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Denting the pride of the bride

11 July 2014
As this case demonstrates, failing to take notice of a patient’s social history can impact as much as neglecting their medical history...

A 25-year-old patient attended a dentist and explained that she was particularly conscious of the appearance of her irregular front teeth and that she wanted to have them straightened. The dentist briefly examined her mouth and advised the patient that she could improve her appearance by fitting veneers on eight of her anterior teeth and that it would take two weeks to complete the work. After agreeing the cost of this treatment, the patient made two appointments at the earliest opportunity.

During the first appointment, the veneer preparations were carried out and the dentist noted in the record that she had found difficulty in obtaining adequate anaesthesia at the upper right lateral incisor (UR2).

The following day, the patient returned to the practice because she was experiencing sensitivity from the UR2 and the dentist applied a fluoride varnish to the tooth. She recommended that the patient use desensitising toothpaste until the permanent veneers were fitted.

Two weeks later, the patient returned to have the veneers fitted and again mentioned the pain in the UR2. The dentist assured her that this would settle down and cemented the veneers in place. The patient was not really certain about her new look, but was reassured by the dentist who said that they would look much better once the gums had healed.

Disappointment

The patient returned to the practice the following week, accompanied by her fiancé, to express their disappointment at the results. The patient was also concerned at the volume of analgesics that she was taking for the pain in the lateral incisor.

This was the first time the dentist had been made aware that her patient was getting married in four weeks’ time. It explained the vehemence with which the patient and her fiancé were demanding immediate remedial treatment.

The dentist assured the couple that these problems were not insurmountable and proceeded to adjust the incisal edges of the veneers with a turbine to improve their alignment and occlusion before ‘repairing’ the gaps at the cervical margin with composite. The cause of the pain from the UR2 was never diagnosed.

Negligence and trauma

Shortly after this, a lawyer’s letter arrived alleging negligence and demanding payment for specialist remedial treatment and compensation for the patient’s traumatic experience. The defence organisation used its discretion to settle the case on behalf of the member; not only for the failure to adhere to a satisfactory result but also because there was no diagnosis made of the pain in UR2. The pain had subsequently become more acute, causing the patient to seek treatment elsewhere.

Learning point:
The social history of a patient can often impact negatively in a situation which does not go as planned, so it is sensible to ensure it is a consideration built into the initial treatment plan.
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