Partner
Example Case
The patient is 62 years old with a cardiac history such that she is on anti-coagulants. Her dental, and medical, history are known by her general dentist. She develops pain in her upper back tooth (tooth #2). That tooth had undergone a root canal procedure followed by the placement of a full crown. The tooth had been without symptoms for several years. She goes to the general dentist who told her that the root canal procedure should be done again told her that he can go through the crown without removing or replacing it. He does not have her sign any consent forms and proceeds on the same day to do the procedure. He does not give her any antibiotics nor does he contact her cardiologist. The dentist opens the canal, removes whatever was place there previously, refills the canal and closes the hole he made in the crown (to get to the canal). Later that day she starts bleeding from her nose so much that her husband takes her to the emergency department of the nearest hospital. That hospital does not have any dentists on staff so she is seen only by a resident physician who is in the hospital’s surgical residency program. He diagnoses a hole in her sinus and calls in the ENT physician on staff. He examines her and tell her that the dental procedure she just underwent perforated the sinus and that she needs surgery immediately to stop the bleeding and repair the perforation. The resident and ENT physician never contact the general dentist before the surgery. The surgery goes forward and the perforation is repaired and the bleeding stopped. She recovers well from the surgery but the numbness from the surgery does not go away and today, 1 year later, she is still numb in parts of her cheek and upper lip.
The Quiz
1. True or False: The general dentist committed malpractice in performing the root canal procedure because he is not an endodontist.
2. True or False: The general dentist committed malpractice in not contacting the patient’s cardiologist.
3. True or False: The general dentist committed malpractice in not giving her antibiotics when he performed the root canal procedure.
4. True or False: The dentist committed malpractice because he did not give her antibiotics.
5. True or False: The dentist committed malpractice because he did not have sign a consent for the root canal procedure.
6. True or False: The general dentist obviously perforated the sinus when he performed the root canal procedure, and that perforating it was clearly malpractice.
7. True or False: The patient should have not agreed to the procedure without consulting her cardiologist.
8. True or False: The hospital committed malpractice when it did not have a dentist examine her in the emergency room.
9. True or False: The hospital’s ENT committed malpractice because the surgery resulted in nerve damage causing her to be numb a year after the surgery.
10. True or False: If the patient sued the hospital for malpractice for causing a nerve injury, the hospital is allowed to sue the dentist.
Solutions and Takeaways
- The general dentist committed malpractice in performing the root canal procedure because he is not an endodontist. Answer: False
- There needs to be more co-morbidities to require the use of prophylactic ANTis. For example, abnormal EKG, heart valve problems, etc. There are AMA guidelines that cover this. The general dentist committed malpractice in not contacting the patient’s cardiologist. Answer: True
- The general dentist committed malpractice in not giving her antibiotics when he performed the root canal procedure. Answer: False
- The dentist committed malpractice because he did not give her antibiotics. Answer: True
- The dentist committed malpractice because he did not have sign a consent for the root canal procedure. Answer: True
- The general dentist obviously perforated the sinus when he performed the root canal procedure, and that perforating it was clearly malpractice. Answer: Maybe True. Depending on what the radiology shows.
- The patient should have not agreed to the procedure without consulting her cardiologist. Answer: True
- The hospital committed malpractice when it did not have a dentist examine her in the emergency room. Answer: False
- The hospital’s ENT committed malpractice because the surgery resulted in nerve damage causing her to be numb a year after the surgery. Answer: Not enough information to determine this–need a scan done.
- If the patient sued the hospital for malpractice for causing a nerve injury, the hospital is allowed to sue the dentist. Answer: True