NHS Tayside is reviewing the way it cares for dental patients after a man complained he ended up in hospital for nine days through complications from a tooth extraction.
The case was investigated by the Scottish public services ombudsman, who has not upheld the complaint but has told health chiefs to apologise for failing to carry out effective pain control.
The man had a badly decayed and impacted wisdom tooth removed at Dundee Dental Hospital. The operation appeared to have gone well, but he later suffered swelling and discomfort.
Over the next few days he was seen by staff at the dental hospital, Kings Cross Hospital and Arbroath Infirmary before being admitted to Ninewells Hospital.
He was found to be suffering from an infected haematoma and needed an emergency operation.
The man felt several opportunities had been missed to recognise the severity of his problem.
NHS Tayside admitted he should have been advised to see his own dentist if there was no improvement within 48 hours of starting on antibiotics.
The ombudsman’s medical adviser said, “It is rather difficult to work out exactly when things actually started going wrong at what point they went from being a normal post-operative recovery to being complicated by the issue around the bleeding and the infection.
“It is rather unfortunate most of these events took place over a weekend when he was seen by several people but none with any great experience in diagnosing this kind of condition.”
The man was taking the anti-coagulant drug warfarin for a heart condition. The ombudsman found there was no evidence that clinicians had considered the impact of the antibiotics and painkillers he was taking on his warfarin level.
There was not enough evidence to allow the ombudsman to establish whether clinicians should have reached a diagnosis of haematoma earlier than they did, so he could not uphold the man’s complaint.
But he added, “It is possible to be critical of the board for their failure to ensure adequate pre-operative planning, post-operative guidance and the failure of clinicians to ensure for adequate pain control.”
He has told NHS Tayside to review the way it plans operations for dental patients with pre-existing diseases or medicine use to ensure effective treatment plans are in place in the event of complications.
This includes providing detailed instructions for patients taking warfarin.
The board has agreed to act on the ombudsman’s recommendation.