What Should a Dentist do if an Instrument Breaks During Treatment? HPARB Affirms Obligations

In a recent decision, the Health Professions Appeal and Review Board (the “Board”) affirmed the obligations of a dentist when a surgical instrument broke during treatment.

A patient had four wisdom teeth removed in 2009. Several years later in 2016, after experiencing pain, a different oral surgeon removed a surgical bur (an item used in oral surgery) from her mouth. Despite the patient not having any other dental work completed since 2009, the dentist refused to take responsibility for the surgical bur. He did, however, admit that there was a power failure during the removal of the patient’s wisdom teeth and that it was possible that a bur broke. A subsequent radiograph revealed a radiopaque marking (i.e. something showing up on the radiograph), but the dentist asserted that it could have been the patient’s earring. He also took the position that there was no indication that the bur caused the patient any problems.  He further argued that the type of bur that was found was not one that he used.

The Inquiries, Complaints and Reports Committee of the Royal College of Dental Surgeons of Ontario (the “Committee”) decided to require the dentist to complete a SCERP (a Specified Continuing Educational or Remediation Program) in record keeping and informed consent (as no signed consent form was present) and required the dentist to attend to be cautioned.

The dentist sought a review of the decision by the Board.

The Board found the Committee’s conclusion that the dentist left the bur in the patient during the wisdom tooth extraction to be supported by the record. The Board also found that the Committee’s decision to issue an oral caution was reasonable as the dentist acknowledged the possibility that he left a surgical bur during the extraction, but he subsequently proceeded to try to convince the College that it was not his bur.

The Board confirmed the Committee’s decision to require the dentist to complete a SCERP and that the dentist must attend before the panel to be cautioned that:

  • He must inform patients when a potential foreign object is identified and conduct follow-up investigations. He must discuss treatment options with the patient and the associated risks.
  • He must take responsibility for mistakes made and not attempt to convince the College that a mistake was not made, especially when there is clear evidence to the contrary.

Not only does this case confirm a dentist’s obligations should an instrument break during surgery, it is also a reminder to health care professionals that where there is clear evidence a mistake was made, denying such a mistake and not taking responsibility before the College is ill-advised.

If you have any questions about this case or other health professionals’ regulatory proceedings, please contact us.

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