04 March 2024

CRO Advisory

The CRO team have recently receive a number of complaints from patients following attempted extraction, especially of lower 8s.

These patients have subsequently attended hospital emergency departments and have been admitted for treatment of systemic signs of infection, severe cellulitis, and Ludwig’s angina. The medical staff have been critical of the care provided by the dentist, in particular the lack of antibiotic cover which is not required under the Therapeutic Guidelines . Significant claims for compensation have resulted, and this appears to be an increasing trend.

One common theme is the time taken for the extraction: some in excess of one hour. If clinical examination shows that an extraction is outside your scope of practice, referral to an OMFS is required and the extraction should not be attempted, regardless of the patient’s insistence. Dentists should review their extraction technique. If an extraction is not going as expected referral to an OMFS should be considered, rather than continuing.

The lack of care provided by the dentist following treatment is also a common factor in claims received by the ADAVB. Following a difficult extraction the patient should be reviewed regularly and antibiotics prescribed at the first sign of systemic infection. Extractions should be avoided on days when, you, or the other clinicians in your practice, will not be available on subsequent days to assess and treat possible complications.

The ADAVB has a CPD events in March addressing principals of surgical extraction assessment and treatment found here , and using an aseptic technique (Aseptic technique: standard and surgical). Webinars are also available on surgical extraction technique and procedures (Surgical extractions: What should I be using?).

The CROs recommend that you consider attending these as a risk management activity.