NEGLIGENT EXTRACTION OF TEETH

1.      This series of articles will look at some common instances of dental negligence and consider in outline the heads of loss which they generate.

2.      The first topic, considered here, is negligent extraction of teeth.

3.      Claims for damages arising out of negligent dental treatment are an expanding area of clinical negligence litigation and are likely to remain so for the foreseeable future.

4.      The reasons for this expansion are varied. Significant factors include the movement away from public funding to conditional fee agreements and the increased demand for cosmetic dentistry in the UK over the past few years.

5.      However, one factor in that expansion which should not be underestimated is the increase in the level of damages awards which, in turn has arisen from the increase in the range of treatments available to repair the damage caused by the initial sub-standard treatment and, in particular, the rapid expansion in the use of implant therapy to replace lost teeth.

6.       This increase in the level of awards has made such claims more attractive not only to the Claimant, who may receive significantly more in the way of damages and may be put in a position to access a therapy (in the form of implants) which is expensive and rarely available on the National Health Service) but also to those Solicitors who represent them.

7.       Claims for negligent extraction can arise from a number of different situations, particularly commonly in relation to children involved in orthodontic treatment, but often in adults when an incorrect tooth may have been extracted in an attempt to relieve pain.

8.       A number of heads of loss are likely to arise in relation to all such cases and can be sub-divided into:-

i)                    Pain Suffering and Loss of Amenity

9.       When considering Pain Suffering and Loss of Amenity in this type of case the JSB Guidelines provide a useful starting point (Facial Injuries (A) skeletal injuries at (f)). Kemp & Kemp has a number of cases reported in section D7 of Volume 3 and Lawtel is a particularly useful source (go to Quantum Search and enter “tooth” or “teeth”).

10.   Awards for loss of a single tooth are unlikely to be high (special circumstances will be required to exceed £2,500). In some limited cases there may be an element of psychological damage arising from the loss of the tooth

ii)                  Treatment Costs

11.   Very probably the most significant element of the claim, the calculation will depend upon the treatment plan suggested by the expert. However, it may well include claims for an initial removable prosthesis (denture) (particularly if the Claimant is a child and any further treatment must await the end of growth in the jaw) followed by an implant supported crown.

12.   Costs for dentures depend upon their type. Acrylic is cheaper than chrome cobalt with price brackets being £200 to £600 and £500 to £800 respectively. If the denture is to be in use for a long period, replacement costs need to be factored in.

13.   Costs for implants will also vary significantly from provider to provider and depending upon whether further surgery (such as bone grafting) is required as a preliminary step. Figures will need to be obtained from a suitably qualified expert (a specialist implantologist). A rough figure is likely to be between £3,000 and £4,500 per tooth.

14.   Whilst implant failure occurs (particularly where the patient is a smoker) the experts will generally suggest that the implant will last for life. However, further costs will arise into the future in relation to replacement of the crown which the implant supports (probably every 15 years at a cost of perhaps £700 to £800), annual maintenance and additional visits to the hygienist (increasingly difficult to obtain on the NHS under the current NHS contract system).

15.   Whilst none of these figures is large in itself, when a multiplier for life, or even to 75, is applied to the annual multiplicand, the product may be significant.

iii)                Consequential Losses

16.   These are unlikely to be high in cases of this type, although there may be some element of lost earnings or travel costs involved in attending surgical procedures and follow-up appointments.

17.   Precise figures will depend upon the facts of individual cases and the figures in this article can only provide an outline indication of the level of figures which might be recovered.