Dr L, a recent graduate, worked in a public health clinic. The clinic was busy, and often demand outstripped resource. Most days Dr L had the support of additional, more experienced practitioners, but on Fridays, Dr L was the sole practitioner. Fridays could be famine or feast, with some days patchy and others in overdrive. This particular Friday was the latter, with more patients scheduled than Dr L could reasonably see.
Mr W attended with pain in quadrant 2, which he reported to be a constant ache that was causing sleep disturbance. Examination revealed gross caries in 27, 26, 25 and 24. 27 was badly broken down and unrestorable. 26 and 25 were TTP with caries extending into the pulp. 26 and 25 tested negative to EPT, however 24 was not TTP and responded to the EFT within normal limits; consequently, 24 was judged likely to be restorable.
Dr L advised Mr W of his findings, and Mr W was pleased that 24 could be saved, as he had a shortened dental arch on the upper right hand side, so he felt he could still function if the 24 remained. It was agreed that Dr L would extract 25, 26 and 27 that day, and Mr W would return for the filling on 24.
The 26 decoronated during extraction, so Dr L decided to remove the premolar unit, and give themselves more space to access the 26 and 27. Regretfully, the loss of landmark of the 26 crown, in a situation where Dr L was already flustered, running late with several patients in the waiting room, and rattled by the unanticipated difficulty of extraction of 26, led to Dr L placing the forceps on 24, which he successfully delivered. Distressed when he realised his mistake, Dr L quickly removed the 25, 26 and 27 as planned and then sat Mr W up to break the bad news to him.
Understandably, Mr W was devastated, as this now led to him having only the 23 and anteriors on that side to function.
Dr L apologised and, while awaiting haemostasis, stepped out to call his mentor. His mentor suggested that it would be appropriate to replace the tooth, and perhaps Mr W would value an upper partial cobolt chrome to restore his occlusion. Naturally, this could be provided by the clinic at no cost. Dr L proposed this solution to Mr W who was grateful the offer had been made and, ultimately, after a period of healing, the cobolt chrome was inserted.
Learning points
- Mistakes often arise when we are flustered or distracted
- A mentor or senior clinician can be a helpful guide when things do not go to plan
The dentolegal view
by Dr Annalene Weston, Dentolegal Consultant at Dental Protection
This unfortunate incident, although considered by many to be unavoidable, occurs all too often. Some helpful strategies to avoid extracting the incorrect tooth include marking the tooth with an appropriate pencil or pen, and getting the patient to check in the mirror once the mark is made, to make sure that the patient agrees it is the correct tooth. Another helpful strategy is known as “pointing and calling”; more information can be found here.
Critically, do seek advice if a tooth is incorrectly extracted. Dr L was lucky to have a supportive mentor who was able to find an acceptable clinical solution in a timely fashion. Many incorrect extractions do not resolve so promptly and amicably. Please do contact Dental Protection, should you find yourself having incorrectly extracted a tooth.