Membership information 1800 444 542
Dentolegal advice 1800 444 542

To prescribe or not?

05 June 2020

Mr T, a 57-year-old male and a long-standing patient of the practice, attended an emergency appointment with pain from tooth 14. The tooth had a deep MOD restoration which had been placed six years ago and had been symptom-free for that time. The medical history was updated at the time and it was clear. The patient was a non-smoker and took no medications.

Mr T complained of pain for two days, which had kept him awake at night, and he was taking painkillers. He reported no other symptoms and was not pyrexic. Upon examination the tooth was very tender to percussion and did not respond to vitality testing. There was no observable inflammation or swelling and a periapical radiograph revealed that the tooth had periapical periodontitis. The dentist Dr F discussed the options to manage the situation and these included doing nothing, which was unsuitable as the patient had symptoms, RCT and the extirpation at that appointment, and the last option was extraction. Pros and cons were explained for every treatment option. Mr T opted for RCT and extirpation and Dr F proceeded with that. After completing extirpation of the diseased pulp, advice was given about further painkiller usage and an appointment was made in two weeks’ time to complete the RCT.

Mr T failed to attend that appointment and two months later the dentist received a letter of claim from solicitors. From the letter it was apparent that Mr T attended hospital a few days after the extirpation appointment with facial swelling, which was treated with IV antibiotics. Unfortunately, he clearly considered that his experience was the result of poor treatment at the emergency appointment.

The solicitors alleged that Dr F failed to provide adequate emergency treatment and prescribe systemic antibiotics; had these been prescribed, the solicitors alleged, the outcome could have been avoided.

After comprehensive assessment of the records and discussions with Dr F, the case was successfully defended as Dr F's records evidenced a thorough assessment took place at the emergency appointment. The cause of the symptoms was correctly identified and appropriate advice and treatment had been provided. It was argued that Dr F had acted in accordance with the Oral and Therapeutic Guidelines, as there had been no indication based on Mr T’s presentation that systemic antibiotics were required.

Learning points

The law on consent provides a framework that protects patients’ rights to decide about their treatment. In this case all treatment options were explained with their associated risks and benefits.

The full symptoms of the patient were assessed and recorded in the notes, where it was clearly indicated that the lack of systemic involvement meant that local measures were indicated, and not systemic use of antibiotics.

Had the records not been as thorough, then defending the claim could have been much more difficult.  


These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription. 
For more detailed advice on any issues, contact us

© 2010-2024 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142) with its registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. All the benefits of MPS membership are discretionary, as set out in the Memorandum and Articles of Association.

“Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADAWA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS

Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADAWA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADAWA membership.

None of ADAWA, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.

Before making a decision to buy or hold any products issued by MDANI, please consider your personal circumstances and the Important Information, Policy Wording and any supplementary documentation available by contacting DPLA on 1800 444 542 or via email.

For information on MPS and DPLA’s use of your personal data and your rights, please see our Privacy Notice.