The importance of discussing and documenting everything with your patients cannot be over-emphasised, as this case proves.
During endodontic treatment of a lower first molar tooth, the dentist separated a file in the early stages of the procedure without the apical 2/3 of the mesio-buccal canal being instrumented in any way. The endodontic treatment was completed without any comment to the patient about the separated file or the possible future implications.
The tooth never settled down following this treatment, in spite of frequent prescriptions of antibiotics. No explanation was offered to the patient, who repeatedly asked why the tooth was not responding. Eventually another dentist extracted the tooth while the patient was on holiday.
The second dentist explained the need for an extraction and made the patient aware of the broken file. A settlement was agreed with the patient not because the file had separated during treatment, but because the dentist failed to discuss and document the presence of the file.
The implication that a separated instrument has on the prognosis for a tooth depends on its position, its effect and whether or not the canals can be effectively sealed. The equipment and techniques required to resolve a situation such as this, where the treatment of choice is the removal of the separated instrument, are often best achieved by referral to a specialist endodontist if available.
Learning points
It is imperative that patients are fully informed about treatment options and their associated risks and benefits and are given the option of seeing a specialist if appropriate. This is particularly important if the treatment might exceed the dentist’s skill and experience and ability to deliver an acceptable standard of care. A clinician should not be pushed into undertaking treatment that is out with their experience or scope, but refer appropriately
It is also important to remember that when things do not go to plan, the dentist has a Duty of Candour to inform the patient.
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