The scene

A patient attended a DDU GDP member for placement of a restoration and extraction of an upper molar. The member explained the treatment and the associated risks and benefits and gave the patient a consent form which specifically included the risks of swelling, bruising and discomfort. The patient had also had other posterior teeth extracted before.

The member placed the restoration and then administered local anaesthetic for the extraction. Swelling began intra- and extra-orally, and so the member stopped the treatment. The patient developed a large haematoma and considerable bruising, which resolved within a few weeks.

The claim

The patient instructed solicitors to pursue a claim against the member. They alleged the member had failed to discuss - adequately or at all - the risks and benefits of the extraction, and had therefore failed to obtain valid or adequately informed consent.

The claim also alleged a failure to ensure the injection of the local anaesthetic did not penetrate or damage any blood vessels, leading to the injury in question.

How we helped

As is typical when assessing a member's case to see if it can be successfully defended, we consulted an independent expert to give an opinion on the treatment provided.

In this instance, the expert was wholly supportive of the member’s care, and we argued that the patient had been appropriately consented for the procedure.

We also held that it's impossible to prevent occasional penetration of blood vessels when injecting local anaesthetic. Because the dentist cannot see the tip of the needle inside the tissues, such penetration does not constitute a breach of duty. As such, the injury in question could not have been foreseen or avoided.

The outcome

The DDU set out the supportive evidence in a formal letter of response. The claimant did not accept this and served court proceedings on the member, but we maintained our stance of denying liability and served a robust defence.

The claimant subsequently made low settlement offers that we rejected, and because the claimant still refused to drop the claim it progressed through the rest of the process to trial.

The member, the claimant and the independent experts instructed by each side all gave evidence and were cross-examined. The judge found that the needle passed through a very small artery in a fraction of a second, and the needle tip would have been resting in the membranes and not the artery, which would have been occluded by the presence of the needle. As a result, blood would not have aspirated into the syringe.

The judge found in favour of the DDU member, ruling that the duty of care had not been breached and also criticising the claimant's expert. The case was therefore dismissed.