Hard to swallow - dental case study

BACKGROUND A 32-year-old patient, Miss D, undergoes root canal treatment from her dentist, Mr F. During the procedure Mr F drops a small metal instrument which slips down the patient’s throat. He finishes the root treatment and then immediately refers Miss D to hospital with a note explaining what has happened.

At the hospital, she undergoes exploratory procedures under general anaesthetic and X-rays and the instrument is finally found in her abdomen. She spends the night under observation in hospital and is discharged the next day under instructions to stay at home until the instrument passes from her system. She is off sick from work for a week and eventually passes the instrument several days after she swallowed it.

Mr F receives a letter of complaint from Miss D who accuses him of negligence for failing to prevent her from swallowing the instrument. She intends to make a claim for compensation for loss of earnings and other out-of-pocket expenses related to her hospital stay.

ANALYSIS/OUTCOME Mr F contacts MDDUS for help after receiving the letter of complaint. When asked by an adviser, the dentist admits that he did not use rubber dam. On that basis, the adviser concludes that the situation is indefensible and seeks to reach an agreement with the patient over compensation. Following discussions, a modest settlement is agreed to cover loss of earnings and expenses but no admission of liability is accepted on behalf of Mr F.

KEY POINTS

• Always use rubber dam when carrying out root treatment to avoid swallowing of dental instruments.
• If a dental instrument is swallowed, or if you suspect an instrument has been swallowed, immediately refer the patient for hospital treatment with a letter explaining the situation.
• Make a clear note of the incident in the patient’s note, outlining the treatment given and whether a referral was made.