A preventative tale of periodontal indifference

Dental Protection often sees periodontal cases and claims for compensation focusing on the failure to provide appropriate periodontal care. Dentolegal Consultant Louise Eggleton looks at a typical case.

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The importance of gum health is often ignored by patients, and even, on occasion, by their dentists. There can be a tendency to focus on other areas of the mouth, where the patient is more motivated to receive a particular treatment.

Dental Protection repeatedly sees cases and claims for compensation that focus on a failure to provide appropriate periodontal care. The case study below demonstrates some of the common problems our members face and how occurrence-based indemnity can benefit clinicians.

Case study

Patient T first attended the clinic for examination with Dr C in May 2013. Following an OPG radiograph, Dr C advised that three restorations were required, which the patient received two weeks later alongside a scale and polish. Two years later, Patient T returned with a fractured lower left molar (tooth 36). Dr C restored the tooth and advised a crown was necessary, which was agreed by the patient and cemented the following month.

Patient T did not attend any further appointments for three years until September 2018, complaining of discomfort at the upper right second molar (tooth 17). A periapical radiograph was taken that showed general bone loss of 60% and deep caries at tooth 17 with a pocket of >8mm at the distal-buccal root. A dressing was placed, however, symptoms did not settle and tooth 17 was extracted two months later, with a suspected perio-endo lesion.

Patient T continued to attend the clinic sporadically for the next five years, receiving some simple restorations. In May 2023, Dr C decided to retire and ceased all clinical practice.

Six months later, Dr C was very surprised to receive a request for records from the patient’s lawyer. Patient T had not indicated any dissatisfaction or made any complaint to the clinic while under Dr C’s care. Dr C contacted Dental Protection for advice, so the first thing we did was help with the release of the records.

A claim for compensation arose relating to allegations that Dr C had failed to diagnose and treat Patient T’s periodontal condition throughout a ten-year period of care. Dental Protection’s claims team and expert dentolegal consultants assisted Dr C throughout this process. After further investigation and request for information, it was discovered that Patient T had sought care from a new clinician following Dr C’s retirement and was diagnosed with generalised periodontitis.

The claim progressed with the allegations including the loss of tooth 17 and deterioration of Patient T’s periodontal condition throughout this ten-year period. The patient requested future maintenance costs and claimed for a shortened life expectancy of other teeth due to lack of earlier intervention to halt the periodontal condition.

Dental Protection obtained an expert report from a specialist periodontist. Unfortunately, the report confirmed evidence of deterioration of Patient T’s periodontal condition and that Dr C had conducted no periodontal assessment, monitoring, or treatment – only an occasional scale and polish.

The radiographs demonstrated horizontal bone loss of around 40% in multiple teeth in 2013, which had increased in the posterior quadrants to approximately 60% with isolated areas of accelerated loss on some posterior molars – including tooth 17 five years later in 2018.

Patient T went on to receive further courses of periodontal care with a new dentist. The treatment was successful and the periodontitis stabilised.

The claim was settled by Dental Protection, which included the loss of tooth 17 and remedial treatment to stabilise the patient’s periodontal condition, together with a nominal sum to reflect the deterioration of the periodontium, but not loss of other teeth.

Dental Protection was able to reject the patients claim for future periodontal care. Even if Dr C had diagnosed periodontal disease at an earlier opportunity, the patient would have always required long-term treatment, which Dr C was not responsible for.

Analysis

The settlement of this claim demonstrates a cautionary tale in the failure to properly assess, diagnose, and treat a patient’s periodontal condition throughout the time they are under the dentist’s care. This was regardless of Patient T’s sporadic attendance pattern. Even though the patient’s periodontal condition was not caused by Dr C, the inaction and failure to provide advice and periodontal maintenance following routine examinations and other treatments, such as simple restorations, was accepted to have led to deterioration of the patient’s condition and the loss of tooth 17.

Occurrence-based indemnity

Dr C’s occurrence-based indemnity with Dental Protection was key in managing the claim for compensation on behalf of our member. Dr C had retired from practising dentistry when he received a letter from the patient’s lawyers. As Dr C was in membership with Dental Protection during the time he had provided treatment, he was entitled to receive assistance under his terms of membership.

Had Dr C taken out a claims-made policy, he would be required to arrange run-off cover to remain eligible for assistance each year should a claim for compensation arise after he had ceased clinical practice. This is not necessary with occurrence-based membership, where there are no additional fees if you choose to move to another provider or stop clinical practice. Assistance can be requested at any point in the future, as long as you were in membership during the time the treatment was provided.

Key points

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A version of this article was originally published in The Dentist