Dentist number one, two or three? - dental case study

...The patient underwent a root canal but suffered complications over the course of two years, receiving treatment from three different dentists...

A 42-year-old patient attends his dentist – Mr A – for an examination complaining of throbbing near LR1 which is found to be tender on percussion. A periapical X-ray is taken and the dentist advises that root canal treatment is necessary. This is carried out a week later.

A month later the patient returns complaining of further pain. The dentist prescribes an antibiotic but offers no further treatment.

Four months later the patient attends a different dentist – Ms B – and X-rays reveal that the root filling on LR1 is 8mm short of the apex of the tooth and that much of the root canal has been left uncleaned and unobturated. Ms B removes the previous filling and obturates the canal with gutta perch and tubliseal, the coronal access is sealed with glass ionomer cement.

Not long after the treatment the patient returns to Ms B with a swelling in the buccal sulcus adjacent to LR1. The patient is given a prescription for penicillin. A month later the patient is referred to hospital for an apicectomy and a large pus-filled cavity is found associated with the root apex of LR1.

Over the next year the patient has further problems and eventually opts for removal of the tooth. A third dentist – Mr C – undertakes the procedure but there are complications with retained root material. The patient suffers further pain and inconvenience. A year after this last treatment he instructs his solicitor to file a damages claim against both Mr A and Mr C.

Analysis and outcome

MDDUS represented the first dentist, Mr A, and the allegation was that he was negligent in not determining the correct apical length prior to the procedure and then also not ensuring the root canal was cleaned and obturated. He was also accused of failing to either re-do the root filling or refer the patient to a specialist when he came back complaining of pain.

The further assertion was that had Mr A carried out the procedure competently it would have been unnecessary for the later removal of the tooth by Mr C and the further complications.

MDDUS experts determined that Mr A fell below standard in his duty of care to the patient and the case could not be defended in court. It was settled on his behalf for a modest sum plus legal costs.

Key points

  • Subsequent treatment to the same teeth may not excuse negligence in earlier procedures.
  • Take time to ensure canal length before carrying out treatment.