessment has been undertaken with notes related to:

  • Medical history (completed and assessed)
  • Clinical history (signs, symptoms)
  • Diagnostic process (exam, X-ray, percussion)
  • Treatment options discussed
  • Treatment plan agreed
  • Treatment undertaken
  • Confirmation of removal of teeth and CP point
  • Post-treatment review


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