Dentist ignored woman's 'thrashing about' in pain during wisdom tooth extraction

• A woman suffered nerve damage after a painful wisdom tooth extraction, where the dentist ignored her distress.
• The Health and Disability Commissioner found the dentist breached health consumer rights by not discussing risks or obtaining informed consent.
• The dentist, now retired, refunded the woman's fees and apologised; recommendations for improved practice procedures were made.

A woman in agony during the extraction of a wisdom tooth was ignored by the dentist as she "thrashed about" in pain.

The procedure left her with nerve damage that took months to heal, with the dentist agreeing she had had "a terrible experience".

The dentist also described the procedure as a "highly difficult extraction on a nervous patient", which was a struggle for both him and her.

Now, the Health and Disability Commissioner has found the dentist breached the woman's health consumer rights because he did not discuss the force required in the procedure or explain the potential risks, including nerve damage.

The dentist believed he had explained the procedure, but did not record this in his notes.

Deputy Health and Disability Commissioner Vanessa Caldwell said in her decision released today that a further breach had occurred in that the dental surgeon's skill was below the standard expected.

The dentist was a subcontractor at the dental practice, but has since retired and asked to be removed from the Dental Council register.

In her complaint to the HDC, the patient said she usually had treatment at a university dental practice, where she had been seen earlier about an infected impacted wisdom tooth.

She was prescribed antibiotics and told that the tooth needed to come out.

She then sought an emergency appointment at a different practice to have her lower right wisdom tooth removed because of the pain and distress she was in.

The woman said she emailed her dental X-rays from the university dental practice, but before the extraction, she was not provided with any information on the procedure and was not asked to sign any consent forms.

There was no discussion about side effects or potential risks, Caldwell said.

The dental surgeon said he would normally assess a patient for extraction, but he felt under pressure to relieve the woman's pain and distress.

'Trashed out in pain'

In her complaint, the woman described the procedure as very painful despite receiving three numbing injections.

She stated that she "thrashed out in pain many times", but the dentist ignored her and continued with the procedure.

He later said he needed to remove more bone than expected and that removal of the tooth required a "greater level of force on the tooth and the jaw than he had expected".

Afterwards, she was given no aftercare or safety-netting advice, but soon experienced ongoing pain, numbness of her tongue, and inflammation of the extraction site.

When she first raised her concerns with the practice, she was given pain medication, and then antibiotics when the pain continued, but was not told what they were for.

She was also provided with "dry socket" treatment, but was not told how to use it and what to expect.

Dry socket was described by the HDC as a painful condition that could occur after tooth extraction, when the blood clot that covered the wound became dislodged or did not form fully.

She then asked for a copy of her dental records, and was told by the practice owner that she had suffered nerve damage and that it would take months to heal.

After further investigation by her usual dental practice, she was diagnosed with possible lingual nerve damage, and the dental wound was "debrided" (removal of bone debris).

The woman was then referred to an oral and maxillofacial surgeon for further analysis and treatment.

The dentist who extracted the tooth completed an ACC claim for nerve injury, refunded the woman's fees and sent her a written apology.

Caldwell was pleased to note that the dental practice accepted the findings of an independent adviser's report and acknowledged the recommendations made, which included continued education for all staff at the dental practice about the importance of full consultation, informed consent, and thorough note-taking.

Caldwell also recommended that if the dentist returned to practice, he was to familiarise himself with the clinical technique for wisdom teeth removal, the complications of altered nerve sensation following removal, and the appropriate postoperative care.

*This story originally appeared in the New Zealand Herald.