As a dental malpractice lawyer at Meyers Evans Lupetin & Unatin, I have seen patients needlessly suffer from injuries caused by negligent dentists. Patients are often harmed during root canal procedures. This is worrisome because root canals are one of the most common procedures performed by dentists and endodontists.
One completely avoidable complication of root canals we have encountered is a patient being caused to swallow a dental instrument like a drill bit, hand file or probe. These are sharp metal objects that can do great harm to a patients internal organs if left untreated. Most dental procedures are accomplished while the patient is partially or totally flat. Resultantly, all patients have the potential and are at an increased risk to ingest or aspirate a dental item. As dental malpractice lawyers we assume dental negligence anytime a patient is caused to swallow a dental instrument during a root canal or any endodontic procedure. This is because the standard of care expected of dentists and endodontists makes such an occurrence a near impossibility.
The standard of care for a dentist or endodontist performing a root canal is to use a dental dam. The American Association of Endodontists has mandated that the use of a dental dam during root canal therapy is the standard of care. This means that if a dentist or endodontist does not use a dental dam during your root canal procedure they are negligent and in violation of the standard of care.
Pictured below is a standard dental dam applied to a patient about to undergo an andodontic procedure.
As you can see from this picture, the dental dam makes it essentially impossible for a broken dental tool to fall into a patient’s mouth where it could be accidentally swallowed. Dental dams are simple, easy to use and mandatory.
Despite the ease with which a dental dam may be set up, many dental practitioners do not routinely use a dental dam during root canals and other endodontic work. The International Endodontic Journal reports that rubber dams are not used routinely by many dental practitioners for root canal treatment. This report revealed many unfounded reasons for its lack of use, including “concerns over patient acceptance, time required for application, cost of equipment and materials, insufficient training, difficulty in use and low treatment fees.” This report goes on to note that failure to use a rubber dam negatively influences the choice of root canal irrigant, has a negative impact on treatment outcome and places the patient at risk of swallowing or aspirating materials and instruments.
When a patient ingests a dental instrument, the dentist must respond accordingly to minimize the risk of harm to the patient. The Journal of General Dentistry recommends the following response- first, the dentist must make sure that the patient’s airway is not compromised. Second, the patient must be told about the problem. Third, the patient must be immediately referred (with escort) to a medical facility for appropriate x-rays and determination of required medical action. This last step is mandatory, regardless of how well the patient looks. According to the literature, all aspirated foreign objects and approximately one-third of ingested items require the patient to be hospitalized.
Ingestion of a dental instrument should never happen if a dental dam is properly used. But if a freak accident should occur and appropriate response must be undertaken for the safety of the patient.