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An unexpected surprise

18 November 2019

Ms C visited her dentist, requesting an improvement on her overall smile and the specific appearance of the upper lateral incisors, which had been restored with porcelain veneers some years previously and the colour match with the natural adjacent teeth was now unsatisfactory.

Ms C, an aspiring actress, who now lived overseas, had been regularly attending this particular dentist since childhood. The dentist had placed the existing veneers more than 12 years earlier to improve the appearance of the peg-shaped lateral incisors. At a previous visit Ms C had obtained some home tooth whitening gel to lighten her teeth which exaggerated the colour mismatch against the veneers.

She told the dentist she wanted all of her teeth to be a uniform and much lighter colour. When the dentist removed the existing veneers he noted the underlying vital tooth structure was particularly dark. He had recently treated a patient with a similar problem, and so was acutely aware of how challenging it was to replace veneers and achieve the desired result to the satisfaction of the patient.

He made a decision to provide a full coverage zirconium crown on each lateral incisor. At the fit appointment, he failed to check the contact point distally at 22 and failed to notice that this crown was not seated correctly. Ms C returned a few days later complaining of sensitivity and was aware of a deficient margin palatally which she could feel with her fingernail. It was agreed that this crown would be replaced, but it proved difficult to arrange an appointment to undertake this treatment given the patient’s overseas commitments.

The sensitivity continued, so Ms C obtained a second opinion and was advised that both crowns had not been fitted correctly. The report from the new dentist was supported by radiographic evidence confirming a substandard marginal fit – which explained the sensitivity reported. The crowns were replaced by the new dentist and a letter of complaint was sent to the original dentist from the patient. She clearly felt that she had been more involved in the latest treatment decision than she had been when the zirconium crowns had been discussed, stating that she had not been fully informed about how much of the additional tooth would be sacrificed in order to accommodate the crowns, and what impact this might have long-term. She failed to mention that the dentist had been willing to rectify the situation, and that it had been her own diary commitments that had delayed the provision of remedial treatment.

The dentist contacted Dental Protection for advice and assistance on how to manage the complaint. He explained that Ms C was now seeking a refund of fees and a further payment to cover the cost of her remedial treatment. Notwithstanding his offer to replace his faulty work, he felt it was unfair that he should be expected to pay for the remedial treatment as well. Having lost the trust of the patient, the dentist lost the chance to recover the situation, particularly where there was factual evidence of a poor fit. He also accepted that the consent process had been undermined by his failure to identify how much information the patient needed, specifically around the long-term risks attached to a more aggressive tooth preparation compared with a like-for-like replacement of two veneers.

In her complaint, the patient stated that had she been given the correct information, she would have made a different decision. Our assessment of this particular case was that it was unlikely the patient would settle for a refund of fees and with this in mind Dental Protection made a significant contribution towards the remedial treatment costs.

Learning points

  • The law on consent provides a framework that protects patients’ rights to make an informed decision about all aspects of their treatment. In this case, the choice of zirconium crowns instead of veneers was not adequately discussed, nor was there anything in the records to defend the dentist’s position. Had the patient obtained legal advice, she would have been told of her right to compensation and it made no sense to allow this situation to escalate, where legal fees would dwarf the cost of paying for the remedial treatment.
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