Decision report 201101191

Summary
Mrs C visited her dentist to have a crown checked that had been causing her pain. After treatment, Mrs C complained that the dentist had extracted a perfectly healthy crown and had failed to give her any anaesthetic at the initial attempt to extract the crown. Mrs C said that after the dentist had pulled a couple of times at the crown, she shouted at him to stop as she felt sick and was shaking badly. The dentist then administered anaesthetic and both the crown and tooth were removed. Mrs C was dissatisfied that the dentist had not carried out an x-ray to see if the tooth was fractured or needed to come out.

In response to the complaint, the dentist said that Mrs C attended the practice complaining of a loose crown and when he attempted to remove it, she experienced quite a lot of pain and so local anaesthetic was given. The dentist documented that he suspected the crown may have fractured the root of the tooth and that extraction was probably required due to the resistance and mobility of the crown. The dentist also said that very little force was required indicating advanced gum disease and that this was supported by an x-ray taken in 2006 that had shown the root of the tooth to be particularly short with surrounding bone loss from periodontal disease.

Our dental adviser said that previous treatment had been carried out on the affected tooth which meant that the nerve and blood supply of the tooth had been removed. We found that it was, therefore, appropriate for the dentist to have attempted to remove the loose crown without giving any local anaesthetic as there was no longer any nerve supply to the tooth.
The adviser stated that the pain Mrs C had been experiencing in this tooth is often indicative of an underlying problem beneath the gum, such as an infection or a fractured root. He explained that the 2006 x-ray showed the presence of gum disease and a relatively short root indicating that a lesser amount of pressure would be required to remove the tooth.

He also said that, assuming the tooth was loose and given the x-ray, it is likely that the bone loss would have progressed in the intervening years and at some point the tooth would require extraction, although it was impossible to predict when this would happen. Therefore, we concluded that the treatment provided was appropriate.