The Dental Defence Union (DDU) issued the advice in an article in the latest digital journal in response to an increase in endodontic claims.
Over a ten year period up to 2014, root canal treatment featured in over 1,400 claims notified by DDU members, which was nearly a quarter of the total. There were 42 per cent more claims in the second five years than the first (838 compared with 591).
Eric Easson, DDU dento-legal adviser and author of the DDU’s endodontic claims analysis, explained:
“Root canal treatment is often regarded with dread by patients, and although the success rate is 90 per cent if carried out to a good standard, it is a significant cause of claims and complaints reported to the DDU.
“Given that over 5.6m NHS dental patients had root canal treatment in England in 2014/15 and many more would have been treated privately, it is not surprising that in a small number of cases, there is a poor outcome. At the same time, root canal procedures demand a higher level of technical skills than many other dental restorations and there are a range of risk factors to consider. In short, endodontic procedures are risky and a miscalculation can prove costly in terms of a poor outcome for the patient and the potential for a claim or complaint. It’s vital that dentists know their limitations and are prepared to refer patients to a specialist if this is in their best interests.”
Endodontist, Howard Lloyd, advises:
“If you carry out root canal treatment, it’s essential to warn patients about possible complications so they can give valid consent and have realistic expectations. These include the possibility of damage to an existing crown, the risk of post treatment flare-ups and of course, the risk of failure and subsequent tooth loss.
“General dental practitioners can be put in a difficult position, because patients aren't prepared to pay more for specialist endodontic treatment and pressure them to undertake the procedure.”
The most common allegations in the claims analysed by the DDU were that the treatment was unsatisfactory, inadequate, or failed completely leading to the patient having to have their tooth extracted. In other cases, patients suffered infections, persistent pain, or fractured teeth, or there was a fractured or retained instrument. Other cases arose because of an adverse incident such as a burnt lip or swallowed instrument or poor management such as a failure to take radiographs or to refer the patient.
Endodontic claims also proved significantly harder to defend successfully, with 62 per cent of claims settled, compared to nearly half of claims for other types of treatment. The average compensation payment was around £5,000 for endodontic cases, although one claim involving root canal treatment and other allegations settled for £65,000 plus costs. In another case solely about root canal treatment, compensation of £25,000 was made to a claimant who was left with persistent numbness and tingling in the lip.
The DDU has issued advice to help dentists reduce the risk of problems occurring with root canal treatment. This includes:
- Carry out a thorough pre-treatment assessment including relevant history and radiographs.
- Don’t undertake a procedure at the patient’s request if referral is in their best interests.
- Warn patients about material risks that they are likely to regard as significant.
- Keep a clear record of the treatment provided and warnings given.
- Keep up to date with current techniques and follow relevant protocols and guidance such as on the use of rubber dam and sodium hypochlorite.
- If something does go wrong during treatment, apologise to the patient and explain what you are going to do next, such as referring them to hospital.