How dental treatment can go badly wrong......what would you do?

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I started a course of private dental treatment with the aim of replacing two partial dentures with crowns and bridges supported by implants. The implants were placed in January apparently without any problems. The stitches came out two weeks later - everything apparently still OK. Seven weeks later I came back for a review: everything looking good.

In early May there was a second surgical appointment to attach healing abutments and I was stitched up again. Two weeks later I returned to have the stitches removed. However, one of the implants had "vanished". The oral surgeon took three X-rays and poked around but there was no sign of it. It seems it could have "fallen out". Anyway, he seemed confident that the treatment plan could continue.

So I was back again early June for metal try-ins for bridgework on the other side of my mouth. He told me I needed another surgical appointment to be certain of the whereabouts of the missing implant. He'd been encouraging me throughout to look for it but was apparently now taking the view it had gone through the jawbone into my sinus cavity. At this point he also carried out what I thought was a temporary restoration of a central incisor. btw  the abutment on the central incisor implant had fallen out but I was able to hand that to him at the appointment!

I didn't like the sound of this exploratory operation on my sinus so I e-mailed the surgery asking if there were other scans which might detect a foreign object in the sinus. I was told by the general dentist who owns the practice that I needed to discuss this with the oral surgeon.

So I turned up for my next appointment to have bridgework fitted and discuss what next where the implant had disappeared. I asked him if the implant could be in the sinus. He didn't think so and told me that if it was I'd know about it. So I got in the chair to have bridgework fitted, then he gave me several shots of lidocaine. I thought this was something to do with the definitive restoration for the central incisor and/or "preparing the ground" for another implant. After an hour of blood, gouging, twisting and boring he pulled out the implant from my sinus cavity. Leaving aside the fact that I did not consent to this aggressively invasive procedure, he has now come to the conclusion that the bone quality is not sufficient for an implant. Surely the bone quality is assessed at an early stage not after an implant is pulled out of the sinus cavity?

Anyway, I have asked the owner of the practice for a referral to the local university dental hospital for a second opinion. But what would you do?

 

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  • Posted

    It depends entirely on what country you're in. It sounds as if legal action would be in order, but I'm afraid every country has its own legal system.

    By the way, did the oral surgeon prescribe a course of antibiotics at the time of the intrusion into your maxillary sinus? I ask that because 25 years ago I also had to have an intervention by an oral surgeon that he warned me might end up with him having to enter the sinus. (This was also the end-result of appallingly bad dental practice, but didn't involve implants in my case.) He discussed the implications of this with me fully before starting, and told me he'd have to put me on antibiotics if he did find himself through into the sinus. In the event, the bone damage was less than he expected once he got into the socket, and he was able to scrape away just a thin layer without entering the sinus, which didn't require antibiotics.

    As a former nurse (though admittedly not specialised in ENT or oral surgery) it's my understanding that intrusion into the maxillary sinus via the mouth, which always has a heavy bacterial load even in a healthy person, is potentially dangerous and should always be done under antibiotic cover.

    Frankly, your story horrifies me. I'm sure you should be due some kind of redress but once again, it depends where you are in the world.

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    • Posted

      Thank you for your reply.

      I'm in the England & Wales legal jurisdiction and I have thought about legal action and a complaint to the GDC, but I'm trying to prioritise and sort out the medical side first.

      They did prescribe antibiotics - in a rather strange way. I went into the reception afterwards to book an appointment for some crowns in the lower mouth and a bridge where the implant would have been. I was in a daze and my legs were shaking  but my first thought was that I had been left with a very limited ability to chew - really at only one point on one side of my mouth. So I booked a prep for bridgework in two weeks (subsequently cancelled by me) and left the surgery. I got my legs back under control, took a couple of ibuprofen and headed off to catch a bus. Then my mobile rang and it was the practice manager telling me I needed to take antibiotics and she would send me some in the post! I told her I had some amoxicillin left over from the first surgical appointment, when they had prescribed 3x500mg amoxicillin for three days but had given me a supply for seven days. She said it was amoxi again for seven days, 500mg, but she didn't know how many a day. So I decided to take three a day and started about two hours after leaving the surgery. The antibiotics-by-post turned up at midday two days later marked 2x500mg. Probably a good thing I started amoxi when I did.

      On the medical front my priorities seem to be:

      1) get the stitches out - I can't think about having this done by them at the moment. I have contacted other private and NHS dentists but they are being a bit vague about whether they would do it or not. One private dentist passed a message to me via her receptionist saying that there was "an unwritten code of practice".....

      2) get a second opinion - a university dental hospital seems the best source of that. Lots of questions: what are the long-term consequences for my sinus of this operation? Why did my implant fail? He said it was because of insufficient bone quality but surely he would have assessed that before putting the implant in? Incidentally, the bridgework on the other side fell out yesterday morning! So why did that last only two weeks? I also have mouth washes and drinks coming out of my nose from time to time because the membrane he put in to cover up the hole in my jaw doesn't quite work!

      3) have some kind of further work because at the moment I have a limited ability to chew.

       

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    • Posted

      I'm sorry, I don't think I read that right. You have mouthwash and drinks coming out of your nose? Is that what you meant to say? If this is the case, you need urgent medical attention. Your maxillary sinus is wide open into your mouth. As already mentioned, I didn't specialise in ENT or maxillofacial nursing. However, neuro was my speciality. In 18 months working on a busy neuro unit (which admittedly had a catchment area covering most of the south of England in those far-off days) I saw several cases where damage to the sinus-mouth barrier had resulted in severe infection which had spread to the brain in the form of an abscess.

      How long has this been going on, and are you still on the antibiotics?

      I think you'd have to be pretty unlucky to get a cerebral abscess, but please be aware this is a possibility. Have you seen your GP? I believe he/she should be involved, and should give you an emergency referral to a maxillofacial surgeon. I also agree with you that going to A&E at a major university or dental hospital could be another option.

      Yes, by all means contact the GDC. This dental practice needs shutting down in my opinion. But you're right - you need to get medical attention first. In the meantime, document everything that's happened very carefully.

      I agree that you're going to need further work - probably quite a lot of it - but I think this will need to be done by a maxillofacial surgeon in a hospital. It sounds as if you have a serious problem with bone integrity which, as you rightly say, should have been picked up before any implant work was ever started. Either that or the dentist was incredibly incompetent. Well, it sounds like the entire practice was incompetent anyway!

      I'm not qualified to say what the long-term implications are for your maxillary sinus. This is another one to be discussed with a maxillofacial surgeon. If healing doesn't take place soon I'd guess that you might need a bone graft but I don't know enough about these things.

      Please get specialist attention as soon as you can. I hope all goes well for you after this appalling experience. And if you feel like it, come back here and post the results. I'd be interested to know how this pans out.

      Once again, I'm so sorry you've had to go through all this.

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    • Posted

      As a follow-up to my post of a month ago, how are things going now? I was extremely concerned about your predicament and would like to know how it evolved.
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    • Posted

      Thanks for your further post.

      I picked up your previous post over the weekend of 8/9 July. One of the things that had been going through my mind was the possibility of infections in the sinus and them spreading elsewhere. So I went to the GP on the Monday morning. She refused to examine my mouth because GPs don't have the training and the health board has told them to have nothing to do with dental problems ("health board" because this is Wales rather than England). She told me she would not refer me urgently to a maxillo-facial consultant because that had to be done by a dentist. However, she said she would write to the dental hospital but didn't think it would speed anything up. She did check my nose and ear and told me there was no sign of an infection.

      Next, I got a copy of the referral from my dentist and turned up at the dental hospital again on the Wednesday. Could I be seen urgently? The trouble is that they define urgent as: severe dental pain or trauma or facial swelling or uncontrolled bleeding. However, she showed the referral to a dentist (the hospital had already had this letter since the end of June and it does mention an oroantral fistula). Anyway, the general dentist I saw at the hospital was able to confirm that gum had healed - I hadn't noticed anything going into my nose since the previous week - so there was a flow between mouth and sinus for just over two weeks. She wouldn't comment on much else but said I had no signs of a current infection and the non-urgent referral to oral surgery/ maxillo-facial would run. I have that appointment on the 25th. Nothing else has happened after the bridgework fell out and I have got used to chewing in a lopsided way! I'll post on here after that appointment - it should be interesting.

       

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    • Posted

      Thank you for getting back, and putting my mind at rest. If the fistula has healed up and you have no signs of sinus infection, you should be OK for the time being. However, it's still important to keep that maxillofacial appointment, as I'm sure you realise.

      My main worry now is the integrity of the bone in the area where the fistula was. You'll need to ask all the right questions at the maxfax appt to get this one cleared up. If there's some missing bone, this means the slightest injury to the gum - e.g. eating something slightly hard or sharp - could open the whole thing up again. It sounds to me as if a bone graft might be in order at some stage.

      You might also want to try and get an opinion on how all this happened in the first place. It sounds as if you might have a serious problem with bone integrity. Again, I don't know a lot about that, but if I were in your place I'd want to know the cause of the bone integrity problem, and also whether it just affected my jaw or was liley to be more widespread.

      I hope you're documenting all this. It's very possible you have some kind of legal case. However, since I haven't lived in England for more than 40 years (and never in Wales) I can't advise you on what steps to take.

      I'll look forward to hearing how you got on at the appointment. I hope all goes as well as possible and you get some answers.

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    • Posted

      Hi Lily,

      I'm still waiting for a copy of the consultant's report - I chased last week: still with the secretaries...

      As far as the appointment went, they took a panoramic X-ray and the consultant confirmed that the bone where the OAF was had healed/ was healing. He did mention that there was no way of telling what the bone state was before the implant and that a bone graft would now be needed before a further implant could be attempted. It seems that if I am going to have conventional bridgework instead of another implant then a bone graft won't be needed. The suggestion was that the bone was thin there because of age and no teeth in that area. He confirmed there was no sign of an infection. As for the bridgework on the other side of the mouth he told me that the bone there might be sufficient to retain the implants.

      As soon as I get his report I will have a chat with the owner of the practice where all this took place and see what the next steps might be. I take your point about documenting all this, which I have been doing, and lawyers but I want to try and resolve this without having to resort to legal action.

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