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A misaligned complaint

03 October 2019

Mrs T attended an appointment with her regular dentist. The dentist was already aware through previous discussions that she was considering a course of orthodontic treatment to address the mild crowding in her upper and lower arch, along with aligning the upper central incisors, which were mesially inclined.

Mrs T informed the dentist that she was now ready to move forwards with orthodontic treatment. The dentist had considerable experience in providing short-term orthodontic aligner treatment; he carried out a full orthodontic assessment and provided the patient with treatment options, along with the option of referral to a specialist colleague for potential fixed braces. Mrs T declined the referral; so the discussion with the dentist was limited to aligner treatment. The patient was also given information about the anticipated costs of aligner treatment and made aware of the need for permanent retention after treatment had finished. Mrs T was asked to book the next appointment for a further discussion, or to begin treatment should she wish.

At the following appointment, Mrs T said she was sure she wanted to begin treatment, so the dentist carried out the aligner treatment over the course of ten months. The patient was very happy with the final result. The dentist reiterated his recommendation that due to the original position of the mesially inclined upper central incisors, he considered it necessary to have both permanent fixed retention of the upper teeth and upper and lower removable retainers, to guard against potential tooth movement in the future.

Mrs T declined fixed retention because she would not be able to floss. The dentist went on to remind her why permanent retention was necessary and warned of the risk of relapse should she not observe a strict regime of wearing the retainers each and every night. She still refused the treatment and so the dentist provided upper and lower removable retainers, being sure to document all their discussions in the treatment records.

Mrs T continued to see the dentist for her routine dental care until she moved from the area five years later.

Unexpectedly, three years later the dentist received a letter from the Dental Council informing him that Mrs T had made a formal complaint regarding treatment he had provided eight years previously. The dentist was shocked and disappointed to learn the identity of the patient, whom he always felt he had enjoyed a good professional relationship with.

The dentist immediately contacted Dental Protection, who assisted him in obtaining more information and who also instructed lawyers to provide local assistance and support.

It became apparent that Mrs T had been wearing her retainers routinely since the dentist provided his initial orthodontic treatment course all those years ago. However, Mrs T had stated to her new dentist that the retainers were no longer maintaining the alignment of her teeth.

In order to establish the current situation, the new dentist’s records were examined and these showed that Mrs T had experienced a mild relapse in alignment of the upper anterior incisors, which had begun to become mesially inclined once again. In addition to the complaint to the Dental Council, Mrs T was also requesting that the original dentist pay for remedial treatment to correct the relapse in alignment of the upper anterior incisors, as she said she was informed the alignment of her teeth would be maintained if she wore the retainer every night.

However, the records also showed that upon examination, the now discoloured and worn retainer had two fracture lines present and a missing section in the upper anterior buccal aspect which allowed flex and movement of the retainer.

Based upon these findings, including the detailed treatment records clearly evidencing the patient and dentist discussion regarding the advice that permanent fixed retention was strongly recommended, and the fact that the retainer would need to be replaced over time, Dental Protection was able to defend the complaint on behalf of the dentist. We wrote to the Dental Council and stated that the onus was on the patient to continue to wear a retainer that was fit for purpose, and pointed out her refusal to comply with the dentist’s recommendations of fixed retention all those years ago had significantly contributed to the problem. There was no finding of fault against the dentist and the case was dismissed.

Learning points

  • Always ensure you write detailed records of all key treatment discussions with your patient. In this situation, the information provided to the patient regarding the recommendation for permanent fixed retention – along with the warnings of potential relapse – was recorded. The patient continuing to wear a now defective retainer clearly demonstrated the dentist was not at fault or responsible for the mild relapse.
  • Even many years after an event takes place, a complaint may arise.
  • Occurrence-based protection with Dental Protection depends on the date on which an adverse incident occurs, and not the date that the matter is reported to us. This is important because it can be years before a case is brought and fully resolved. This type of protection offers peace of mind, and in this instance, meant that Dental Protection were still able to provide assistance, at no further expense to the dentist.

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 Protection members enjoy as part of their subscription. 
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