In the recent case of Kazi v Kapoor, 2023 CanLII 86114 (ON HPARB), a patient complained that the dentist had extracted the wrong, healthy tooth and also performed the extra poorly and was unable to extract the entire tooth (i.e. left root tips).
Background
The case dated back to October 2020, when the patient attended the dental office and complained of pain their right lower back region. Per the dentist: the patient pointed to their 46, which was mobile and requested an extraction. The dentist took very good notes, including:
- the dentist noted that, owing to supra and sub gingival calculus buildup teeth #46/47/48 ALL showed indications of moderate to severe bone loss with furcation involvement and Grade II mobility;
- periodontal prognosis of all teeth was questionable to hopeless.
- the dentist advised the patient to return for a complete oral examination and scaling to assess the overall condition of their oral cavity since treating a single tooth would not resolve their immediate pain;
- after discussion regarding the treatment alternatives, the patient insisted on having tooth #46 extracted and the patient was shown the tooth via handheld mirror and the radiographs; and
- Tooth #46 was only extracted after multiple confirmations.
Dentist’s Notes
Specifically, the dentist’s notes included the following:
i have pain in my lower bottom back tooth [points to #46]
………………………………………………………………
Ioe: #46 grade II while, bone loss with furcation involvement, were prognosis adv exo.
discussed rpd, bridge, implant as replacement options
adv pt to get a comp exam and prophy
wants to get the exo done
extraction #46
………… root piece left in the mesial [1-2mm0. Pt. informed.
Decisions
Based on the dentist’s records, the Inquiries, Complaints and Reports Committee of the RCDSO (the “Committee“) found that the dentist had not failed to meet the professional standard expected of them and took all appropriate steps (including removing the 46, leaving the root tips in, and advising the patient to get a complete oral exam and scaling). As such, the Committee took no further action against the dentist.
The patient appealed to the Health Professions Appeal and Review Board (the “Board“). The Board confirmed the Committee’s finding (that no further action was necessary) and concluded that the Committee had conducted an adequate investigation and its decision was reasonable.
In coming to that re-confirmation, the Board wrote the following about the importance of patient records as supporting evidence in coming to a conclusion:
The Board notes that the patient record is considered to be a legal document and provides a contemporaneous record of the care provided by the Respondent. The patient record documentation is made prior to the commencement of any complaint or legal process. As such, in the absence of compelling information to the contrary, the patient record is a reliable source of information as to what occurred during dental encounters, and it was reasonable for the Committee to rely on that information in reaching its decision. The Board finds that the patient record supports both the Respondent’s description of the events surrounding her care of the Applicant and the conclusions reached by the Committee.
Conclusion For Dentists
Moral of the story for dentists: have very good notes, take your time (don’t rush your treatment planning or case presentation), and make sure to get informed consent from your patient (which includes weighing the risks and alternatives, etc.).
P.S. I personally feel bad that this dentist did nothing wrong, but still had to wait 3 years (and a Committee hearing and Board appeal) before being vindicated as such. And it likely cost the patient nothing, but it likely cost the dentist a lot of time, money and stress to have to defend themselves. Personally: a big waste of energy. So please take the lessons above and use them in your daily practice. This dentist paid a price for all dentists to learn these lessons. So let’s respect that.
