A young cyclist who hit the back of a car and knocked out five front teeth came close to losing them permanently when hospital dental staff failed to treat it as an emergency.

The 14-year-old was rushed to hospital, with his teeth placed in milk to help save them, but a staff member at the oral and maxillofacial surgery (OMS) department did not think that it warranted urgent care.

Specialists later said even with the delay it was still advisable to reimplant them, especially as they had been “stored in the most favourable medium”, milk.

Deputy Health and Disability Commissioner Dr Vanessa Caldwell said Health NZ failed to act sooner over a dental emergency, and had therefore failed to adhere to relevant standards.

The Health and Disability Commissioner found in a report released today that the long-term prognosis for the young person’s teeth had been “seriously jeopardised” and that failure to act sooner was in breach of a section of the code that protects health consumers’ rights.

Deputy commissioner Vanessa Caldwell said Health NZ should have adhered to the relevant standards, and that the “avulsed teeth”, meaning they had been knocked from their socket, should have been reimplanted with urgency on the day of the accident.

“I am critical that this did not occur,” she said.

The teen’s teeth were ultimately saved by two dental specialists who re-implanted them more than 24 hours after the accident, the office of the HDC confirmed to NZME.

Reimplantation ‘not urgent’

The teen was badly injured in the accident in May 2021. As well as knocking out his teeth, he sustained a head injury, fractures, cuts and bruising.

He was assessed at one hospital and after a CT scan he was taken to another hospital for neurological monitoring overnight.

The complaint to the HDC raised concerns about the lack of awareness of best practice when dealing with the avulsion of teeth.

Caldwell said each hospital contacted the OMS for advice about assessing and reimplanting the teen’s teeth, and was told it wasn’t urgent.

According to the first hospital’s clinical records, the dental house officer noted that reimplanting teeth was not advised because it was, at best, a temporary solution.

The house officer instead recommended seeing a private dentist the next day for replacement therapy.

The advice was similar from the second hospital.

Health NZ said in its response to the HDC, an offer had been made to reimplant and splint the teeth if the patient was fit to be transferred. A suggestion was made for a referral to a third hospital and that a contact number was provided, but no further call was received.

Caldwell noted that the house officer’s statements were inconsistent with the clinical records from the first public hospital, and that the handwritten note from the phone call in question had been destroyed by the house officer.

The teen was transferred to the second public hospital and “the opportunity to undertake reimplantation/splinting at Public Hospital 3 was lost”, the HDC said.

Dad’s complaint prompts investigation

The teen’s father complained to the HDC about the delay in treatment and the “inappropriate recommendation” that there was no need for urgent care from OMS.

Twenty-four hours after the accident he arranged an appointment with a private surgeon, who phoned two dental specialists. They said it was “almost certain” the delay would end in the teeth being lost because of “resorption of the roots”, or deterioration from the inside.

Steps were taken in the interim to maintain the bones around them so that implant treatment could be considered, the HDC said.

Following re-implantation of the teeth, an orthodontist placed braces on the upper teeth to serve as a splint to support the re-implanted teeth.

Another orthodontist then sutured the “extensive lacerations” of the teen’s upper gum tissues and arranged for him to see an endodontist for specialist follow-up treatment.

He told the HDC he was “surprised and disappointed” that the OMS dental house officer had not recommended re-implantation, or arranged a review on the day of the accident.

The orthodontist said avulsion of teeth was one of the “true emergencies” in dentistry.

He said that once a tooth had been out of the mouth for more than 60 minutes, the chances of it “taking” reduced significantly.

Health NZ accepted that the teeth should have been reimplanted earlier.

A doctor who reviewed the clinical notes apologised on behalf of the service that “the best care was not provided on this occasion,” and for the distress it had caused.

Health NZ confirmed that the concerns had prompted a review into all aspects of management of its dental trauma service, which included house officer education and support when working after-hours.

Caldwell said Health NZ should have adhered to the relevant standards.

Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.