A patient completed a medical history form for treatment under sedation. Under the allergies section was the entry: 'Allergic to aspirin – facial swelling’.
The dentist, on his own admission, stated that the patient was seen for two appointments with regard to removal of a lower carious wisdom tooth. At both of these consultations, the patient confirmed his allergic reaction to aspirin and even noted the severity of the reaction by indicating he had a facial swelling from a previous reaction.
The wisdom tooth was removed and the dentist provided written and verbal postoperative instructions which included advice to take paracetamol and ibuprofen.
The patient rung later that day to advise he had developed a facial swelling with itchy skin and shortness of breath. The patient confirmed he had taken ibuprofen and shortly afterwards he developed the described adverse symptoms. The dentist advised the patient to immediately attend the local Emergency Department (ED). He also promptly emailed and phoned the (ED) to alert them of the procedure that had been provided along with medication taken by the patient.
The dentist was not aware of the crossover of the allergic nature of aspirin and ibuprofen even though he knew they were both NSAIDs.
The dentist contacted Dental Protection to alert us of the incident, in case a complaint followed. A dentolegal consultant advised the dentist to check up on the patient and, a few hours later, the dentist rang the patient to ensure he was alright. The wife of the patient answered and thanked the dentist for his prompt advice and referral to the ED. The patient had been admitted to hospital but was now comfortable and due to be discharged tomorrow morning.
Learning points
It is important that appropriate action is taken on the information in a medical history and if there is any concern about interactions and side-effects, every opportunity should be taken to explore such issues further.
Thankfully, even though the patient became aware the member had not provided appropriate advice, the member’s immediate action and engagement with the patient defused the situation.