Deviation in the Standard of Dental Care Resulting in Nerve Damage, Loss of Taste Sensation, Damage to Dentin

Evaluate breaches in the standard of care when determining Deviation in the Standard of Dental Care Resulting in Nerve Damage, Loss of Taste Sensation, Damage to Dentin

Answer the following questions to find out if the standard of care was followed for your case.

  • Which of the following injuries did the patient sustain?
    Nerve damage
    Loss of taste
    Dentin damage
    Why is this important?
    Trauma, tumors, connective tissue diseases, infectious diseases, demineralization, or idiopathic diseases have been reported as possible causes of paresthesia of the IAN.
    (2011) 112 OSOMOP 1 126-131

  • Were rotary instruments used during the procedure? Why is this important?
    Answer this question
    
Rotary instruments are used for cutting of enamel and dentin during preparation of tooth for restoration or crown placement. The purpose of incorporating these advanced instruments is to perform endodontic procedures more accurately, thus experiencing less postoperative discomfort, fewer procedural errors, and a more efficient procedure.

    (2004) 48 EDECNA 1 1-9 



  • Was sealing of the exposed dentin performed? Why is this important?
    Answer this question
    
Improper sealing of the tooth surface during the restoration or crown placement can lead to severe complications.

    (2004) 48 EDECNA 2 359-385 



  • Were follow up visits advised? Why is this important?
    Answer this question
    
Regularly scheduled follow up visits are necessary for the early detection of any complications.

    (2006) 102 OSOMOP 4 e1-e7 



  • Which dental procedure did the patient undergo? Why is this important?
    Answer this question
    
All dental procedure, regardless of their simplicity, must be performed with precision.

    (2003) 15 EOMSCA 2 243-249 



  • Was the local anesthetic improperly injected? Why is this important?
    Answer this question
    
Bell’s palsy is characterized by loss of sensation in one side of the face, and is also accompanied by loss of taste sensation until recovery.

    (2011) 19 EAOMSC 1 63-78 



  • Were signs of Bell’s palsy noted immediately? Why is this important?
    Answer this question
    
Bell’s palsy occurs as a consequence of accidental injection of local anesthetic solution into the parotid gland.

    (1999) 83 EMEDCN 1 179-195 



  • Were follow up visits advised? Why is this important?
    Answer this question
    
Injuries to the nerve cannot be corrected immediately, therefore it is necessary to provide education to the patient and to advise periodic follow-up. 

    (2011) 19 EAOMSC 1 63-78 



  • Which dental procedure did the patient undergo? Why is this important?
    Answer this question
    
Dental practitioners prefer to retain the natural tooth, but if loss of tooth structure, periodontal disease, or trauma is too severe, the tooth might be unrestorable.

    (2011) 37 EJENDO 3 311-315 



  • Was a pre-operative radiograph of the affected tooth region obtained? Why is this important?
    Answer this question
    
The inferior alveolar nerve (IAN) is located in the mandibular canal, which runs through the mandible to the mental foramen. Anterior to the mental foramen, the nerve is known as the mental nerve, which usually begins in the second premolar area. Branches of the IAN leave the mental foramen to innervate the teeth and neighboring structures of the lower jaw. Performing dental surgeries posterior to the mental foramen increases the risk for damaging the IAN as a result of its proximity to the root apices of mandibular premolars and molars. Dental procedures including endodontic, implant placements or mandibular third molar extractions can cause injury to this nerve, with resulting neuropathic pain or anesthesia.

    (2011)37 EJENDO 3 311-315 



  • Was a pre-operative radiograph of the affected tooth region obtained? Why is this important?
    Answer this question
    
Improper positioning of the tooth may lead to complications during extraction, therefore pre-operative radiographs need to be obtained. 

    (2011) 37 EJENDO 3 311-315 



  • Did the clinician assess the proximity of the nerve to the tooth? Why is this important?
    Answer this question
    
Dentists need to be aware of the position of the IAN before attempting invasive dental procedures in the lower jaw to avoid potential nerve injury.

    (2011) 37 EJENDO 3 311-315 



  • Was an appropriate surgical plan prepared based on the radiographs? Why is this important?
    Answer this question
    
Surgical planning includes precautionary plans for the protection of adjacent structures during the procedure.

    (2001) 59 JLOAMS 9 1012-1017 



  • Was the patient referred to a neurologist? Why is this important?
    Answer this question
    
Since damage to a nerve may be permanent, consultation with a neurologist is necessary.

    (2011) 112 OSOMOP 1 126-131 



  • Was the patient advised to have follow-up visits for further evaluation? Why is this important?
    Answer this question
    
Anesthetic effects take a minimum of three hours to wane off, and therefore patients need to be given post-operative instructions and be encouraged to keep follow-up examinations to identify any possible complications.

    (2006) 102 OSOMOP 4 e1-e7 



  • Were follow-up visits recommended? Why is this important?
    Answer this question
    
Since the anesthetic effects take a minimum of three hours to wane off, patients need to be given thorough post-operative instructions and advised to contact the dentist if untoward symptoms develop.

    (2006) 102 OSOMOP 4 e1-e7 



  • Was the patient educated about lingual nerve injury? Why is this important?
    Answer this question
    
Injuries to the nerve cannot be corrected, therefore it is necessary to educate the patient regarding signs and symptoms of nerve injury.

    (2011) 19 EAOMSC 1 63-78 



  • Was a pre-operative radiograph of the affected tooth region obtained? Why is this important?
    Answer this question
    
Dental implants represent technology that requires high precision for success. Radiographic assessment is required in all patients undergoing implant placement, as it serves as a valuable tool in determining the location, size and number of the implants.

    (2010) 109 OSOMOP 3 335-345 



  • Was a surgical plan prepared based on the radiographs? Why is this important?
    Answer this question
    
Careful implant site selection, appropriate angulation and soft tissue handling, may decrease mucosal inflammatory complications.

    (2003) 15 EOMSCA 2 243-249