Pause before pulling, dentists told

Dental professionals should pause for thought before they pull out a patient’s tooth, the Dental Defence Union (DDU) warns today (.  

Claims for erroneous extraction are rising, an analysis of files has revealed, as are other requests for assistance. 

In the six year period between 2006 and 2011, the DDU received 138 claims and opened 109 advice files involving allegations of erroneous extractions. The number of files received in 2011 was nearly three times that in 2006 (57 compared with 21).

The most common allegations were:
• The wrong tooth was extracted because the dentist had misread the chart or referral letter
• The dentist failed to extract the tooth causing pain
• The extraction was unnecessary and the tooth could have been saved; and
• The dentist had not properly obtained consent from the patient. 

The cost of settling 56 claims was over £413,000, an average of more than £7,300 per claim plus legal fees.

Of the remaining claims, 31 were discontinued, closed or found to be outside the three-year statutory limitation period, and 51 remained active at the end of the period.

The highest payout was for a patient who had an incisor removed rather than a pre-molar. The patient received over £23,000 compensation, plus legal costs.

Rupert Hoppenbrouwers, head of the DDU said: 'When you consider the number of procedures carried out each year, erroneous extraction allegations are rare. However, they often cause distress for the patient involved, particularly if they have to have the correct tooth extracted and further treatment such as an implant or bridge. And of course, this means claims can be costly to settle.'

In the DDU’s experience, erroneous extraction cases are often the result of a breakdown in communication, either between dentist and patient or between dentists. For example, 24 cases concerned patients who required extractions before receiving orthodontic treatment but the wrong teeth were removed.

Rupert Hoppenbrouwers said: 'In highlighting these cases, we want to bring this problem to the attention of dentists and help them avoid a claim or complaint themselves.'

How to reduce the risk of an extraction error.

1. Consider using one form of tooth notation in the patient’s records when referring to the tooth or teeth to be treated. When making a referral, you may prefer to refer to each tooth in longhand to avoid confusion, such as ‘upper left first premolar’

2. If you cannot immediately determine which tooth requires extraction, it may be better to treat the pain and defer recommending a treatment plan. For example, the patient may not be able to indicate which tooth is the source of their pain, there may be generalised soft tissue swelling adjacent to several teeth, or an x-ray could be inconclusive.

3. When obtaining consent, take time to explain the risks of treatment, such as fractured teeth, and the alternatives, such as root canal treatment. Make a careful note of the discussion in the clinical records.

4. Before beginning treatment, ask the patient to confirm which tooth they believe is being treated, and then cross-reference with the clinical notes, any other documentation such a referral letter and the radiograph.

5. Recognise the limits of your own clinical skills. Be prepared to refer the patient to a specialist if complications are likely or if the patient has a complex history.

6. If the tooth is to be treated under a general anaesthetic or sedation, the treating dentist should see the patient before administration of anaesthesia or sedation and check the tooth to be treated. They should also ensure the correct clinical documentation (referral letter, source of referral, a signed consent form and any supporting radiographs) is available.

7. If extractions or other treatment are requested by another dentist, satisfy yourself that the treatment plan appears reasonable and in the patient’s best interest before proceeding. If there is any doubt, consult with the referring dentist.


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