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Read between the lines

15 July 2014
As this case demonstrates, seemingly grateful patients can have gripes...

A dentist received the following letter from a patient:

Dear Sir,

I am just writing to thank you for all of your very kind treatment for myself and my family over the last 10 years. I have just moved house and although I am only 15 miles away and I could travel to see you, it would be more convenient to see a dentist nearby. I also appreciate how busy you are, as it has always been difficult to get appointments with you after working hours or at short notice. I realise that you have a lot of people to see, as my check-up appointments are always very short.

I recently attended a dentist near my new home with my broken tooth. He carried out a long examination of my teeth and gums and took a number of x-rays. He informed me that he had measured the gum pockets around my teeth and that I had lost a significant amount of bone due to rapidly progressing periodontal disease. I was very concerned to hear about this, as I am only 34-years-old. I am now having some intensive treatment with the hygienist at my new practice.

I would be grateful, therefore, if I could have a copy of my dental records (including the x-rays) for reference by my new dentist. I realise that you are very busy but I would also be grateful if you could explain the reasons why I should be having this problem with my gums as I do brush regularly and I have always attended your surgery at six-month intervals for my check-ups. I can remember us always having a pleasant conversation in your surgery but I do not recall you telling me that I had any problems with my gums. I look forward to hearing from you.

This was a very polite letter. It did not appear threatening but it contained some particularly worrying messages for the original dentist:

• The difficulty of obtaining appointments

• Short appointment times compared to the new dentist

• Apparent non-diagnosis of an aggressive periodontal condition

• Patient not informed of any such problem

No pocket charting or radiographs

An adviser at Dental Protection examined the patient records and discussed the situation with the member. It transpired that although this patient had received scaling by the member, no pocket charting had ever been carried out, nor had any radiographs been taken. The patient appeared caries-free and had no existing restorations, so the dentist decided it was unnecessary. The member was vulnerable as a result of that decision and the case could not be defended. It was duly settled to the satisfaction of all parties.
Learning point:
Although this particular patient’s letter did not seem very threatening, it raised serious concerns regarding the supervised neglect of the rapidly progressing periodontal disease, which had occurred in this particular case.
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