The scene

A patient attended her general dental practitioner for removal of an impacted lower right third molar, which was causing recurrent pericoronitis. The dentist was experienced in removing wisdom teeth and performed the extraction with the patient under local anaesthetic.

However, the procedure was not as straightforward as the dentist had hoped and took longer than expected to complete. The patient had been anxious about the procedure but was otherwise well. She was given advice on surgical aftercare and told to come back if she had any problems.

The patient returned 10 days later, reporting tingling and a loss of sensation on the right side of the tongue and floor of the mouth, with occasional throbbing. On examination, the dentist found reduced sensation to pinprick and realised that the right lingual nerve had been damaged, possibly when using the periosteal elevator during the extraction.

He explained what had happened to the patient and, although he had warned about the possibility of nerve damage before undertaking surgery, apologised that it had happened. The dentist offered to refer her to a maxillo-facial surgeon with a particular interest in nerve damage, and the patient agreed.

DDU advice

The dentist called the DDU advice line. He was reassured that he had acted appropriately to date, but was advised to discuss the adverse incident with practice owner and practice manager, as the statutory duty of candour would probably apply. After the discussion, the practice owner and the dentist jointly agreed that although the neural symptoms may well resolve, they were likely to persist for at least 28 days continuously, meaning the statutory duty of candour did apply.

Because the practice was in England, it was also necessary to notify the CQC without delay to comply with registration requirements. The practice owner agreed that the initial notification to the patient had been appropriate, and that they should write to her as well.

Although he understood that the statutory duty of candour falls on the organisation, not the individual, the dentist believed it was right for him to write personally to the patient, on behalf of the organisation, reiterating his initial apology. Meanwhile, the practice manager notified the CQC.

The outcome

Several weeks later, the practice reviewed the case as a significant event audit. By that time the patient had seen the maxillo-facial surgeon, who believed the prognosis was good and that she could be expected to recover.

The practice's discussions, which took into account comments from the maxillo-facial surgeon, concluded that although it had been reasonable to offer to remove the third molar in the practice, with hindsight there were some features on the X-ray which may have merited referral for hospital removal.

The dentist wrote again to the patient, detailing the further discussions and apologising once again. He also offered her a meeting to discuss the matter, which she accepted. Her lingual nerve symptoms began to improve and she was optimistic that she would fully recover.

She was pleased that the dentist and practice had been so open about what had happened and had immediately offered an apology for what had been a distressing and worrying experience. Because she expected to recover, the patient said she considered the matter closed.

The CQC asked the practice manager to give an update with any further developments. This was done and the CQC told the practice that it noted the incident had been notified promptly and that the duty of candour had been followed. No further action was required.