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Inadequate follow-up dental care and delay in referral to oral specialist (05HDC06970)

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(05HDC06970, 10 May 2006)

Dentist ~ Dental centre ~ Molar extractions ~ Root fragments ~ Oral surgery ~ Standard of care ~ Right 4(1)

A woman complained about the dental care provided by a dentist when he performed two extractions. She presented with toothache from tooth 26, and from tooth 46 a month later. Both had deep fillings and secondary decay. She opted for an extraction on both occasions although it is unclear what advice she was given orally prior to the procedure. Due to the structure and condition of tooth 26 and 46, each tooth broke during extraction. On both occasions, the dentist left the roots in the woman's gums as the risk of removal was thought to outweigh the risk of leaving the roots in place.

The woman experienced ongoing pain after both extractions. Two days after the second extraction, the dentist referred her to an oral surgeon to remove the remaining roots of both teeth.

It was held that the dentist's care on the first occasion was satisfactory. While it would have been good practice to make a follow-up telephone call a day or two after the first extraction to check with the woman on the progress of her recovery, omitting to do so was relatively minor and did not compromise the standard of care that he provided.

In contrast, the dentist did not provide adequate dental care on the second occasion and breached Right 4(1). It was imprudent for the dentist to proceed with extracting tooth 46 without discussing the option of a referral to an oral surgeon. In addition, he failed to arrange a follow-up appointment to check progress following the second extraction.

The dental centre was not held vicariously liable for the dentist's breaches.

This case highlights the importance of dentists recognising limits in their skill and expertise, and making timely referral to specialists in such situations. It also highlights the need for dentists to be attentive to patients' postoperative symptoms by arranging follow-up care to review them after carrying out major dental work.­

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