Missed decay

BACKGROUND: MR B attends his dentist Ms L to have a bridge fitted to three of his lower right teeth along with a crown on his lower left 5. Six months later he returns complaining of pain in UL5. The dentist notices it is tender to percussion and takes a periapical radiograph. She proceeds to root fill the tooth and takes a post-operative radiograph before later placing an amalgam restoration. Seven months later Mr B again returns to Ms L complaining of pain. She finds UL5 has fractured and the patient consents to an extraction as well as having a crown fitted on the neighbouring tooth after appropriate healing of the extraction socket.

Over the course of the next three years, Mr B attends the surgery on a number of occasions complaining of toothache. Ms L takes several radiographs and carries out a number of root fillings, including restorations on various upper and lower teeth, as well as two restorations on LR6 over the course of 18 months.

Mr B then changes dentists and begins to receive treatment from Mr C. He continues to experience tooth pain and, over the course of four years, Mr C carries out X-rays on several occasions. He provides various treatments including a bridge at UL56, a crown to UR6 and restoration of UR5. On three occasions Mr C provides root canal treatment.

Mr B then begins to consult a third dentist who X-rays Mr B’s mouth and finds evidence of numerous carious lesions, an unrestorable tooth and caries around and under his restorations and crowns. The dentist also states that the bridgework is of poor quality and root treatments have not been carried out to the correct standard. He states the prognosis is poor for many of Mr B’s teeth, recommending several extractions and implants.

OUTCOME/ANALYSIS: Ms L and Mr C receive letters of claim from Mr B alleging negligence. It is claimed they failed to diagnose and treat caries that were evident on radiographs, provided poor quality dental treatment and failed to show reasonable care and skill in providing bridgework. It is alleged that their failure to treat Mr B’s decay allowed it to progress, accelerating tooth loss.

Ms L is an MDDUS member while Mr C is a member of another dental defence organisation. An expert report is commissioned which is largely critical of the care provided by both dentists. Reviewing the many X-rays taken throughout Mr C’s treatment, there is clear evidence of the presence of caries which neither dentist acted upon in a timely manner. The expert also agrees that the crown and bridgework provided is not of an acceptable standard and mistakes have also been made in the root canal treatments.

Record keeping by both dentists is also poor, meaning there is little evidence with which to defend the accusations.

A settlement is reached with the patient and a considerable sum of compensation is paid (shared with the other defence organisation) in recognition of the pain endured by Mr B, the avoidable remedial work he underwent and the cost of past/future remedial work.

KEY POINTS

• Carefully review dental radiographs, being alert to evidence of dental caries, particularly in patients persistently presenting with pain.

• Take comprehensive notes of treatment carried out, including details of preparatory work taken. Ensure risks are reviewed and signed by the dentist/treating professional.

• Advise all patients of clinical and radiographic findings, ensuring they fully understand treatment need, including the risks/benefits of treatment as well as not having treatment.