The case 

A nine-year-old patient accompanied by a parent attended a promotional check-up with a private general dentist. The dentist noted extensive caries on several permanent and primary molars and recommends that the more urgent permanent teeth (two molars) be treated first under conscious sedation. The dentist also advised that some primary teeth were nearing exfoliation and proposed an orthodontic opinion before deciding whether to extract or restore them. The plan was accepted by the patient’s mother and sedation treatment was booked.

On the day of the procedure, the parent confirmed that the orthodontic consultation had not yet taken place but consented to proceed with treatment of the permanent teeth only. The restorative work was then completed under conscious sedation. The dentist explained that the restorations, particularly on the permanent molars, were deep and would need monitoring.

Nearly a month later, the patient’s parent emailed the dentist, stating that one of the permanent molars had become symptomatic and had been re-treated by another dentist (a former colleague of the member). The parent requested a full refund for both the dental treatment and the sedation, citing dissatisfaction and costs incurred. The second dentist also sent a report indicating recurrent decay and the need for extractions and a new filling. 

How Dental Protection helped 

The member sought advice from Dental Protection on how to respond to the complaint. The dentist provided a detailed timeline, confirmed informed consent had been obtained at each stage, and expressed a willingness to offer a refund for the permanent molar which had been re-treated by the second dentist, as a gesture of goodwill.

Dental Protection advised on the strategic wording for a draft response, which carefully:

• Acknowledged the parent’s concerns without admitting liability 

• Reaffirmed that all options were discussed and consented to 

• Explained that the treatment plan was clinically justified and guided by both radiographic findings and parental input 

• Tactfully noted that the second dentist had not contacted the first dentist, which may have contributed to confusion 

Dental Protection also suggested a non-adversarial reference to HPCSA Ethical Rule 10, which requires practitioners to contact the original treating provider when continuing care. This was intended to gently discourage escalation and reinforce the professionalism of the member’s approach. 

Outcome 

The dentist implemented the advice and sent a refined, empathetic response offering to refund the restoration on the re-treated molar. They made it clear that they would have replaced the filling at no cost had the child returned to them. They also respectfully declined the request for a full refund, as the sedation and other treatments had been necessary, discussed, and consented to.

The parent of the patient accepted the explanation and refund, and the matter did not escalate further. The member confirmed resolution shortly thereafter, and the file was closed without the need for formal regulatory defence or legal proceedings. 

Learning points 

• Goodwill refunds can be powerful tools for de-escalation when used strategically and framed carefully. They should never be an admission of fault – and members should feel supported in making such offers without fear of setting precedent. 

• Informed consent documentation and clear notes about treatment discussions (e.g. why certain teeth were prioritised) are critical in paediatric cases, where parents may have different interpretations of what was agreed. 

• Where a second opinion leads to criticism or re-treatment, it is appropriate to flag the ethical expectation (under HPCSA Rule 10) that the new provider should contact the original dentist, especially if the patient is still under active care. This not only supports clinical continuity but may deter inappropriate or inflammatory patient commentary. 

• Practitioners should not feel that disappointment or frustration in these situations implies they are unprofessional – the goal is to remain constructive and engaged, but also to create a clear, defensible record.