The background

I am a dentist who only does surgery for dental implants - extractions, implant placements and grafting for implants. That's all I do.

Some years ago, I saw a patient for an implant assessment. She had been having toothache for some months and she'd had enough. I went through the options with her, but she wanted the tooth removed and she asked if it could be done then and there.

Using two ID blocks and local infiltrations, I extracted the tooth using luxators and forceps. My notes from the time included the phrase 'Curettage +++', as every set of pre-scripted extraction notes said the same thing.

To our team, this meant that we had checked the socket and had cleaned out any granulation tissue that was there, in preparation for a later implant once the socket had healed.

I wrote nothing unexpected about the extraction in the notes from the appointment, and from reading them back, the extraction had seemed rather unremarkable.

The patient reports a problem

The patient phoned the following day to say that she was still numb, and I arranged to see her at her earliest convenience, which was five days after the extraction.

She reported that she had experienced an 'electric shock' when I had given her the IDB, as well as that her left lower lip and chin felt both numb and tingly and she had some tingling of the left side of her tongue.

My diagnosis was one of neuropraxia with an intact nerve. I explained that I thought the nerve was intact and so the symptoms were likely to fully resolve, but that it may take some weeks to do so.

The patient rang a few weeks later saying that the tingling and burning feeling was really affecting her life. I therefore referred her to a specialist dental nerve injury clinic, giving the full story and saying that I didn't know if the symptoms had been caused by the ID block or by the curettage of the apical granuloma.

The letter arrives

And that was the last I heard of this patient case until I was finishing up for Christmas almost two and a half years later. My practice manager emailed me to say that she had received a letter from the patient's lawyers.

This was right out of the blue - I really didn't see it coming. I was shocked, but I also felt some embarrassment and shame that I was being sued by a patient. This was a first for me.

I knew nothing about what to do about the lawyer's letter other than to contact the DDU, so I phoned them immediately. They were great, guiding me through the process of responding to the letter and what information they needed - my records, but also my initial thoughts about the case - all of which was a bit of a rush before finishing for Christmas.

I also emailed all my dental colleagues at the practice and the practice managers, letting them know what was happening. They have all been great, and I have always felt it is better to be open about the whole process with them, rather than try to keep anything a secret.

Writing a witness statement

A few months later, I was asked to give a formal witness statement. I had no idea what this was and what I should write, but the lawyer from the DDU who was handling my case guided me through the process.

This statement is a formal legal document that everyone relies upon during the pre-trial discussions and again during court proceedings. I truthfully didn't realise just how incredibly important it was at the time.

My lawyer gave me a whole series of questions and then we had a long online chat about the answers. Finally, he took all my information and set it out in the form of the witness statement.

My advice for anyone in a similar situation is to really take your time over this witness statement. Get every tiny point correct, as everything you write will be picked apart by the claimant's legal team and expert witness in the months and years to follow.

The case comes to court

What followed was a long, four-year period of hearing very little about the case, until it became clear that we were heading to court. Then a lot happened in a very short time!

I discovered that my team at the DDU had grown to include another DDU lawyer and my amazing barrister. I also had my expert witness, who been busy writing his own report as well as meeting with the claimant's expert witness, to give their opinions on some points pre-trial.

One of these was an agreement that if it was determined that the patient's nerve injury had occurred as a result of the ID block and not the curettage of the socket, then that would not be deemed negligent.

For a while, it seemed like it was touch and go as to whether the case was actually going to court. During this period, I said to my team on one of our frequent meetings that the cost of going to court was going to be far greater than the cost of settling - even if we ended up winning our case.

I really wasn't precious about 'clearing my name' and said that whether they chose to settle the case or to defend it in court, I would be fine with their decision. But my lawyers said they all felt this was a winnable case, and that we should strongly defend claims when we can.

Preparing for trial

During this waiting period, I got busy so that I could answer the question about the phrase 'Curettage +++'. It was a note I commonly used and not an actual description of me scraping the hell out of the ID nerve!

I spent a few hours auditing the two months of extractions following the patient's nerve injury, looking at the extraction notes to see how many had 'Curettage +++' in them. Fortunately, 100% of the extraction notes had this exact comment written in them, with no alternatives like 'Curettage +' or 'Curettage ++' instead. Although I couldn't put the patient names on the spreadsheet, I could put their unique patient numbers on it, so the whole process could be verified if necessary.

After that, it was off to a week at trial - seven years after I'd extracted the tooth, and more than four after I'd first heard about the claim. This was a civil claim and had nothing to do with the GDC (thank goodness!), but I had never been in a court before, let alone as the person being sued, so it was all a new and frightening experience. But again, my DDU team was amazing throughout.

Expert witnesses

And then it was time for the expert witnesses. Although the claimant's expert witness was a professor, he hadn't been asked to examine the patient in the four years since he had been instructed by her solicitors and had only carried out a phone consultation with her.

His cross-examination was at times painful to watch. He was clearly an experienced expert witness, and so he sat there very calmly saying, "I disagree" over and over as my wonderful barrister poked hole after hole in his testimony.

Then my expert witness took the stand. He was an expert in dental nerve injuries, having run nerve injury clinics every month for 25 years. His testimony was also calm and measured, but it was extremely persuasive too.

The claimant's barrister cross-examined him for five hours, trying to trip him up without any success. By the end, even the judge was getting tired of the barrister going over and over the same points. He was an absolute legend!

Resolution and relief

And that was it - a week in court followed by the wait for the judgement. I had hoped that this might be a week or two, but it ended up being four months before the judge ruled in my favour on all counts. He excoriated the claimant's expert witness in his judgement and praised our expert witness.

So that was that. It was all over. I felt elated at having won, but also slightly deflated by the whole experience. All that had been proved was that I hadn't acted negligently. I knew I had still caused that patient's nerve injury - I just did it with the ID block and not by curetting the socket.

It felt like a huge waste of everyone's time and resources - why couldn't the claimant's expert witness have been more thorough? The patient would have been spared the huge expense of trial if her advisers had given her good advice.

Finally, my whole DDU team were incredible from start to finish. They helped me at every stage and were encouraging when I felt disheartened and discouraged that this was happening to me. They were so thorough and every one of them was outstanding. If you are ever in the same boat as me, they'll get you through it safely.

The views expressed in this article are those of the author and do not necessarily reflect those of the DDU.