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Are you incompetent?

03 November 2022
Dr Annalene Weston, Dentolegal Consultant at Dental Protection, walks us through a case where this very question was asked of a practitioner.

Mr R was an irregular attender, with a heavily restored dentition that included an incomplete root filling in tooth 36. Dr L had raised this as an issue that required addressing and reiterated this to Mr R at every appointment. Mr R was reluctant to undergo treatment as the tooth was asymptomatic.

However, as Dr L had anticipated, the tooth became symptomatic. These symptoms quickly became unbearable and unresponsive to pain relief. Mr R attended Dr L in the pre-lunch emergency spot, hypoglycemic as he could not eat, exhausted as he could not sleep and in tremendous pain.

Dr L talked through the risks and warnings, including that the tooth would likely fracture during the extraction and may require a surgical approach. She offered Mr R a specialist referral; however, understandably, Mr R wanted the tooth extracted there and then.

As anticipated, despite sufficient anaesthesia, the extraction was uncomfortable and challenging. Regretfully, the tooth fractured on application of cowhorns, leaving the distal root in situ. Dr L was unable to remove this retained root by luxation and recommended a surgical approach.  Overwhelmed, Mr R declined a surgical procedure on that day, and they agreed to talk the following day to arrange for the remainder of the tooth to be extracted by an oral and maxillofacial surgeon. Critically, Dr L did not charge for the extraction and offered to take Mr R home, as he was feeling so unwell. Desperate to leave, he declined. He missed the calls made to him the following day.

Mr R then had a challenging few days of pain and vomiting. He had taken a considerable number of painkillers, well above the recommended dose, but did not consider this to be the likely cause of his sensitive stomach. He was very focused not on Dr L’s repeated recommendations to get tooth 36 assessed and treated, nor the risks and warnings she had outlined before attempting the extraction, but rather her perceived inability to ‘get the job done’.

Mr R sent an unpleasant letter of complaint to Dr L, asking whether “she was incompetent” and this was swiftly followed by a letter to the regulator setting out his perceived failings on her part including her incompetence, charging for treatment not provided and her complete lack of care for his wellbeing.

Dental Protection assisted Dr L with her formal response to the complaint. Pleasingly, the matter was dismissed, as there was no evidence that Dr L had acted incompetently. Dr L was also able to evidence she had not charged Mr R and that all appropriate steps had been taken to care for him.

For a more in-depth discussion of this case, subscribe to our CaseMatters podcast series now at




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