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What is root canal treatment and what are the causes of negligence claims relating to root canal treatment.
By Naomi Todd
Endodontic treatment, or root canal treatment as it is more commonly known, results in one of the largest number of negligence claims of all areas of dentistry.
Endodontic treatment is a dental procedure used to repair and save a tooth that is badly decayed or becomes infected. The decision to carry out root canal treatment on a tooth will depend on many factors, including the restorability of the tooth. It is not always an option to carry out root canal treatment, for example if the tooth is severely decayed, to the extent that it will need to be extracted, or if the tooth is fractured or broken. In these circumstances, it is unlikely that root canal treatment would be successful.
During the treatment, the dental practitioner will remove the nerve and pulp from the tooth and thereafter clean, fill and seal the tooth. Assuming the treatment is carried out to a satisfactory standard, a tooth can survive for up to 10 years after root canal treatment.
The majority of negligence claims arise due to a failure of the treating dentist to obtain the right diagnosis and carry out careful clinical and radiographic examination prior to treatment. This can result in undisclosed fractured instruments and perforations, which themselves form a significant proportion of the claims.
Some examples of what can go wrong are as follows:
• Residual infection – most endodontic failures are due to the presence of residual infection. This may be caused by under filling of the root canal, which can allow bacterial contamination of the under filled root canal, resulting in an abscess or chronic inflammation.
• Fractured instruments – Instrument fractures occur when the tip or part of the instrument breaks of into the canal. This can be caused due to the application of excessive force. If the fracture occurs early on in the process, and the instrument has blocked access to the canal, then failure is likely to occur. This is because bacteria left behind are inaccessible to disinfection procedures. Although fracturing an instrument in a canal is not in itself negligent, failing to recognise it and inform the patient is.
• Perforations – Perforations can occur when locating root canals or over filling the root canal, and can lead to nerve damage. Perforations should be repaired as soon as possible, as if left, bone loss around the perforation can occur and it may not heal.
All of the above can also be a result of a lack of clinical expertise. If the treating dentist recognises that the treatment is exceptionally difficult, the treatment should be halted and the patient referred to a more experienced colleague.
Although failed root canal treatment is not always due to negligence, unfortunately, we continue to deal with a number of claims where root canal treatment has gone wrong due to negligence on the part of the dentist causing the patient pain and suffering and requiring further dental treatment.
Providing your dentist provides a good level of care, makes the right diagnosis and carries out careful clinical and radiographic examination, root canal treatment can play a vital role in helping to maintain the natural tooth. However, it must be recognised that endodontics is a branch of dentistry that requires a great deal of skill, patience and understanding and a failure to offer an adequate standard of care can result in failed treatment and a dental negligence claim for compensation.
If you think you may have suffered injury due to root canal treatment negligence, please contact a member of our team for advice on making a claim.