Sir, a 28-year-old male patient presented to our maxillofacial department with an iatrogenic mandibular fracture, confirmed by imaging, following removal of an impacted lower right third molar tooth.

The extraction was carried out under local anaesthetic in a general dental practice where upon delivery of the tooth, both dentist and patient heard 'a crack'. Subsequently, the patient's occlusion was deranged and mobility was evident in the right side of the mandible. The following day, open reduction and internal fixation was carried out under general anaesthetic and the patient was discharged two days post-admission.

In light of the recent changes to the law regarding consent, we feel this case highlights the important implications for clinicians. The landmark decision in Montgomery v Lanarkshire Health Board,1 given by the UK Supreme Court on 11 March 2015, means that the 'Bolam test' no longer applies to the issue of consent. This previously-used test asked whether a clinician's conduct would be supported by a responsible body of medical opinion. However, the law now requires doctors to take 'reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment'. The definition of a 'material risk' is one to which a reasonable person would be likely to attach significance.

In this case, the risk of mandibular fracture was not discussed with the patient during the consent process. It can be argued that, due to the low incidence of mandibular fracture associated with the removal of teeth (<0.005%),2,3,4 this need not be discussed during routine procedures. We believe this is now a perilous attitude in an increasingly litigious world. In the case of Rogers v Whitaker,5 an Australian court found the ophthalmologist to be negligent for failure to disclose the chance of blindness due to its remote risk (0.007%). Whilst we respect that the loss of vision is a far greater morbidity than a mandibular fracture, we feel the latter would be deemed of significance by the majority of patients. Our advice is that the rare risk of mandibular fracture is discussed with all patients before removal of lower third molar teeth.