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An unexpected surprise

23 October 2019

Ms C visited her dentist, requesting an improvement on her overall smile and the specific appearance of the upper lateral incisors, which had been restored with porcelain veneers some years previously and the colour match with the natural adjacent teeth was now unsatisfactory.

Ms C, an aspiring actress currently living overseas, had been regularly attending this particular dentist since childhood. The dentist had placed the existing veneers more than 12 years ago as she had peg-shaped lateral incisors. At a previous visit Ms C had obtained some home tooth whitening gels, which she had been using, and the veneers were now a good few shades darker than the rest of her teeth.

She told the dentist she wanted all of her teeth to be a uniform, very light colour. When the dentist removed the existing veneers he noted the underlying vital tooth structure was particularly dark, suggesting there had been some longstanding bond failure. He had recently treated a patient with a similar problem, and so was acutely aware of how challenging it was to replace veneers on a like-for-like basis and create the aesthetic outcome the patient desired.

He therefore made a decision to provide a full coverage zirconium crown on each lateral incisor. For some reason – possibly because he was overloaded with distractions at the fit appointment and was running late – he failed to check the contact point distally at 22 and had not noticed that this crown did not sit correctly. Ms C returned a few days later complaining of sensitivity and a deficient margin palatally that she could feel with her fingernail. It was agreed that this crown would be replaced; however, it became impossible for an appointment to be scheduled due to the patient’s overseas commitments.

The sensitivity continued, so Ms C obtained a second opinion and was advised that both crowns had not been fitted correctly. The report from the new dentist was supported by radiographic evidence confirming a substandard marginal fit – which explained the sensitivity reported. The crowns were replaced by the new dentist and a letter of complaint was sent to the original dentist from the patient. She clearly felt that she had been more involved in the latest treatment decision than she had been when the zirconium crowns had been discussed, stating that she had not been fully informed about how much of the additional tooth would be sacrificed in order to accommodate the crowns, and what impact this might have long-term. She did not reference the fact that the dentist had been willing to rectify the situation, and that it had been her own scheduling difficulties that had caused the problem to remain unresolved.

The dentist contacted Dental Protection for advice and assistance on how he might manage the complaint, as Ms C was now seeking a refund of his fees and a payment covering the cost of her remedial treatment. Notwithstanding his offer to replace his faulty work, he felt it was unfair that he should be expected to finance the remedial treatment as well. Having lost the trust of the patient, the dentist lost the chance to recover the situation, particularly where there was factual evidence of a poor fit. He also accepted that the consent process had been undermined by his failure to identify how much information the patient needed, specifically around the long-term risks attached to a more aggressive tooth preparation compared with a like-for-like replacement of two veneers.

In her complaint, the patient stated that had the correct information been given at the time she had the veneers replaced, she would have made a different decision. Our advice to the member was that a refund of his treatment fees would not be sufficient to resolve this matter, so we made a contribution towards the additional costs of the remedial treatment.

Learning points

  • The law on consent provides a framework that protects patients’ rights to make an informed decision about all aspects of their treatment. In this case, the choice of zirconium crowns instead of veneers was not adequately discussed, nor was there anything in the records that we could use to defend the dentist’s position. Had the patient obtained legal advice, she would have been told of her right to compensation and it made no sense to allow this situation to escalate, where legal fees would dwarf the cost of paying for the remedial treatment.
  • Unlike a tightly-worded contract of insurance that may only respond to a claim, the use of discretion means that in some situations we can proactively manage a case by providing financial assistance towards the remedial treatment. In doing so, we protected the interests of the member and his reputation. We also protect the mutual fund and the interests of the wider membership by containing unnecessary legal costs.
   

 


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