Case Study

Mr C, aged 30, contacted the practice to arrange for a dental examination as he had just moved to the area. The examination of this patient’s mouth proved unremarkable except for some staining of the teeth due to his smoking habit. The examination revealed that the patient had two symptomless partially erupted lower wisdom teeth. After the visual examination, the dentist decided to take a panoral radiograph to assess whether or not the wisdom teeth were likely to cause any problems in the future.

The patient agreed to have the radiograph taken and it was intimated that he would be contacted if anything abnormal was detected. The exposed radiographic film was developed by one of the nurses in the practice who subsequently placed the developed radiograph in the patient’s records without showing it to the dentist. Unfortunately no agreed sequence had been established within the practice to prevent such a situation arising and in this particular case the examining dentist did not actually look at the panoral radiograph which had been taken that day. By the following day he had forgotten the episode.

Six months later the patient returned to the practice for a regular check up. No reference was made to the radiograph either by the dentist or the patient. At this visit the patient was not experiencing any problems from his mouth and nothing abnormal was detected during the examination. The patient turned out to be a very regular attender and was seen every six months during the next four years. Not long after his most recent visit, the patient had to return to the surgery complaining of pain and looseness of his lower right molar teeth. The patient’s dentist was on holiday at the time so he was seen by one of the other dentists in the practice. During the consultation the dentist noted the patient was suffering from a degree of trismus and there was a diffuse swelling on the right hand side of the patient’s face. Intraorally the examination revealed significant mobility and some swelling surrounding the three molar teeth in the lower right quadrant.

The dentist undertook a periodontal examination of the patient but there was no evidence of any periodontal disease whatsoever. Not having seen this patient before, the dentist examined the records to see whether any recent radiographs had been taken before arranging for an intraoral radiograph of the lower molar teeth to be taken. He spotted the panoral film sitting in the record card but there was no reference to the radiograph having been reported upon within the clinical records. When he viewed the panoral radiograph he could see a radiolucent cyst-like lesion which was just beginning to erode the apices of the lower molar teeth on the right side. With an intervening period of four years since the last x-ray the dentist decided to take an intraoral film together with a panoral radiograph which revealed that 50% of the roots of the lower molar teeth had been resorbed by the lesion, which had grown considerably since the previous radiograph had been taken.

The patient was immediately referred to hospital where a locally invasive tumour was removed together with an amount of the surrounding mandibular bone. Fortunately the patient made a full recovery. The patient’s regular dentist was totally distraught when he realised that his failure to view, and write up the original findings from the panoral radiograph on the record card, was responsible for this patient’s current condition and prognosis.