Persistent Numbness After a Third Molar Extraction
A 34-year-old patient had a surgical extraction of the lower right third molar at a private clinic. The dentist used a bur to section the tooth and recorded only one line in the notes: '38 surgically extracted, no complications'. No written consent form mentioning nerve injury exists, and no post-operative instruction sheet was given. Eight months later the patient has persistent numbness of the right lower lip and chin, has burnt the lip twice while eating, and is distressed. She complains to the Council. Two weeks after being notified of the complaint, the dentist adds a new paragraph to the clinical record describing the close proximity of the roots to the canal and the warning he says he gave verbally. He telephones the patient at home to ask her to withdraw the complaint, and tells her that 'these things happen and you signed for the risks'.
1. Trace how this complaint will be handled by the Council and what the patient should expect at each stage.
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Lodging and acknowledgement. The complaint is submitted in writing with the patient's account and any records she holds. The Council acknowledges it and sends a copy to the practitioner for a response within a stated period.
Screening. A preliminary inquiry stage decides whether there is enough substance to justify a formal inquiry. Not every complaint proceeds; the question at this stage is whether a prima facie case exists on conduct or competence. The patient may be asked for further information or a clinical report.
Formal inquiry. If referred, the matter goes to the disciplinary body, which hears evidence, allows the practitioner to be present, to be represented and to answer the allegations. Expert clinical evidence is usually central. Findings must be based on the evidence, and reasons are given.
Outcomes. Possible outcomes include dismissal of the complaint, a caution, conditions on practice, suspension for a period, or removal from the register, and the body may also make recommendations about the practitioner's practice. The Council's process addresses professional conduct and competence. It does not award the patient damages; compensation is a civil matter, and she may separately pursue a negligence claim, with a limitation period that she should be advised about promptly.
What she should expect. A written outcome with reasons, and an explanation in plain terms. She should be told that the process takes time, and she should keep her own clinical records from the treating hospital or specialist who assesses the numbness, since her evidence of ongoing injury is important.
2. The dentist argues that nerve injury is a recognised risk and therefore cannot be negligence. Evaluate that argument.
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Partly right, and mostly beside the point. Injury to the inferior alveolar or lingual nerve is a recognised complication of lower third molar surgery and can occur with impeccable technique. The mere occurrence of numbness therefore does not establish negligence, and the patient should be told that candidly.
Where the argument fails. The standard of care is not 'did a known complication occur' but 'was the patient adequately assessed, warned, treated and followed up'. Four issues arise here:
- Assessment. Were pre-operative radiographs taken and the relationship of the roots to the canal assessed and recorded? The new note suggests that it was known, but only after the event.
- Consent. A recognised, material risk of permanent numbness must be disclosed in a way the patient can understand and remember. A verbal warning that cannot be evidenced is weak, and 'you signed for the risks' is meaningless if no document exists.
- Technique and records. A single-line operative note does not show sectioning technique, flap design, difficulty or haemostasis. Poor documentation makes the care impossible to defend, though it does not itself prove poor surgery.
- Follow-up. Persistent numbness should have triggered review, referral and documented advice about lip care to prevent burns. No post-operative instruction sheet and no follow-up record are omissions.
Conclusion. The risk argument may defeat a claim that the surgery was performed negligently, but it does not answer the consent and follow-up deficiencies, which are freestanding breaches.
3. Address the post-complaint conduct: the added note and the telephone call. Advise the dentist on what should have happened and what to do now.
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The added note. Adding a paragraph about root proximity and a warning, weeks after notification and without any indication that it is a later addition, is not a record correction; it is the creation of evidence to meet a complaint. If a genuine recollection surfaces later, the correct method is an addendum clearly dated on the day it is written, labelled as a late entry, stating why it is being made, signed, and kept alongside the original - never written into the body of the original note. As done here, it damages the dentist far more than the original gap: it undermines every other record he relies on and is independently a serious professional conduct issue.
The telephone call. Contacting a complainant to ask her to withdraw, and asserting that she 'signed for the risks', is an attempt to interfere with the regulatory process and to pressure a patient. Even a well-meant call is improper once a complaint is lodged; all communication should go through the Council or the insurer's lawyers. The assertion is also inaccurate on the documents available.
What to do now.
- Do not alter anything further; preserve the record as it stands and be able to explain honestly when and why the paragraph was added. Concealment is worse than the original omission.
- Respond to the Council fully and frankly, addressing the documentation, consent and follow-up issues.
- Notify the indemnity provider immediately and take legal advice before any further contact with the patient.
- Consider open disclosure through the proper channel: an explanation and apology for the communication failures, without arguing that no injury occurred.
Likely view. The clinical care may be defensible; the post-complaint conduct is likely to be found more serious than the original complaint.