Dental Claims: The Tooth of the Matter

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Clinical Negligence Article

21 November, 2019

Clinical negligence claims do not only involve medical care received in a hospital, they also include treatment and care received from your dentist. Claims can include periodontal mismanagement, dental caries mismanagement, lingual nerve and inferior alveolar nerve injuries and implant claims.

Periodontal Mismanagement

One of the most common claims regarding dentists for teeth loss is in relation to periodontal disease, also known as gum disease. It is relatively common and there are a number of stages, from gingivitis to advanced periodontitis, which can be caused by a number of factors including plaque, calculus, smoking, genetics, stress and teeth grinding.

The general duty of your dentist is to provide a basic periodontal examination (BPE) on every check-up, which is a careful assessment of the periodontal tissues and is an essential component of patient management, as well as conducting bitewing radiographs (BWs), which is an image depicting the maxillary and mandibular crowns of the teeth.

Breaches of this duty can include your dentist not conducting a BPE, not taking BWs, not responding to mobile teeth or spacing, not providing stop smoking advice, not treating with root surface debridement (also known as deep or subgingival scaling) and not referring if the treatment is not working.

Potential defences of dentists in a periodontal mismanagement claim are likely to be the patient not stopping smoking or not following oral hygiene advice. If you are considering making a dental claim, it is important to stop smoking, seek treatment whilst the claim is initiated and get an implant quote which is likely to assist with an interim payment.

Dental Caries Mismanagement

Dental Caries, also known as tooth decay, is the breakdown of teeth due to acids made by bacteria. A dentist's duty of care includes visually examining the teeth, taking BWs, conducting transillumination (passing a strong beam of light to examine the tooth) and assessing the risk level. A dentist can be in breach of this duty if they do not take BWs every 2 years (or more often for higher risk patients), not assessing diet/giving diet advice, poor radiography quality or using dental x-rays for diagnosis.

Lingual Nerve and Inferior Alveolar Nerve Injuries

The lingual nerve supplies sensation to the tongue and the gum on the tongue side of the teeth. The nerve sits on the soft tissue between tongue and wisdom tooth and can be damaged in wisdom tooth extractions.

Once damaged the patient can suffer numbness, will often bite their tongue, interferes with speech and can cause loss of taste or disturbed taste (although it is not the taste nerve, it can supply some taste ability in some people).

The inferior alveolar nerve (IAN) supplies sensation to the lower lip and chin, and the gum to the cheek side. The nerve sits deep in bone under the teeth.

A dentist can be in breach of their duty if, prior to a wisdom tooth extraction they do not warn the patient about the risks, including the fact that they can be permanent, warning but then reassuring the patient, trying to protect the nerve but failing, not referring for repair if the nerve is damaged and in the case of IAN injury, not recognising the proximity of the nerve, not using a CT scan and not offering a coronectomy, which is an alternative to having a wisdom tooth extraction.

Implant Claims

Dental implants are a relatively new treatment and are a long-term solution for replacing missing teeth. Your dentist places them directly into your jawbone, where they provide an artificial replacement for the root of your missing tooth or teeth. Nonetheless, a breach can occur if your dentist does not treat a concurrent periodontal disease before placing the implant, placing the implant when other teeth have unstable periodontal disease, not providing stopping smoking advice and the implications, there not being enough bone for the implant, as well as sinus and nasal perforations.

These are just a few examples of things that can go wrong whilst at the dentist. If you have concerns about your previous dental care or if you consider it fell below the proper standard, please contact the Clinical Negligence team on 01254 872111 to discuss the matter further.

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