Comission critises dentist after woman suffers tooth infection for eight months

Deputy Health and Disability Commissioner Vanessa Caldwell says from the time of the initial procedure on 4 December 2019, Ms A had concerns.
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A woman whose dental implant and bone-graft failed and who suffered an undiagnosed infection for eight months says she still has pain, headaches and brain fog four years on, and ended up losing her job as a result.
In a report released on Monday, the Health and Disability Commission has criticised the dentist for failing to adequately explain the risks of the procedure, and for poor record-keeping and medication management.
The complainant, known as "Ms A", had an implant supported crown placed in her upper left central incisor by a specialist periodontist in 2009.
However, after two years of problems with the implant starting in 2017, she consulted the dentist in July of 2019.
He suggested a treatment plan involving a bone graft to support a new implant and crown, which was approved by her insurance provider.
Ms A told HDC that in discussing risks, the dentist "mentioned only that infection was a possibility, but he said that he had performed the procedure many times and only one other person had had an infection, which had healed well".
She said he made the procedure sound very low risk and "all very fixable", and never mentioned anything about the possibility of it failing.
"I really didn't think I was going to have a problem and I trusted [the dentist]."
However, in the days following the procedure, she began feeling unwell and had "a burning sensation".
Between 4 and 19 December, the dentist saw Ms A four times to assess the healing.
He could see no sign of infection but prescribed antibiotics.
On 16 December, he reported there was slight puffiness at the site of the graft, but no pus or other evidence of infection.
At 6.55am on 19 December, Ms A texted the dentist asking him to call her.
He ended up seeing her after hours and removing the "membrane" (a special wound dressing made from the patient's own blood), at her request.
"He stated that he discussed the possible complications of re-opening the site, but she was very insistent that the membrane be removed. Dr B stated: 'In the end I abided by her wishes'.
"In response to the provisional opinion, Ms A told HDC: 'This is not correct … It was his only suggestion he gave me to remedy the issue.'."
On 20 December, Ms A went to a public hospital Emergency Department with swelling to her upper lip and left cheek, but an X-ray was normal and there was no sign of infection.
She went back to the dentist on 23 December, who reassured her the site was healing well.
He gave her a medical certificate.
The patient told the HDC she asked him to write out an insurance claim but he declined, saying she was "Okay [and there was] no need to do that."
"She said that she told him that she had no more sick leave and had started to use up her annual leave, but he did not seem to care and shrugged everything off, seemingly ignoring her.
"Dr B said that the process was that she should have downloaded and completed the relevant form, which he would then have countersigned."
She phoned the clinic again on Christmas Eve, and reception staff advised her to either go to the hospital or she could see another dentist at the practice on the following Friday.
On Boxing Day, she went to the ED again with pain in her face, and was given painkillers and discharged.
She texted the dentist, asking him to call her urgently.
He called her that afternoon and she said blood tests were normal but clinicians suspected inflammation as the probable cause.
On 27 December Ms A was seen by the dentist, who extended her medical certificate to 3 January 2020 and recorded that her gum looked "ok".
The sutures were removed on 13 January by another dentist, who noted there were no signs of infection.
On 20 January and again on 18 February, she was seen again by the dentist, who assured while the site looked normal and was healing well. Ms A was upset and worried that the infection was back.
On 15 May Ms A's general practitioner (GP) referred her to an oral and maxillofacial surgeon at a public hospital, querying whether Ms A had an infected dental cyst.
Meanwhile, she had several more appointments over 2020 with the dentist , who uncovered the implant and put a temporary crown in place.
"I felt like he wasn't listening, [and I was] at a loss to know what was happening to my body.'"
On 17 August 2020 Ms A was seen by the maxillofacial service at the public hospital. The specialist noted the presence of a soft tissue pocket, peri-implantitis and bone loss, and that there was "large force put on [the] implant due to incorrect crown/implant ratio".
She was referred to oral and maxillofacial surgeon, who removed both the implant and crown on 13 October 2020.
Ms A told HDC that when the infected implant and surrounding bone in her jaw was removed, it left her with gum and bone shrinkage and stained teeth.
She said the bacterial infection had been left undiagnosed for over eight months, and it had taken a toll on her health.
"Today I still have burning, swelling and discomfort around the area where the implant use to be. I suffer from headaches, brain fog and concentration issues. Coupled with very bad fatigue. I also couldn't go back to work and I ended up losing my employment.
"Four years on from then my life has never been the same."
In response to the HDC provisional opinion, the dentist said it was "unfortunate Ms A has had to go through this".
"No one likes to see a patient struggle and their treatment not go to plan."
Two other dentists, two hospital visits and two X-rays had not found any evidence of infection either, he said.
"It seems there was a low grade bone infection… We are all disappointed and sorry for [Ms A] that she got an infection and did not get the desired outcome."
Deputy Health and Disability Commissioner Vanessa Caldwell said from the time of the initial procedure on 4 December 2019, Ms A had "concerns".
She said while the dentist pointed out the infection was only detected in December 2020 - when the hospital specialist conducted a CBCT (cone beam CT scan) - Ms A's GP had been "sufficiently concerned in May 2020 to refer her to a maxillofacial specialist".
"And when Ms A was seen at the public hospital on 17 August the maxillofacial service identified a soft tissue pocket, peri-implantitis and bone loss.
"Further, on 19 December 2019, the dentist had recorded 'infection tissue removed'."
A dental expert who reviewed the clinical record for the HDC found the dentist "demonstrated considerable skill".
"Although the procedure failed, the treatment was within his scope."
Caldwell said however, the dentist failed to provide Ms A with the information she needed to make informed choices about her treatment, and his records were "incomplete in several respects".
Dr B stopped practising dentistry in June 2021 due to a medical condition, but he said after receiving the complaint, he and the dental practice reviewed all clinicians' note-taking, and consent forms were being reviewed and updated.
The HDC has recommended that the dentist apologise to Ms A for the criticisms in the report, and before returning to practice he undertake additional education on record-keeping, informed consent, person-centred care and effective communication with health consumers.
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