UK: Death At The Dentist

Last Updated: 24 May 2011
Article by David Reissner and Jenin Khanam

Recently a patient died after suffering from an allergic reaction to Chlorhexidine. David Reissner discusses this issue and provides some recommendations.

The recent Coroner's Inquest into the death of a patient after suffering from a fatal reaction to mouthwash given by his dentist1 will give dentists cause for concern, particularly because the February Inquest into the death of Graham Dalby was followed in late March 2011 by reports of the death in a Brighton dentist's chair of Sacha Rumaner2 after a suspected fatal reaction to mouthwash.

In the case of Mr Dalby, an allergy to latex was ruled out by the coroner after hearing at the inquest that before treatment the practice had requested information regarding allergic reactions and Mr Dalby had stated that he had been allergic to rubber but not latex.

Mr Dalby's dentist, Rachael Gibson, had used chlorhexidine, a commonly used antibacterial solution contained in mouthwash, to wash his tooth socket. Unfortunately Mr Dalby suffered from anaphylactic shock inducing a cardiac arrest.

The Oxford Journal reported on 26th March 2009 that chlorhexidine has been widely reported to cause IgE-mediated allergic reactions (from urticaria and angioedema to anaphylaxis) among patients undergoing surgery/invasive procedures. The study concluded after identifying four cases of chlorhexidine allergy among heath care workers that despite its excellent antimicrobial properties, chlorhexidine is an occupational allergen.

Dentist should therefore be aware that the use of mouthwash containing chlorhexidine runs a risk of a patient having an adverse allergic reaction and should therefore take steps to assess the patient's full medical history to identify whether they suffer from allergies.

Staff at the Penrith practice were praised during the inquest by several medical experts in their handling of the incident and believed that Mr Dalby had received the best possible treatment. This included the senior dentist recognising the symptoms of anaphylactic shock whilst Mr Dalby was still at the chair and injecting Mr Dalby with adrenaline, the common method of treatment for such adverse allergic reactions. Two senior dentists and a paramedic treated Mr Dalby at the scene, but his reaction was so sever that he went into respiratory arrest and died at the Cumberland Infirmary on 10th October 2009 without regaining consciousness.

The Coroner returned a verdict of accidental death and the coroner expressed concern that an allergic reaction suffered by Mr Dalby whilst visiting the Cumberland Infirmary in Carlisle in 2002 had not been sufficiently investigated at the time. If it had been it may have given Mr Dalby sufficient information to prevent a further allergic reaction on a subsequent occasion, leading to his death.

John Lewis, the practice owner of the Penrith's Ghyllmount practice, recently expressed his views regarding the incident and how the investigation had been handled. Dr Lewis stated that he would recommend the following to dental practitioners:

  • Pre-register your location with ambulance control using "point taken"
    The Ghyllmount dental practice was a new build and as such was not recognised in the satellite navigation system. Ambulance control had become regionalised and local knowledge had become lost. It had taken 6 minutes for the paramedics to arrive but 30 minutes for the ambulance to arrive. By pre-registering your location you can save vital minutes in an emergency.
  • Update your allergic questionnaire
    Dr Lewis has stated that the BDA medical history questionnaire was inadequate in respect of allergies, his practice has now designed one that includes a more comprehensive guide and his practice regularly uses the Heath and Safety Executive guide on allergic screening. Dentist should therefore take the time to assess whether their measures for medical history and allergies should be updated in light of these events.
  • Become a more allergic free practice
    The Ghyllmount practice has become latex free and now used hypo allergenic products wherever available. This may prevent and minimise risk of adverse allergic reactions.
  • Signed care/treatment plans
    Dr Lewis has stated that computer records alone are not sufficient for the purposes of a police investigation. It is good practice to have signed updated medical history at the start of each treatment and recommended that where treatments include any amendments these should also be signed and placed with the patient file.
  • Next of Kin Form
    Unfortunately it had taken 3 days to find and inform the family of the incident as Mr Dalby had written the wrong telephone number in his medical history form. Dr Lewis's practice now has a 'next of kin' form. However practitioners should be aware that where such forms are used they should be regularly checked to see whether the information continues to be correct and updated where and when necessary.
  • Use of training and knowledge
    Dr Lewis recommends that practitioners do not hesitate to take control and to use their training and knowledge when dealing with emergencies; and also not to assume that the paramedic will be more experienced. The practice and staff were praised at the inquest in the way that they had dealt with the incident including knowledge of anaphylactic shock and taking control of treatment by injecting adrenaline.
  • The vital importance of training
    The practice staff had regular training and was up to date with their training. The practice was praised in observing all proper procedure at the inquest.

Measures such as signed updated medical records and requesting that patients complete a comprehensive allergic reaction forms may cause some patients or even practice staff to complain about over-regulation or inducing overly bureaucratic procedures however having such measures in place may prevent a tragic event such as Mr Dalby's taking place in the first place. It is too soon to comment on the death of Sacha Rumaner and whether it was a reaction to mouthwash, as suspected. An Inquest into her death took place on 15 February 2011.

Footnotes

1. Vol . 59 Issue 4 p270-272

2. Metro, 23 March 2011

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
David Reissner
Jenin Khanam
 
In association with
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.

Disclaimer

Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.

Registration

Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.

Cookies

A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.

Links

This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.

Mail-A-Friend

If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.

Security

This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.