Appropriate Assessment Not Completed By Dentist Prior To Undertaking Complex Wisdom Tooth Extraction

Dr Caldwell found the dentist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to provide services with reasonable care and skill to a woman in the removal of one of her wisdom teeth. The dentist proceeded to remove the woman’s wisdom tooth without clarifying a second opinion from an oral and maxillofacial surgeon. The procedure was complex and the actions of the dentist resulted in nerve injury, an increased chance of infection and pain, and anxiety for the woman.

The woman sought treatment from the dentist for pain in her lower left wisdom tooth. Removal of the wisdom tooth was discussed with the woman and a second opinion was sought from an oral and maxillofacial surgeon at another dental service regarding removing both lower wisdom teeth (which were not fully formed). The oral surgeon advised they would consider extracting both teeth and asked the dentist to refer the woman to them.

The dentist proceeded with extraction of the woman’s wisdom teeth, but due to complications during the surgery only extracted the lower right tooth, and not both teeth as planned.

Following the surgery, the woman felt very unwell and was subsequently referred by the dentist to an oral and maxillofacial surgeon. The woman underwent surgery by the oral surgeon to treat complications from the extraction of her first wisdom tooth by the dentist.

This case highlights the importance of practitioners appropriately assessing the complexity of a procedure, and obtaining a second opinion if required, to ensure they are practising within their professional knowledge, skills, and competence, as set out in the New Zealand Dental Council’s professional standards.

"I am critical that as part of assessment of the procedure and patient, the dentist, having recognised a second opinion was required before progressing, did not clarify this request with the Dental Service to obtain this before proceeding with the surgery," says Dr Caldwell.

Dr Caldwell did not consider the error that occurred indicated broader systems or organisational issues at the dental practice.

"In my view, the dentist’s errors were the result of individual clinical decision-making, and were not due to any shortcomings in the policies and procedures of the Dental Service," says Dr Caldwell.

Dr Caldwell recommended the dentist develop a system for the assessment of patient complexity for surgery; implement a system where consultations with a specialist for an opinion are recorded in the dental records; undergo further training on the removal of wisdom teeth; audit a sample of ten patient records to ensure all records are dated; and provide a written apology to the woman.

Editors notes

The full report of this case can be viewed on HDC’s website - see HDC's ' Latest Decisions'.

Names have been removed from the report to protect privacy of the individual involved in this case. We anticipate that the Commissioner will name Te Whatu Ora - Health NZ (previously DHBs) and public hospitals found in breach of the Code, unless it would not be in the public interest, or would unfairly compromise the privacy interests of an individual provider or a consumer. HDC’s naming policy can be found on our website here.

HDC promotes and protects the rights of people using health and disability services as set out in the Code of Health and Disability Services Consumers' Rights (the Code).

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