The scene

An associate dentist contacted the DDU advice line after an incident at the practice affected a number of patients. The dentist had been working with an agency dental nurse who was new to the practice, and at the start of the morning session began treating his patients in the usual way, carrying out examinations on his first three patients while also providing a scale and polish using the ultrasonic scaler. The first two patients said that they noticed an unusual taste during the procedure, but the dentist did not suspect there was anything wrong.

When the third patient also described a poor taste as well as a burning sensation, it became clear that the water bottle supplying the ultrasonic scaler contained disinfectant solution. The disinfectant had been used at the end of the treatment session the previous day, but the agency dental nurse had been unaware that the system hadn't been flushed through with water afterwards. When the dentist realised what had happened, he told the patient and apologised before calling the DDU.

DDU advice

The DDU's dento-legal adviser suggested what further steps the dentist could take, and reminded the associate that all dental professionals have a responsibility to be honest with patients when something goes wrong with their treatment or care which causes harm or distress, or has the potential to do so. The dentist called the previous two patients to tell them what had happened and advised all three to attend the local hospital and seek medical advice.

All three patients subsequently reported chemical burns and ulceration to their oral mucosa. The practice principal was informed and the incident was recorded in the practice's adverse incident log book. As well as writing detailed notes in the clinical records regarding the incident, with assistance from the DDU, the dentist wrote to each patient, explaining again what had happened and offering a written apology.

The dentist also described what steps the practice had taken to avoid the incident happening again. An investigation had been carried out, with all staff involved giving their version of events, and notes were kept of these discussions. A practice meeting was held, further staff training was arranged where necessary, and changes to the practice's policies and procedures were introduced.

The following week two of the patients contacted the practice confirming they wanted to make a claim for compensation.

All dental professionals have a responsibility to be honest with patients when something goes wrong.

Responsibility

The DDU has received a number of requests for assistance about similar cases. If a patient were to make a claim for compensation after an incident like this, who would have responsibility for the claim might be debatable, and could depend on a number of factors.

Practice principals have a responsibility to ensure that all staff - including associate dentists, employed nurses and agency staff - receive a full induction to the practice, as well as being made aware of their role and of the practice's policies and procedures. This includes knowing their responsibilities for setting up and shutting down the surgery at the beginning and end of each day.

If a member of staff did not follow such a policy when they had been made aware of it, they could be liable for any claim. However, if they had not been made aware of the policy, responsibility would likely rest with the practice principal.

Vicarious liability

A practice will also likely have a degree of vicarious liability of the acts and omissions of employed staff. If it is registered as a company, a claim could be made against the practice, rather than against any one individual. The DDU offers indemnity for practices registered as a company through our corporate membership, but dental nurses may also have their own professional indemnity - or if they are not employed by the practice, this may be provided by the agency they work for.

If you are a practice principal, associate dentist or dental nurse and are involved in a similar incident to the one described above, it is important to be honest with your patients from the start about what has happened and advise them to seek medical assistance. You should also call the DDU advice line so a dento-legal adviser can offer support and guidance.


This article was correct at publication on 19/04/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.