The case

A dentist in private practice assessed a young adult patient who had been referred for evaluation of a painful ulcer on the tongue that had persisted for several weeks. On examination, the lesion was consistent with a major aphthous ulcer, a condition known to recur and, in some cases, persist for extended periods.

The patient was prescribed a topical regimen and reassured. Importantly, a follow-up appointment was arranged for later that month to allow reassessment. Sufficient time was allocated at that visit to perform a biopsy if the lesion had not resolved or if any atypical features developed.

The review appointment did not take place after the patient was advised that the lesion appeared to be improving.

Some weeks later, while abroad, the patient experienced worsening symptoms and sought further medical advice. A biopsy and imaging were performed, and the patient was diagnosed with squamous cell carcinoma of the oral cavity. Treatment involved a combination of chemotherapy and radiotherapy.

The patient’s parent subsequently wrote to the dentist expressing concern about the initial diagnosis and the delay in identifying the malignancy. The correspondence was emotive and alleged that earlier intervention may have altered the course of the disease. A refund of the consultation fee was requested.

How Dental Protection helped

The member contacted Dental Protection shortly after receiving the complaint and provided a draft response. He was understandably concerned about the seriousness of the outcome and was also mindful of maintaining a professional relationship with the referring clinician involved in the patient’s earlier care.

Dental Protection reassured the member that the initial presentation of oral lesions can be clinically challenging, and that not all persistent ulcers demonstrate features warranting immediate biopsy at first presentation. However, given the nature of the complaint and the subsequent diagnosis, careful handling of the response was essential.

Advice focused on tone and structure. The member was encouraged to lead with empathy, acknowledging the patient’s experience and the impact on the family, before setting out his clinical reasoning. Suggested wording ensured that the explanation remained factual and clear, while avoiding any perception of defensiveness or attribution of blame.

We also discussed how to refer to the missed follow-up. The member was advised to include a neutral, factual statement that a review had been arranged and later did not take place after the lesion was thought to be improving. This ensured the chronology remained accurate without implicating any other clinician.

Given the relatively modest financial request and the highly emotive context, Dental Protection further advised that a goodwill refund could be an appropriate and proportionate way to bring the matter to a close. It was emphasised that such a gesture would not constitute an admission of liability, but rather a demonstration of empathy and professionalism.

A revised response was drafted with these elements in mind, combining compassion, clinical clarity, and a non-adversarial tone.

Outcome

The member implemented the advice and sent the revised response, including an apology for the patient’s experience and an offer to refund the consultation fee as a gesture of goodwill.

The patient’s parent accepted the response and the refund. The matter did not escalate to a formal complaint, legal claim, or regulatory investigation, and the file was closed shortly thereafter.

Learning points

• Persistent oral lesions require clear safety-netting. Even where initial clinical features appear benign, it is important to document a clear plan for review and escalation, including when a biopsy will be considered.

• Follow-up arrangements are critical. Where reassessment is part of the management plan, ensuring that the patient understands the importance of review – and documenting this – can be pivotal if outcomes later come into question.

• Clinical uncertainty is common and should be acknowledged. Not all serious pathology presents with classic features at an early stage. A defensible approach lies in careful assessment, appropriate initial management, and a structured plan for review.

• Tone matters in high-stakes complaints. Where outcomes are serious, a purely factual response may be perceived as cold or dismissive. Leading with empathy can significantly influence how a complaint is received and resolved.

• Goodwill gestures do not equate to admissions of liability. In appropriate cases, a modest financial gesture can demonstrate professionalism and compassion, and may prevent escalation into more formal and stressful processes.

• Early engagement with Dental Protection supports effective resolution. By seeking advice at an early stage, the member was able to respond in a measured and strategic way, avoiding unnecessary conflict and achieving a swift resolution for all parties.