This case study has been published with the member's permission.

The scene

During an initial consultation with a patient, a dentist identified retained roots at LL5 and LL7, which required extraction. Radiograph images showed the second molar had divergent roots, and the dentist explained he would need to section the roots before he could carry out the extraction.

The patient, who was accompanied by a family member to interpret for them, consented to the dentist's treatment plan and returned several days later for the procedure under local anaesthetic.

The dentist went through the treatment plan again and agreed a hand signal with the patient if they wanted to stop at any point. The same family member accompanied the patient and an experienced dental nurse assisted the dentist. After successfully extracting the first root, the dentist found that the patient became fidgety and kept talking when he was using the drill, meaning the treatment had to be stopped several times.

During this part of the procedure, the floor of the patient's mouth was inadvertently damaged by the drill being used. The contemporaneous records noted a superficial abrasion with negligible bleeding and only redness. The dentist paused the procedure to check on the patient and apologised before completing the extraction.

The dentist arranged for the patient to be reviewed by the in-house oral surgeon and the patient also consulted the hospital and their GP. Unfortunately, the wound to the floor of the patient's mouth did not heal as expected, and they developed a ranula that required treatment.

The claim

The dentist contacted the DDU after the patient brought a claim alleging negligence for failing to take appropriate steps to protect the soft tissues during the procedure. They also contended that the dentist should have deferred or stopped the procedure and referred the patient for extraction under general anaesthetic, that they had not been properly warned before drilling started, and that there was a failure to take account of their general anxiety and communication needs.

The claimant sought damages of over £21,000 for the injury and its consequences, including the need for treatment and the associated pain and psychological damage.

After obtaining supportive expert reports, the DDU put forth a strong defence of the member's actions, and the case eventually went to trial.

The outcome

The judge found that the dentist followed recognised, responsible practice in the assessment and treatment, including the steps taken to protect the patient's soft tissues using the dental mirror and suction device. The judge accepted expert evidence that "the trauma that occurred was a result of an accident and could not necessarily have been avoided".

He rejected the argument that the injury was itself evidence of lack of care and that the dentist should have stopped and referred the patient to a more experienced colleague. Accordingly, breach of duty was not proved and the claim was dismissed.

Learning points

While the judge found in favour of the DDU member, this case highlights the pitfalls of managing an anxious patient who is being supported by a family member as interpreter and who may have difficulties in understanding and expressing themselves.

For more information on this topic, see the DDU's guide on how to handle challenging patient interactions and always seek dento-legal advice if you have specific concerns.