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Asking the right questions

11 July 2014
Quality of care and the standards expected of a clinician can always be called into question, as this case illustrates...

A child attended a dentist for regular consultations over a period of time between the ages of 11 and 14. During that period, no radiographs were taken and most of the posterior teeth were fissure-sealed.

Concern was raised over the number of teeth sealed at each appointment and the fact that one year after the last visit to the dentist the child (now 15) required the extraction of a lower second molar and an upper second molar needed root-filling. Both teeth had developed gross caries.

For both the patient and the dentist, the difficulty in a case of this nature is the link between the cause of the patient’s problems (dental caries) and the treatment, or lack of it, provided.

Questions arise for both parties, including:

• Were the teeth examined at the right time in order to detect caries?

• What are the appropriate time intervals for such examinations?

• Should x-rays be taken in children and with what frequency?

• How long does it take to complete a satisfactory fissure seal, and how many can be undertaken in a 15 to 20-minute appointment?

• If a tooth is carious, when should it be extracted in a child?

• If a teenager has gross caries in a molar tooth, is the treatment of choice an extraction or root canal therapy?

Along with other concerns, these are fundamental questions to be asked by those examining the quality of care provided.

When considering the quality of dental care, assessment will vary from country to country, depending on:

• local conditions

• attitudes to care

• the balance between traditional practice and evidence-based dentistry 

Learning point:
It goes without saying that all clinicians should be aware of the prevailing standards in their own situation.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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