An examination of the trend in large claims that members are currently experiencing with dental implants and periodontal disease.
These cases are increasing both in number, frequency and cost. The size of the claims account for a disproportionate share of our total claims expenditure as they increasingly represent a higher proportion of all the cases currently under our management. It is not surprising, given this recent history, that implant dentistry is more of a concern than was the case five to seven years ago. These are concerns that are known to be shared by the General Dental Council (GDC).
Cases arising from implant dentistry can be related to either the placement of the implant fixtures, or the restorations or prosthetic appliances supported on them. In a significant number of cases, an element of both is involved, and where two (or more) clinicians are involved in the treatment of the same patient, any or all of them can become drawn into the claim. This is particularly likely when there is any question about the case assessment and treatment plan, or any lack of co-ordination or communication between the various clinicians.
Another noticeable feature amongst the growing number of implant cases overall, is the appearance of more “late failure” cases, especially involving so-called “peri-implantitis”. These cases can be attributed to the clinician who placed the implants, or the clinician who provided any subsequent treatment, but more commonly both, at least while the case is being investigated and an expert opinion sought. Another feature is that these claims can additionally include clinicians (whether dentists or hygienists) who have examined or treated the patient subsequent to the provision of the implant(s) and restorations placed upon them and failed to identify and act upon the situation. There is a growing consensus amongst those involved in the field of implant dentistry that we will be seeing more of these cases in the years ahead.
Implant dentistry is almost always private dentistry, of course, and the costs involved can contribute to patients being less willing to tolerate and accept unfavourable outcomes.
Impact of NHS changes
One of the concerns we had voiced at the time of the changes in the GDS and PDS contracts in England and Wales ten years ago, was the potential risk created by the UDA system where the management of periodontal disease was concerned. In many cases the new arrangements effectively removed any kind of remuneration for the treatment of periodontal disease, or at least introduced a powerful financial disincentive that had not existed previously. The disappearance at that time of the narrative and provisos that had accompanied the fee-per-item remuneration system also removed the specific requirement to have recorded BPE scores and full mouth probing depths in certain situations.
Those who had always (and quite rightly) viewed this as an important part of the monitoring of periodontal health, continued to do this, but those who had viewed it as a tedious administrative burden imposed by the NHS, no longer felt the need to keep these records and as a result have unwittingly left themselves especially vulnerable to these claims. This is a perfect example of the law of unintended consequences at work, coupled with an alarming disconnect between the aim of legislative changes and their practical impact - but the cost looks set to run into many millions of pounds and we can expect these claims to be arriving at our door for many years into the future.