Commission criticises dentist after woman suffers tooth infection for eight months
Deputy Health and Disability Commissioner Vanessa Caldwell says from the time of the initial procedure on 4 December 2019, Ms A had concerns.
Photo:
123rf
A woman whose dental implant and bone-graft failed and who suffered an undiagnosed infection for eight months says she still has pain, headaches and brain fog four years on, and ended up losing her job as a result.
In a report released on Monday, the Health and Disability Commission has criticised the dentist for failing to adequately explain the risks of the procedure, and for poor record-keeping and medication management.
The complainant, known as "Ms A", had an implant supported crown placed in her upper left central incisor by a specialist periodontist in 2009.
However, after two years of problems with the implant starting in 2017, she consulted the dentist in July of 2019.
He suggested a treatment plan involving a bone graft to support a new implant and crown, which was approved by her insurance provider.
Ms A told HDC that in discussing risks, the dentist "mentioned only that infection was a possibility, but he said that he had performed the procedure many times and only one other person had had an infection, which had healed well".
She said he made the procedure sound very low risk and "all very fixable", and never mentioned anything about the possibility of it failing.
"I really didn't think I was going to have a problem and I trusted [the dentist]."
However, in the days following the procedure, she began feeling unwell and had "a burning sensation".
Between 4 and 19 December, the dentist saw Ms A four times to assess the healing.
He could see no sign of infection but prescribed antibiotics.
On 16 December, he reported there was slight puffiness at the site of the graft, but no pus or other evidence of infection.
At 6.55am on 19 December, Ms A texted the dentist asking him to call her.
He ended up seeing her after hours and removing the "membrane" (a special wound dressing made from the patient's own blood), at her request.
"He stated that he discussed the possible complications of re-opening the site, but she was very insistent that the membrane be removed. Dr B stated: 'In the end I abided by her wishes'.
"In response to the provisional opinion, Ms A told HDC: 'This is not correct … It was his only suggestion he gave me to remedy the issue.'."
On 20 December, Ms A went to a public hospital Emergency Department with swelling to her upper lip and left cheek, but an X-ray was normal and there was no sign of infection.
She went back to the dentist on 23 December, who reassured her the site was healing well.
He gave her a medical certificate.
The patient told the HDC she asked him to write out an insurance claim but he declined, saying she was "Okay [and there was] no need to do that."
"She said that she told him that she had no more sick leave and had started to use up her annual leave, but he did not seem to care and shrugged everything off, seemingly ignoring her.
"Dr B said that the process was that she should have downloaded and completed the relevant form, which he would then have countersigned."
She phoned the clinic again on Christmas Eve, and reception staff advised her to either go to the hospital or she could see another dentist at the practice on the following Friday.
On Boxing Day, she went to the ED again with pain in her face, and was given painkillers and discharged.
She texted the dentist, asking him to call her urgently.
He called her that afternoon and she said blood tests were normal but clinicians suspected inflammation as the probable cause.
On 27 December Ms A was seen by the dentist, who extended her medical certificate to 3 January 2020 and recorded that her gum looked "ok".
The sutures were removed on 13 January by another dentist, who noted there were no signs of infection.
On 20 January and again on 18 February, she was seen again by the dentist, who assured while the site looked normal and was healing well. Ms A was upset and worried that the infection was back.
On 15 May Ms A's general practitioner (GP) referred her to an oral and maxillofacial surgeon at a public hospital, querying whether Ms A had an infected dental cyst.
Meanwhile, she had several more appointments over 2020 with the dentist , who uncovered the implant and put a temporary crown in place.
"I felt like he wasn't listening, [and I was] at a loss to know what was happening to my body.'"
On 17 August 2020 Ms A was seen by the maxillofacial service at the public hospital. The specialist noted the presence of a soft tissue pocket, peri-implantitis and bone loss, and that there was "large force put on [the] implant due to incorrect crown/implant ratio".
She was referred to oral and maxillofacial surgeon, who removed both the implant and crown on 13 October 2020.
Ms A told HDC that when the infected implant and surrounding bone in her jaw was removed, it left her with gum and bone shrinkage and stained teeth.
She said the bacterial infection had been left undiagnosed for over eight months, and it had taken a toll on her health.
"Today I still have burning, swelling and discomfort around the area where the implant use to be. I suffer from headaches, brain fog and concentration issues. Coupled with very bad fatigue. I also couldn't go back to work and I ended up losing my employment.
"Four years on from then my life has never been the same."
In response to the HDC provisional opinion, the dentist said it was "unfortunate Ms A has had to go through this".
"No one likes to see a patient struggle and their treatment not go to plan."
Two other dentists, two hospital visits and two X-rays had not found any evidence of infection either, he said.
"It seems there was a low grade bone infection… We are all disappointed and sorry for [Ms A] that she got an infection and did not get the desired outcome."
Deputy Health and Disability Commissioner Vanessa Caldwell said from the time of the initial procedure on 4 December 2019, Ms A had "concerns".
She said while the dentist pointed out the infection was only detected in December 2020 - when the hospital specialist conducted a CBCT (cone beam CT scan) - Ms A's GP had been "sufficiently concerned in May 2020 to refer her to a maxillofacial specialist".
"And when Ms A was seen at the public hospital on 17 August the maxillofacial service identified a soft tissue pocket, peri-implantitis and bone loss.
"Further, on 19 December 2019, the dentist had recorded 'infection tissue removed'."
A dental expert who reviewed the clinical record for the HDC found the dentist "demonstrated considerable skill".
"Although the procedure failed, the treatment was within his scope."
Caldwell said however, the dentist failed to provide Ms A with the information she needed to make informed choices about her treatment, and his records were "incomplete in several respects".
Dr B stopped practising dentistry in June 2021 due to a medical condition, but he said after receiving the complaint, he and the dental practice reviewed all clinicians' note-taking, and consent forms were being reviewed and updated.
The HDC has recommended that the dentist apologise to Ms A for the criticisms in the report, and before returning to practice he undertake additional education on record-keeping, informed consent, person-centred care and effective communication with health consumers.
Sign up for Ngā Pitopito Kōrero
,
a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
RNZ News
2 hours ago
- RNZ News
NZ's goal to get smoking rates under 5 percent this year – why that's highly unlikely
By By Janet Hoek and Jude Ball* of More than 80,000 people would need to quit smoking this year to bring Aotearoa's overall smoking prevalence under 5 percent. Photo: Next week is "scrutiny week" in Parliament - one of two weeks each year when opposition MPs can hold ministers accountable for their actions, or lack thereof. For us, it's a good time to take stock of whether New Zealand is on track to achieve its smokefree goal of reducing smoking prevalence to under 5 percent and as close to zero as possible, among all population groups, this year. The latest New Zealand Health Survey shows that, for the first time in a decade, smoking rates have flatlined rather than fallen. Stark inequities persist, with daily smoking prevalence among Māori at 14.7 percent (compared to 6.1 percent among European New Zealanders). To bring New Zealand's overall smoking prevalence under 5 percent would require more than 80,000 people to quit this year. Achieving the goal equitably means more than 60,000 of those people would need to be Māori. The government's repeal of earlier measures predicted to bring rapid and equitable reductions in smoking prevalence means achieving the Smokefree 2025 goal for all population groups is now highly unlikely. Proposed by the Māori Affairs Select Committee and adopted by the then National-led government in 2011, the Smokefree 2025 goal has always had equity at its heart. At that time, smoking prevalence among Māori was 37.7 percent and 14.7 percent among European New Zealanders. Reducing smoking rates to less than 5 percent for all population groups offered an opportunity to profoundly reduce health inequities burdening Māori. Early discussions recognised the large inequities in smoking rates. Speaking about his role in the select committee inquiry, former National Party leader Simon Bridges stated: The picture I had of smoking was quite wrong. Most of the time, smoking is not this idea of a free market with adults who freely consent to take up smoking but the more complex, difficult situation of children smoking as a result of parents and grandparents who smoked . That means that a more intense, stronger, more interventionist approach is called for. The first Smokefree Action Plan, only introduced a decade later in late 2021, included more intense measures and established a Māori and Pacific oversight committee to ensure all actions taken promoted equity. The action plan introduced three key initiatives: denicotinisation, a large reduction in outlets selling tobacco, and the smokefree generation strategy. All were expected to have strong pro-equity outcomes. Modelling predicted denicotinisation would bring unprecedented reductions in smoking prevalence, eliminating the gaps between Māori and non-Māori. Reducing tobacco availability would end the widespread access to tobacco in lower-income communities. The smokefree generation, a longer-term endgame strategy that would have meant anyone born after 2009 could no longer buy tobacco, was predicted to significantly reduce inequity, given the younger Māori (and Pacific) population structure. Then Minister of Health Ayesha Verrall noted: While smoking rates are heading in the right direction, we need to do more, faster, to reach our goal. If nothing changes, it would be decades till Māori smoking rates fall below 5 percent, and this government is not prepared to leave people behind. The coalition government's repeal of these measures in early 2024 left a void, but Associate Health Minister Casey Costello reaffirmed a commitment to the Smokefree 2025 goal. A January 2024 update to Cabinet stated: The government remains committed to further reducing smoking rates and achieving the Smokefree 2025 goal of daily smoking prevalence of less than 5 percent for all population groups. However, by late 2024 the narrative began changing. In November, Costello launched a new smokefree action plan in a final push to reach the headline 5 percent target. Her plan does not emphasise the structural changes (such as fewer outlets selling tobacco) called for by the Māori Affairs Select Committee. Instead, it relies on health promotion programmes to reduce smoking uptake and on increasing attempts to quit by "reinvigorating" stop-smoking messages and improving referral rates to support. We argue New Zealand will likely fall well short of its 2025 goal to bring smoking rates below 5 percent and reduce inequities, despite an ongoing commitment by Health New Zealand-Te Whatu Ora. During scrutiny week, we hope Associate Health Minister Costello will be asked how she explains the discrepancy between her earlier commitment to achieving the Smokefree 2025 goal among all population groups and more recent comments which appear to roll back the equity goal. More importantly, we hope questions will probe how she plans to reduce smoking prevalence among Māori to a third of its current level, and what evidence she has that the steps she proposes will work. * Janet Hoek receives funding from the Health Research Council of New Zealand, the Marsden Fund, NZ Cancer Society and NZ Heart Foundation. She is a member of the Health Coalition Aotearoa's smokefree expert advisory group and of the Ministry of Health's smokefree advisory group, a member of the HRC's Public Health Research Committee, and a Senior Editor at Tobacco Control (honorarium paid). She serves on several other government, NGO and community advisory groups. Jude Ball receives funding from the Health Research Council of New Zealand, the Marsden Fund, NZ Cancer Society, NIB Foundation, and the Health Promotion Agency. She is affiliated with the Public Health Association of New Zealand, a member of Health Coalition Aotearoa's smokefree advisory group, and serves on other NGO and community advisory groups. - This story originally appeared on The Conversation.
RNZ News
5 hours ago
- RNZ News
Auckland hospitals in spotlight over infant's care
Starship Hospital in Auckland. Photo: RNZ / Cole Eastham-Farrelly Two Auckland hospitals have become locked in a dispute with a couple over the medical care given to their 15-month-old infant. Born prematurely, the infant is currently admitted in the paediatric intensive care unit of Starship Hospital, following earlier treatment at Middlemore Hospital. "Since birth, we have experienced what we believe to be a sustained pattern of medical negligence, poor clinical judgment and dehumanizing treatment by medical staff across both facilities," said Aarti Sarna, the infant's mother. "These concerns have now culminated in a High Court-ordered guardianship that has stripped us of our rights as parents to make even the most basic medical decisions regarding our child's pain management." The parents lodged a complaint with the Health and Disability Commission on 5 June. An HDC spokesperson said the complaint had been assessed and was now closed. "A referral was made directly to the provider to follow up with the family, as we consider they were best placed to respond to the family's concerns immediately and resolve their questions," the spokesperson said. "HDC has requested that the provider report back to us on the steps they take to ensure the concerns raised have been appropriately addressed." Sarna and her husband, Ajar, moved to New Zealand from New Delhi in 2010. The Sarnas have a 10-year-old daughter in addition to the 15-month-old infant. All four are New Zealand citizens. In their complaint to the Health and Disability Commission, the parents outlined a series of allegations against Starship and Middlemore hospitals. "On 29 April 2024, under coercive pressure from Middlemore Hospital clinicians, [our son] was transferred to Starship Hospital for a bronchoscopy," the parents said. "We were explicitly told that he would not be discharged unless the procedure was performed. At that time, he was stable and breathing independently without oxygen, even during minor illnesses and aspiration episodes," they said. "We were not adequately informed of the risks involved, nor offered less-invasive alternatives," they said. "Following the bronchoscopy, his condition deteriorated significantly. He was intubated and ventilated immediately, and his respiratory health has since worsened. He now requires oxygen even for minor respiratory issues." The parents alleged they had witnessed multiple instances of "serious clinical negligence and a lack of humane care". "Soiled diapers not being changed in a timely manner ... painkillers administered unnecessarily ... feeding delays of up to four hours, followed by sedative use to manage resulting distress ... inadequate respiratory care, including insufficient suctioning during visible respiratory distress ... sedation used during nursing shift changes to prevent [our son] from 'interfering' with staff routine, rather than for medical necessity. "Despite raising these issues repeatedly, we are told that the court guardianship order overrides our concerns." The Auckland High Court placed the infant under its guardianship on 23 May. The judge appointed two of the infant's treating physicians "as agents of the High Court for the particular purpose of consenting to the administration of pain medication to [the infant], where the administration of such medication is in accordance with good clinical practice and in [the infant's] best interests as assessed by [the physicians]". The judge also appointed the parents as general agents of the court for all purposes other than consenting to the administration of pain medication. The court directed the treating physicians to keep the parents informed at all reasonable times of the nature and progress of the boy's condition and treatment. The initial guardianship order was put in place until 28 May, which has since been extended until 25 June. Middlemore Hospital in Auckland. Photo: LDR / Jarred Williamson In an affidavit submitted to the court, the primary physician said the infant had a "profound congenital multisystem disorder" with "no unifying diagnosis". "[The infant's] prognosis is poor and sadly he is unlikely to survive. This is still the case even with the most aggressive life-prolonging interventions possible," the affidavit said. "[The infant] needs the immediate administration of pain relief, specifically opiates, alongside any other palliative treatment to provide comfort-orientated care." The physician said the case had been reviewed by a multi-disciplinary team of 12 health practitioners involved in the infant's care. "The team also considers that it is not currently [in the infant's] best interests to be intubated," the affidavit said. "The team acknowledges this conflicts with [the infant's] parents' wishes, however, the team agree that [the infant] has a human right to pain control and comfort." The parents claimed the affidavit contradicted what doctors had told them after the boy was born. "Last year, the ENT specialists at the Starship Hospital told us narrow airways - with which my son was born - grow as the child grows. They even commented its reassuring his airway is growing with time," Aarti Sarna said. "We were told the ENT team believes by the time my son reaches 3 or 4 years of age, he might not need hospital admissions for rhinovirus infections." In their complaint to the commission, the parents detailed what they called "disturbing attitudes" by medical staff at Starship Hospital. "Several clinicians have openly and orally told us they are tired of treating [our son]," Sarna said. "To date, no conclusive diagnosis has been made. Instead, multiple speculative conditions have been listed without supporting evidence. "We believe [our son] is suffering unnecessarily due to procedural harm and a systemic failure in care and oversight." The couple claimed the situation had affected the whole family. "Aarti has remained by our son's side 24/7 since his birth. She is now on extended unpaid leave, and we are surviving on a single income, which is increasingly unsustainable," Ajar said. "This ongoing situation is forcing us to choose between caring for our critically ill infant and supporting our daughter at home, all while enduring emotional trauma, financial hardship and what we believe to be institutional injustice." Mike Shepherd, group director of Operations Auckland at Health New Zealand, confirmed the agency had received a complaint from the parents. "We won't be commenting publicly on individual patient care due to privacy reasons. We acknowledge how distressing it can be for parents with a child in hospital and empathise with what they are going through," Shepherd said. "We can confirm that we are aware of this complaint and the concerns of this family. Our team are working with the family to address their concerns and optimise the child's treatment plan. "We are proud to have highly skilled and hard-working clinical teams who are focused on the well-being of all our community and work to provide patients with treatment plans most appropriate for their individual needs. "As always, we encourage patients and whānau to talk to us directly if they have questions about their or their loved one's care." On Saturday, the Sarnas launched a petition to get their son what they called "life-saving treatment". "This fight is about our son ... but it's also about the rights of every parent, every child and every family to access care, not a death sentence, when treatment exists."
RNZ News
8 hours ago
- RNZ News
Safer dining options needed for our gluten-free community
health life and society 30 minutes ago A call has gone out to restaurants across the motu to buck up their ideas when it comes to their gluten-free dining offerings. More than 100,000 New Zealanders are estimated to be living with coeliac disease, with thousands more likely undiagnosed. Now Coeliac New Zealand says people too often are navigating a minefield of hidden ingredients, cross-contamination risks, and the fear of being misunderstood or dismissed for being coeliac. The non-profit says this will both benefit our gluten-free community and could revitalise the struggling hospitality sector. Wendy Bremner is general manager at Coeliac New Zealand. She joins Jesse.
