A consultant anaesthetist planned to manage a 63-year old patient with combined spinal anaesthesia and light sedation during knee replacement surgery. Her plan was thwarted, however, when a spinal block could not be achieved. Accordingly, the anaesthetist advised the patient that he would require a general anaesthetic.
It would have been the consultant’s normal practice, before administering a general anaesthetic, to counsel the patient regarding the risk of tooth damage from oral instrumentation.
She was aware that the patient had a number of veneers. Perhaps distracted by the last minute change to the treatment plan, the consultant did not note in the patient’s records whether she had warned the patient of this risk, and could not later recall whether she had actually done so. The patient was ventilated through a laryngeal mask but required insertion of a different type of mask to achieve an adequate seal. The bite block of this mask may have caused dental injury when the patient awoke in recovery and bit on it.
Some time later, the patient wrote to the consultant seeking compensation, alleging damage sustained to a veneer during the general anaesthesia. The affected veneer was one of four matching veneers on the lower incisors.
The patient was asked to provide all dental records preceding and post-dating the alleged injury. He had not had any recent dental checkups before the surgery, which might have indicated any pre-existing damage.
The consultant was willing to agree to settlement of the claim as the notes clearly lacked evidence that she had warned the patient of the potential for dental injury. However, most patients would not decline surgery when informed about this risk. Tooth damage itself does not imply substandard practice, when the obvious priority is to secure an adequate airway and ventilation.
The claimant was offered, and accepted, £2,750, in recognition that he would probably need to replace all the veneers, in order to obtain a good colour match. The sum represented a proportion of the likely cost of the new veneers, on the basis that they would have required replacement, in any event, at some stage. No admission of liability was made.
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