Delayed Diagnosis of Dental Abscess Results in Facial Disfigurement

This case involves a previously healthy twenty-five-year-old male with no significant past medical history. He presented to a dentist with a sudden onset of tooth pain, trismus, and severe swelling of the jaw. At the initial visit, no x-rays or other diagnostic studies were performed. The patient’s dentist referred him to an oral specialist when he returned to the practice four days later complaining of worsening of his symptoms. The oral specialist prescribed analgesia for relief of the pain and muscle relaxants. No examination was performed at this time despite the severity of the patient’s symptoms. The patient collapsed at home the following day. He was found unconscious by his roommate who called an ambulance. It was apparent that the patient was unconscious for an extended period of time before he was discovered. He was admitted to hospital. Subsequently, a large abscess was discovered two days after admission. A tracheostomy was put in place and surgery for the removal of neck and jaw muscles were required to prevent the spread of the infection to surrounding tissue. The delay in treatment resulted in further radical treatment. The patient now has a permanent injury and facial disfigurement.

Question(s) For Expert Witness

Expert Witness Response E-006947

As a general dentist, I have many years of dealing with complicated dental issues and significant experience in what a general dentist, or specialist, should be able to diagnose, treatment plan and/or refer. In my opinion, it seems that there may be several errors made by the dentist treating the patient in this case. Based on the first visit, did the dentist refer that same day? Why did the dentist take four days to refer the patient to a specialist? Do the medical records reflect his diagnosis and potential treatment/referral plan? The next observation is what type of records did the specialist take? And thirdly, why did it take the hospital two days after admission to diagnose the abscess? What records or films did they take? In my opinion, this patient could have been diagnosed much sooner, perhaps even at initial presentation to the dentist, however, further review of the patient’s medical records would be needed to confirm this suspicion. Standard of care would involve, at the very minimum, an examination, x-rays and some sort of treatment. Now, that treatment might just be a referral, but no treatment is not appropriate and is a departure from the standard of care. Time is of the essence in an infection of this severity and any delays can lead to increased morbidity, as was the case for this patient, or even fatality.

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