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Remember who’s in the driving seat

11 July 2014
Although patients have fears and concerns, without following your duty of care you could be leaving yourself open to claims of negligence, as this case illustrates...

A 25-year-old male, Mr A, attended Dr C as a new patient with a neglected mouth containing many carious teeth. In 1973 a course of treatment was begun and restorations were placed in 23 different teeth. The records make no mention of the state of the periodontal condition at that time or indeed any attempts to discuss oral hygiene.

The patient attended regularly for the next seven years, during which time many of the fillings were replaced, but at no time do the records contain any reference to the soft tissues. In March 1980, however, the words ‘chronic marginal gingivitis’ were noted on the record card.

The patient continued to attend regularly and in May 1982 chronic marginal gingivitis was again noted. Many fillings needed replacement on a regular basis until 1990 when the patient joined a capitation payment plan.

Slowing down

Over the next 11 years, minimal scaling was all that was provided, together with far less frequent restorative work than in the preceding years. When Dr C retired in 2001, he signed an exit summary form for the scheme, noting only that the anterior gingival condition was poor.

In the 27 years during which Mr A had attended the same dentist, he had never been given any oral hygiene instruction and only basic scaling in later years. No radiographs were taken at any time. He had been examined and treated on 81 occasions and had received 219 fillings, nearly all of which were replacements of the initial restorations.

Unchecked and untreated

One month after Mr A’s last consultation with Dr C, a new dentist diagnosed major restorative and periodontal problems. Mr A was now aged 53 and faced the prospect of losing many of his teeth as a result of gross periodontal disease which had been allowed to progress unchecked and untreated.

When Dr C was asked why he had not provided any periodontal treatment or advice – even when periodontal problems had been diagnosed as early as 1980 – he responded that the patient ‘disliked operative procedures in the mouth’!

The ensuing claim for negligence was patient-led without the involvement of lawyers and a settlement was fortunately reached directly with Mr A to cover the costs of the periodontal treatment, basic restorative work and replacement of the condemned teeth with a removable prosthesis.

Learning point:
The routine quantitative periodontal monitoring of adult patients should prompt discussions about disease management and could prevent an accusation of neglect.
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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 members enjoy as part of their subscription. 
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