9 August 2022

Question mark on dentist’s competence for extracting wrong tooth

Incorrect extraction of tooth by a dentist has raised the question of the most basic requirements of a competent dentist in a report released by the Deputy Health and Disability Commissioner.

The dentist, Dr B* subject of this report, pulled out the wrong tooth despite his patient *A’s resistance during the extraction process.

In her report, the Deputy Health and Disability Commissioner Dr Vanessa Caldwell has found the dentist, Dr B in breach of the Code of Health and Disability Services Consumers’ Rights and has been referred to the Director of Proceedings with recommendations to the Dental Council to consider whether a review of the dentist’s competence is warranted.

According to the report, the complainant, Mr A (in his forties at the time of events) was booked for extraction of his sore and loose “upper front tooth” (tooth 52) with Dr B at a dental service on 3 December 2020. However, Dr B removed tooth 17 by ‘wrongful assumption’ and subsequently the correct molar after realising mistake.

When asked where the toothache and the tooth to be extracted was located, Mr A recalls stating to the dental assistant, Ms D* that it was the tooth “top to the right”.

Patient’s request for an Xray was declined by the dental assistant and Dr B relied on an earlier Xray of the patient taken in November 2020.

As per the info gathered by HDC during investigation, while sitting on the dentist chair the complainant, Mr A recalls Dr B asking him to open his mouth and took a “very quick glance” before walking away. Mr A told HDC that at this point he had some concerns because his interaction with Dr B had been very short. “We did not discuss anything, nor the procedure or risks were informed in detail.”

The dentist started extraction procedure on tooth 17, despite the patient’s vain efforts to convey it was the wrong tooth.

After the anaesthetic injection was administered, Mr A raised his hand in an attempt to point to the correct tooth that was loose. But “Dr B interrupted me and said, please put your hand down…” As a result, Mr A was unable to point to the correct tooth.

“The dentist stopped the extraction midway, as he encountered resistance, and realised the wrong tooth was being extracted,” Caldwell says in her report.

“The dentist asked the man to confirm which tooth he wanted removed, and, despite the man identifying another tooth, continued with the initial extraction without obtaining consent from the man, before proceeding to extract the correct tooth,” says the Deputy Health and Disability Commissioner.

“Throughout the process, the dentist only briefly asked the man about the location of the tooth he wished to have extracted, provided minimal information about the treatment proposed, and made assumptions about his wishes and expectations for care,” she said.

Dr B acknowledged to HDC that he made an incorrect assumption when deciding to operate on tooth 17, because he had remembered from Mr A’s November appointment that he had a decayed tooth on his right.

After the wrong extraction, “I told the patient that the 17 was so badly decayed, that it was good that we removed it to save (Mr A) the hassle of coming in again when it became symptomatic…” Dr B told HDC.

In the findings of her report, the Deputy Commissioner considered that the “dentist did not obtain an adequate history from the man or conduct an appropriate clinical examination prior to proceeding with the extraction, and, consequently, failed to identify the correct tooth for extraction.”

Additionally, the dentist “did not provide adequate information to the man about his diagnosis, the options available for the management of his tooth, and the plan to extract the first tooth the dentist extracted.”

HDC also concluded Dr B created false clinical records by incorrectly documenting that he had obtained consent for the extraction of tooth 17, and not noting that tooth 17 was removed in error.

The Deputy Commissioner has recommended Dr B to apologise to the patient and undertake further training. She has also recommended that the “Dental Council consider whether a review of the dentist’s competence and conduct is warranted.”

The DHB has also been recommended to undertake an audit of the dentist’s recent tooth extractions, including documentation.

*Names removed to protect privacy, and identifying alphabetical order bear no relationship to the person’s actual name.

Comments are welcome