Dr M was a recent graduate who had been working as a dentist for around 12 weeks. He was the only practitioner in on Easter Saturday and was leaving that night for a holiday. Mr D attended as a walk-in emergency with constant pain, keeping him awake at night. The clinic was ending, and the practice closing, but Dr M did not feel that he could turn Mr D away. Mr D pointed to tooth 27 as the cause of his pain, and Dr M could see a large filling in this tooth. Dr M took a PA, which captured 17 16 15, but not the apices of these teeth. The x-ray revealed a large composite filling, proximal to the pulp in tooth 17. 17 was mildly TTP and responded non-vital to cold spray.
On discussion of his options, Mr D agreed to an emergency extirpation of 17 on that day, for relief of pain, and for his treatment to be continued after Dr M returned from annual leave. The procedure was uneventful.
Dr M returned from annual leave to find a letter from the regulator, as Mr D had complained that Dr M had treated the incorrect tooth. Mr D claimed that the pain had not abated after his treatment, and that he had attended another dentist who had identified a cavity on tooth 15 as the cause of the pain. Extirpation of this tooth immediately resolved the pain. He now believed that he needed an additional root filling due to a misdiagnosis.
A PA was included in the bundles of documents with the complaint, and this showed 17 16 15 14 and their apices. There was a clear clinical cavity in the 15 which extended to the pulpal complex and 15 had a visible peri apical area. Dr M quickly opened his clinical notes to compare the x-rays and look at his examination and findings on that day. To his horror he found that he had coned off the x-ray, and, worst of all, in his haste to leave the practice for his holiday, he had not made any clinical records. Dr M entered records about the appointment from his recollection, appropriately dated when he made them, not the date of the treatment. He contacted Dental Protection.
Ultimately, the regulator requested a meeting with Dr M to consider the issues. He was able to explain what he had seen on that day; however, as the records had not been written contemporaneously, it was impossible for him to truly prove what he said.
However, the regulator was impressed by Dr M’s honesty about why he failed to make records and his integrity in making them without attempting to falsify when they had been created. Dr M had also attended some targeted record keeping CPD, and improved his processes regarding the creation of records, which he was able to evidence. He had also enrolled in a radiography course.
The regulator counselled Dr M on the positioning of his x-ray and encouraged him to look at the whole side of the mouth, not just ‘one tooth’ as the cavity on 15 was clearly apparent. The regulator accepted that Dr M was not lying about the findings of the testing of 17, and formed the view that booth teeth were non-vital, although 15 was the likely cause of Mr D’s pain on the day he presented.
Dr M received a stern telling off, but no other action was taken.
Learning points
- Ensure you create accurate records as soon as possible after seeing a patient, and preferably before you see the next one
- Additions to dental records can be made, providing they are appropriately date stamped
- Look beyond one tooth when examining an emergency patient
- Honesty is always the best policy.