In April 2018 in New Zealand, a twenty something year old woman had to spend two nights in the intensive care unit (ICU) after having a wisdom tooth removed. The woman had a lower right wisdom tooth extracted. This was after she presented at a dental clinic and told the dentist that she had experience on and off pain for over two years near the lower right wisdom tooth. Recently she had constant pain for over a week and and found it difficult to eat or open her mouth. The dentist diagnosed pericoronitis, which is inflammation of the tissue surrounding wisdom teeth and said the woman could either have an antibiotic to take or have the wisdom tooth extracted. The woman elected extraction.
In the days that followed the woman “was in pain, her face was swollen, and she could not open her mouth.” She returned for three subsequent visits with the dentist who performed the extraction. In the first post-operative visit, five days after the wisdom tooth surgery, she said she was not given a prescription or treatment and records from the dental office don’t show her as having even visited that day. In the second post-operative visit, two days later than the first post-operative visit, the woman said the dentist washed her injury but no medication was prescribed and records from the from the dental office also don’t show her as having even visited that day. In the third post-operative visit, three days after the second post-operative visit complained that teeth in front of the wisdom teeth extraction site were painful and she was noted to have swelling and limited mouth opening.
In the third post-operative visit the woman mentioned to the dentist that she had begun taking antibiotics (specifically later found to be levofloxacin) for the past two days that she had obtained from overseas. The dentist decided to prescribe the woman amoxicillin to treat what was believed by the dentist at the time to be dry socket. Due to lack of records, there is some dispute between the dentist and the woman about the discussion over the amoxicillin. The dentist attests the woman said she wanted to keep taking the antibiotics from overseas and tried to obtain the name of this antibiotic but was unable to. The dental service director of the clinic said that ultimately the woman left the dental clinic on the third post-operative visit without a script for amoxicillin. However, the woman said she did fill the prescribed amoxicillin and took it.
Three days after the third post-operative visit with the dentist who extracted the wisdom tooth, the woman returned to the dental clinic without an appointment. She was told her original dentist was not available but elected to see another dentist at the clinic. This dentist checked the woman’s socket and said it was improving and continue with the antibiotics. There were no records of what occurred for this visit, although the dentist who say the woman says he did complete records and they “seemed to have gone missing.”
After this appointment, the following day, the woman decided to visit a different dental clinic. While there she was given augmentin and metronidazole and told to come back in a week to reassess. A day after visiting the second dental clinic, the woman visited a medical center. She was in severe pain, had a fever, had a swollen right mandible and neck, and had an upset stomach. In the emergency department, the on-call dentist observed pus in the woman’s right submandibular space. She was taken for surgery that included incision and drainage and a two night recovery in the ICU.
In a report by the Health and Disability Commissioner in New Zealand, it is said that the original dentist failed to recognize that the woman’s complication was an infection and not a dry socket. The report says the dentist
“… both failed to diagnose an infection…., and also failed to provide the appropriate treatment for his inaccurate diagnosis of a dry socket.”
The report says the expected treatment for infection is to prescribe the correct antibiotic and possibly curettage and irrigation of the socket. The report said
“…a patient who is taking self-prescribed medication is a significant ‘red flag’, and that [the dentist] should have investigated further to ascertain what antibiotic [the woman] was taking.”
It is also noted in the report that the antibiotic the woman was taking from overseas, levofloxacin, in the case of a dental infection, can lead to a super infection. The report indicates that the original dentist failed to recognize the complication was an infection and also did not provide the correct treatment for dry socket. Further, the original dentist failed to find out what antibiotic the woman was taking on her own and failed to use this opportunity to recommend she stop taking it and to take amoxillicin. The report states
“I find that [the dentist] failed to provide services to [the woman] with reasonable care and skill and, accordingly, breached Right 4(1) of the Code of Health and Disability Services Consumers’ Rights (the Code).”
The report was also highly critical over the lack of maintaining adequate records and as such found the dental clinic did not comply with professional standards mandated by the Dental Council in New Zealand. The report states
“I consider that the poor record-keeping and missing records also indicate broader systems issues at the practice.”
Further, the report was critical of the policies the dental practice had to deal with the situation when a patient is taking a medication not prescribed by that dental practice to treat a dental condition. The report made several recommendations. This included an audit of the records of the dental practice to ensure that adequate records are maintained. In addition, this included that the dental practice develop a policy to ensure dentists are aware of the risks to patients who take medications provided by others. This also included that the dentists at the original dental clinic complete training on medication management and post-extraction infections. Further, the original dentist was recommended to take training on maintaining adequate clinical records.
Sources:
- NZHerald, “Wisdom tooth removal: Young woman spends two nights in ICU after failures by dentist,” Oct, 11, 2021. https://www.nzherald.co.nz/nz/wisdom-tooth-removal-young-woman-spends-two-nights-in-icu-after-failures-by-dentist/M3ULRAUMSILOWFC3MUBWCQTQD4/
- Health and Disability Commissioner. A Report by the Deputy Health and Disability Commissioner. Case 18HDC01168. New Zealand. June 30, 2020. https://www.hdc.org.nz/media/5606/18hdc01168.pdf