Dental Injuries overview
Bringing a Claim
Dental Conditions
Fillings
Root Fillings
Extractions
Crown and Bridgework
Gum Disease
Fillings
Partly because of the mercury content of silver amalgam, and partly for cosmetic reasons, there is a growing interest in enamel-coloured composite fillings. Such fillings are, however, technique-sensitive and difficult to place in back teeth. The fillings may be very sensitive to pain or extremes of temperature; leakage may occur, causing further decay; poor contacts between teeth may occur.
Claims in relation to composite fillings are likely to be founded on consent issues, and whether the patient was properly informed about the relevant risks.
Root Fillings
The purpose of root canal treatment is to fill the entirety of the root with filling material. If the filling goes beyond the apex of the root it will have a poorer prognosis than if filled exactly to the end, or within 2 mm of the end.
If a root filling is poorly executed, this can result in chronic infection, which may cause an abscess. If the tooth has been crowned, or forms part of a bridge, all the additional work may fail also.
Although imprecise filling of a root canal does not always imply negligence, a failure to take a post-treatment x-ray, recognise any over-or under-filling, make a note on the record care, inform the patient and subsequently review the position, would be difficult to defend.
The standard procedure for root canal fillings is to take an x-ray before treating as a diagnostic aid, an x-ray during treatment to determine the working distance and an x-ray post-operatively to confirm the success of the treatment.
An alternative method of determining the working distance of a root canal is by using an electronic apex detector. Failure to use any method to determine working lengths is likely to constitute negligence.
If a root canal instrument is broken and left in the canal, while it is not negligent per se to break an instrument, there may be a claim if the dentist has not recognised the error and taken appropriate remedial action.
It would be indefensible to allow a root canal instrument to drop into the airway.
Extractions
Various claims may arise in relation to the extraction of teeth. To state the obvious, it is negligent to take out the wrong tooth.
Anaesthetic accidents are thankfully uncommon.
Most teeth are extracted under local anaesthesia. There are very strict guidelines for the use of general anaesthesia and failure to adhere to them would usually constitute negligence.
It is possible to damage important nerve structures during wisdom tooth extraction. The nerves which may be damaged are the inferior dental nerve (supplying sensation to the lower teeth) and the lingual nerve (which supplies sensation to the tongue).
While it is not necessarily negligent to damage nerves during wisdom tooth extraction it would certainly constitute sub-standard care to fail to warn of the risk. It is also vital that diagnostic x-rays are performed, to demonstrate the relationship between the roots and the canal containing the inferior dental nerve.
When a patient is consented to wisdom tooth extraction, he should be warned of pain, swelling and bleeding, as well as the risk of transient numbness of the lip or tongue.
Sometimes the jaw may be fractured during wisdom tooth removal. It is not negligent to fail to warn of this risk, unless the pre-operative x-ray reveals something which significantly inflates the risk. Breaking the jaw may be defensible, if the pre-operative assessment has been adequate.
Crown and Bridgework
A common source of litigation in relation to crowns is that they are ill-fitting, and have unacceptable marginal gaps. Consequently there may be sensitivity to heat and cold and ultimately a pulpitis (nerve inflammation) may occur. The gaps may allow food to collect, leading to gum disease and decay.
If a patient undergoes multiple crown and bridgework, there may be problems with occlusion (the patient’s bite). Altered occlusion may lead to discomfort of the tempero-mandibular joint.
A further possible complication arises because crowns made on root-filled front teeth require some form of metal post. It is possible to perforate the root while preparing the post hole, which may give rise to a claim. It is also important to ensure that posts are of sufficient length to retain the crown, and their position should always be checked by x-ray.
It is vital before placing crowns to be reasonably certain of the long-term prognosis of the tooth to be crowned. A crown should not be placed until it is clear that there is a successful outcome to the relevant root canal work.
Gum Disease
Claims concerning long-standing gum disease are on the rise, partly because patients are keeping their teeth for longer!
A common scenario is that a patient will see a dentist for many years, and then may see another dentist who alerts the patient to gum disease of which he has been unaware. Failure by a dentist to instruct a patient in oral hygiene, or to properly measure and record the health of the patient’s gums may constitute negligence.
