The patient was a 67-year-old female who had been treated at regular intervals at the general dentist’s office for almost six years. The patient was seen by the hygienist for routine prophylaxis. The general dentist was not in the office at the time (allowed in certain states such as Massachusetts). The patient had a small area of tissue that looked “puffy on both the lingual and facial in the area of teeth #6, 7, and 8.” No radiographs were taken; the patient was told to keep an eye on the area and call the office if there were changes or if it persisted.
The patient was next seen on a regularly scheduled recall appointment six months later. The patient had now developed a lump above her right front teeth and several of the teeth were loose. A panoramic radiograph was taken and the patient was examined by the general dentist. The general dentist arranged for the patient to be seen by an oral surgeon that same afternoon. The oral surgeon did a biopsy and made a diagnosis of adenoid cystic carcinoma.
An ENT physician performed surgery on the patient two weeks later, removing the patient’s septum, right orbit, and eye. Surgery showed that the tumor resulted in lachrymal duct involvement. Additional surgeries were required, with the patient ultimately having to wear an obdurater and an external eye prosthesis.
The patient filed suit against the individual general dentist, his corporation, and the hygienist. The plaintiff’s theory was that a dentist should have been informed of the abnormality and the patient should have been seen in follow-up. The patient further argued that it was below the standard of care for the patient to be seen only by a hygienist and for the provider to rely solely on the patient for follow-up. The patient also stated that the six-month delay in diagnosis made a significant difference in the plaintiff’s outcome.
The case went to non-binding mediation, resulting in a $750,000 settlement in favor of the patient.
The responsibility for an examination, a diagnosis, and/or treatment planning belongs to the dentist alone even when a dentist goes on vacation.