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Incorrect Extraction Of Tooth Neglects The Most Basic Requirements Of A Competent Dentist

Deputy Health and Disability Commissioner Dr Vanessa Caldwell today released a report finding a dentist in breach of several rights in the Code of Health and Disability Services Consumers’ Rights (the Code) for removing the wrong tooth for a patient under his care, and referred him to the Director of Proceedings for legal review.

A man in his forties attended an appointment with his dentist, with the intention of having his right front tooth 52 removed, as it was sore and loose. 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. As a result, the dentist mistakenly assumed that the man wanted tooth 17 to be extracted, and extracted this without his consent.

The dentist stopped the extraction mid-way, as he encountered resistance, and realised the wrong tooth was being extracted. 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.

Dentists must ensure they provide treatment with reasonable care and skill, and obtain informed consent for the treatment they provide. Having the consumer identify which teeth he or she wants to be extracted is a basic step to obtain informed consent for a tooth extraction.

In her report Dr Caldwell said 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. She also found that the dentist did not provide the man with adequate information about the procedure; did not gain informed consent, nor maintain adequate or accurate records.

Dr Caldwell stated that the care provided neglects the most basic requirements of a competent dentist. This case highlights the importance of accurate record keeping, conducting robust clinical examination and obtaining informed consent from patients for any treatment provided.

In addition to a referral to the Director of Proceedings, Dr Caldwell recommended the dentist apologise to the man and undertake further training. She also recommended the Dental Council of New Zealand consider whether a review of the dentist’s competence is warranted and the DHB undertake an audit of recent tooth extractions by the dentist.

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