From the CNA Claim Files
Infection Following Root Canal Therapy Leads to Six-Figure Settlement
Although dental/oral infection could be associated with any procedure, this injury is among the top three most frequent for root canal therapy (RCT) and extraction procedures, according to the CNA and Dentist Advantage Dental Professional Liability Claim Report: 2nd Edition
. It is not unusual for a patient to develop an infection associated with RCT either before or after treatment. Infection may occur with no breach in the standard of care as this is a recognized risk of RCT that may require extraction and treatment plan reassessment. Dentists may mitigate the risk of infection with RCT by performing a thorough assessment and following recommended infection control practices, including isolation of the tooth with a dental dam. Dentists also may wish to consult the ADA Clinical Practice Guideline entitled “Antibiotic Use for the Urgent Management of Dental Pain and Intra-oral Swelling
In the following case example involving infection, the dentist proceeded with RCT against his better judgment:
A female patient in her mid-30s sought care for pain in the posterior mandible. Obvious severe decay was noted on examination and treatment options were discussed. The dentist recommended extraction due to the extent of decay and the possibility of root fracture. The patient preferred to save the tooth and RCT was completed without complications.
Two days after the procedure, the patient presented with complaints of continued pain, slight swelling, and trismus. Upon examination, the dentist advised that these symptoms were not unusual and should improve progressively over a few days.
The patient did not return for a follow-up visit and did not respond to telephone calls. However, the patient sought care at a local hospital for increased swelling several days after the last dental office visit. The lawsuit described a hospital stay with antibiotic therapy, incision, and drainage, as well as ongoing medical care after discharge and lost time from employment.
Expert review found the dentist’s records to be incomplete and radiographs were not of sufficient quality. A root crack was suspected, but no imaging such as cone-beam computed tomography (CBCT) was employed to confirm or rule this out prior to treatment.
The dentist preferred to settle the case rather than proceed to a jury trial, resulting in payment and expenses of more than $100,000.
For further risk management information on dental/oral infection, consult the CNA and Dentist’s Advantage Risk Management Spotlight: Oral Infection
© Dentist’s Advantage, 2021 © The National Society of Dental Practitioners, 2021
Risk Management services are provided by Dentist’s Advantage and the NSDP to assist the insured in fulfilling his or her responsibilities for the control of potential loss-producing situations involving their dental operations. The information contained in this document is not intended as legal advice. Laws are under constant review by courts and the states and are different in each jurisdiction. For legal advice relating to any subject addressed in this document, dentists are advised to seek the services of a local personal attorney. The information is provided "AS IS" without warranty of any kind and Dentist’s Advantage and NSDP expressly disclaims all warranties and conditions with regard to any information contained, including all implied warranties of merchantability and fitness for a particular purpose. Dentist’s Advantage and NSDP assume no liability of any kind for information and data contained or for any legal course of action you may take or diagnosis or treatment made in reliance thereon.