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04 September 2020

The ever-changing nature of contemporary dental practice means no two days are ever the same. 

Unfortunately, this also applies to dentolegal issues, which are unpredictable in nature and can result in anything from requests for advice through to complaints, claims for compensation or the feared letter from the regulator, the Dental Council of Hong Kong.
Your membership with Dental Protection means you can contact us 24 hours a day, 7 days a week to request assistance. Our team consists of dentolegal consultants – qualified dentists with legal training, local panel lawyers, in-house clinical negligence solicitors and case managers who are all on hand to support you through a wide range of scenarios. Our press office is also available to handle any media intrusion on your behalf.

Making discretion work for our members

We are not an insurance company and can use our discretionary status to intervene early in matters, and unlike a traditional insurance company, we do not wait until a claim for compensation arrives. In this way we can often achieve an early resolution and therefore prevent matters becoming claims for compensation and reduce the risk of a complaint being made to the Dental Council, helping protect your professional reputation. It is almost impossible to list everything we assist members with. However, the following short case studies are just a sample from the full range of advice calls and other matters that we have supported members with over the years.

Early intervention to prevent escalation 

Dr P was a GDP who provided orthodontic aligner treatment to a somewhat demanding patient, Miss A. The patient had requested orthodontic treatment to give her the perfect smile as quickly as possible, stating that she had been unhappy for a long time with the appearance of the slightly imbricated upper incisors.  

Aligner treatment was started with instructions given to the patient and initially this proceeded well. However, after progressing through several aligners the patient started to question the length of the treatment and was becoming increasingly impatient. Reassurance was provided and treatment did continue to completion despite a few issues being highlighted by the patient along the way. However, following the provision of a retainer, the last review appointment was not kept due to the closure of the practice as a result of COVID-19. 

Dr P did not maintain contact with the patient during this period and there was no communication until he received an aggressive complaint that she could not bite into food, and was spitting, and that the teeth were moving back again. 

Dr P contacted Dental Protection and we promptly assisted, suggesting he offer to see Miss A as soon as lockdown was lifted, and assure Miss A that her concerns would be addressed. Unfortunately, the patient refused to return and said she would be speaking to a lawyer.

Our assistance included taking an objective view of Dr P’s treatment and records to identify any potential vulnerabilities that could undermine a defence if Miss A did proceed to litigation. Unfortunately, it became clear that there was no record of discussions relating to potential issues arising during active treatment and the need for retention to be maintained. As a result, we advised Dr P that the patient could reasonably challenge the validity of the consent process on the basis that she had not been given sufficient information to make an informed choice.

It was also clear from the patient’s description of her concerns that there may have been a suboptimal outcome to the treatment. With her expressed intention to escalate the matter legally, we advised the member that he should contact the patient once again and with our financial support, offer to fund a specialist examination to establish what the issues were and how the matter might be resolved. Thankfully the patient accepted the approach and as clinics were reopening, an examination was completed promptly. The subsequent report identified an anterior open bite together with some relapse and the need for remedial treatment was identified. 

As the report identified clinical vulnerability in addition to concerns about the consent process we shared our concerns with Dr P. With the potential for criticism of Dr P should the matter progress either to a claim or to the Dental Council, Dental Protection agreed to reimburse the fees attached to the remedial treatment which, together with a refund of the fees for the aligner treatment, resolved the matter and avoided unnecessary and potentially damaging escalation. 

The Consumer Council complaint

Dr H provided an immediate full denture to Mrs C. Despite warning Mrs C that it was likely that it would need relining as bony remodelling occurred, Mrs C attended the practice two months after the fit complaining that her new upper denture would not stay up when she ate.  Although earlier than intended, Dr H provided a reline for which he made a charge. The patient objected strongly to this charge and reported the matter to the Consumer Council.

Dental Protection reviewed the records of Mrs C’s care. Whilst they were generally good, Dr H accepted that they did not reflect the warnings he had made at the outset with regard to bone resorption, relines and further fees. With Dr H’s agreement, we instructed our panel lawyers to write a letter, in Cantonese, to the patient and her family, apologising for the misunderstanding and providing a refund of the reline costs. The family took the matter no further. Mrs C returned to Dr H for a definitive denture, which she paid full price for, because both the immediate denture and the reline had had such a good fit. Whilst Dr H was rather surprised to see Mrs C again, it was clear she trusted his clinical skills and knowledge, and they continue to have a good professional relationship.

A hot situation – hot extruded GP and the ID nerve

New to the practice, Dr B carried out an apparently routine root filling for Mr J, on a lower molar tooth, using a heated Gutta-Percha system to fill voids in the root canal system that might normally be missed with GP cones. Had Dr B spent a little longer reviewing the pre-operative radiograph, he might have noticed that the apex was somewhat open on the distal root and overlying the inferior dental nerve canal. As a result, hot GP was extruded through the apex and caused thermal damage, resulting in nerve injury. Dr B contacted us the next day when Mr J returned with numbness and a periapical x-ray showed GP in the mandibular canal.

We used our discretion to provide prompt assistance and advised Dr B to make an immediate referral to a suitable specialist oral surgeon for assessment, and to pay the consultation costs directly with the surgeon. We continued to support Dr B whilst Mr J had surgery that day to relieve pressure on the nerve bundle, and through a series of follow-up review appointments. Dental Protection chose to stay out of sight in this case, reimbursing Dr B those remedial treatment costs after he had paid them. In this way Mr J was unaware of the support Dr B was receiving from Dental Protection, reducing the risk that Mr J would initiate a claim for compensation or to report the matter to DCHK. Two years later, neither has occurred, despite a small area of residual numbness. 

Our experience is that those practitioners who proactively support the patient and assist in the early management of a complication are less likely to be sued. Using discretion to support our members differentiates us from those indemnifiers and insurers who prefer to sit and wait for a claim. Early intervention and support generally preserves the relationship and it is most often the patients who feel abandoned after an adverse outcome that will pursue matters further, for example, by complaining to the Dental Council.


Supporting practice owners through a Dental Council inquiry 

Drs A, B, C and D were partners in a clinic offering cosmetic treatment. They made contact with Dental Protection when the Dental Council wrote to them regarding their business name and alleged that the name of clinic was ”lacking in propriety” and not in accordance with the Code of Professional Discipline.

We instructed one of our firms of panel lawyers who prepared a response to the Dental Council and liaised with them over potential other clinic names. The matter was resolved with a letter to the Dental Council advising them of the agreed name and clarifying they would not revert to the previous clinic name.

Support for your mental health and wellbeing

In addition to our expert dentolegal advice and support, Dental Protection provides access to a counselling service, which is provided at no extra charge as part of your membership. The service means we can support you with work-related stress, or stress that you feel could impact your practice. The service is entirely independent and confidential. We’re here to support you beyond cases and claims, by not only protecting your career and reputation, but your wellbeing too. 

Find out more about the counselling service