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Longstanding periodontal disease

20 July 2018
A patient had attended the same general dental practitioner for more than 20 years, and had undergone regular treatment by a dental hygienist during that time.

The treating dentist retired and a new dentist purchased the practice. He examined the patient and advised her that she had periodontal disease. Full-mouth radiographs were taken, and the patient was given a vigorous course of oral hygiene instruction, scaling and root planing. The new practitioner handed the patient a report that included a charting of the teeth, the radiographs and notes about the bone loss around the roots of the teeth.

The new dentist also recommended a referral to a periodontal specialist because of the advanced state of her periodontal condition. The patient was horrified that this condition had not been discussed with her in the past, and was upset by the cost quoted by the periodontist for ongoing treatment to manage the situation.

A letter of complaint was received by the retired dentist, in which the patient asked about compensation and mentioned legal action. The retired dentist then contacted Dental Protection for assistance.

A dentolegal adviser reviewed a copy of the original treatment records, which simply recorded the dates of the patient’s examination appointment and occasionally noted when scaling and polishing had been performed. There were no radiographs or evidence of any periodontal screening, such as a periodontal pocket charting.

The situation was discussed with the retired dentist. Seemingly, he had regularly and persistently advised the patient about her periodontal condition, and sent her to the hygienist for oral hygiene instruction and scaling, but this treatment and the discussions supporting the diagnosis and treatment were not recorded in any detail. The dentist also mentioned that he had frequently spoken to the patient about her periodontal condition over the early years of her treatment. More recently he had not further discussed the matter because the patient seemed disinterested.

The lack of detail demonstrating how the disease had been identified and monitored left the original dentist in an uncomfortable position simply because he could not provide sufficient evidence to show that the patient had been correctly informed of her condition and had been made aware how the condition had been deteriorating over time. A quantitative analysis of attachment loss at each visit would have reduced the obvious discomfort the dentist was feeling upon receipt of the complaint and Dental Protection’s considered views on how the matter could be concluded. Fortunately, the matter was settled by reimbursing the fees paid to the new dentist and the periodontal specialist for the patient’s recent periodontal treatment.
 
Learning points
  • Keep detailed records of all discussions with patients regarding advice and treatment.
  • Ensure that patients clearly understand the significance of periodontal disease and the likely outcomes should treatment advice be ignored.
  • Use every appointment as an opportunity to remind patients with periodontal disease of the need to maintain good oral hygiene.
  • Keep adequate notes of home care advice given to patients and the importance of flossing, brushing and smoking cessation.
  • Patients should be actively involved in their care, rather than just being a passive receiver of treatment.
  • Ensure periodontal disease is identified, recorded and monitored appropriately in accordance with current guidelines.
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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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