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Falling to pieces

Post date: 03/12/2020 | Time to read article: 3 mins

The information within this article was correct at the time of publishing. Last updated 03/12/2020

By Dr Simrit Ryatt, Dentolegal Consultant at Dental Protection

Case study

Dr W successfully completed endodontic treatment at tooth 15 for Mrs R in early March and asked her to return a couple of weeks later to have an onlay preparation. Tooth 15 was already heavily restored with only the buccal wall fully intact and the other surfaces just above gingival level; Dr W therefore advised it would be prudent to provide extracoronal coverage following completion of the endodontic treatment and an appointment was arranged for an onlay preparation on 25 March.

The appointment was later cancelled due to the country being in lockdown. Mrs R was advised to be careful and to avoid eating on tooth 15 due to its remaining fragile structure.

In early April, Mrs R lost the temporary dressing that was placed on tooth 15 and she contacted the clinic in order to urgently rearrange her onlay preparation. Dr W advised he was unable to organise routine treatment as per government advice and suggested Mrs R obtained a temporary filling material from a pharmacy. He reassured Mrs R he would attend her for the agreed treatment once the lockdown measures were less restrictive and routine dentistry was permitted. Mrs R was unhappy with this explanation as she believed her appointment was not routine, but indeed an emergency.

A few days later Mrs R contacted Dr W via telephone and advised that not only had some of the temporary filling been lost, but a large piece of tooth had become loose; she forwarded photographs she had taken of the 15 with the buccal wall coming away from what was left of the remaining tooth structure. When Mrs R demanded to be urgently attended to, Dr W revisited the previous advice he had provided and explained Mrs R did not meet the emergency criteria that would permit her to have treatment, which had been set out by government guidance.

When the lockdown restrictions were lifted to allow routine dentistry, Dr W reviewed Mrs R and unfortunately the 15 had lost the buccal wall below gingival level; the tooth was no longer restorable and would need to be removed. The patient did not receive this news well and promptly left the clinic.

The patient complains

A couple of days later Dr W received a complaint from Mrs R. She said she had visited another dentist who had suggested she would lose tooth 15 but could have an immediate implant placed as a replacement, and she believed Dr W should cover the cost.

Dr W was clearly upset about the complaint and was uncertain how this should be managed. He contacted Dental Protection and a dentolegal consultant discussed Dr W’s management of the case and acknowledged Dr W had been correctly observing national guidance. Had Dr W attended the patient when she had wished to have treatment, he would have been breaching guidance and may have potentially faced regulatory proceedings.

The dentolegal consultant could also clearly see Dr W had recorded within his treatment records what had been discussed during each remote consultation. This aided Dr W with his response to the patient, as Dr W’s team at Dental Protection could refer to particular dates when advice was provided and relate this to the government guidance in place at that specific time.

The conciliatory response acknowledged the unfortunate position the patient was in due to Dr W being unable to provide full coverage protection of the root filled tooth, and it explained the obligation on Dr W to observe government guidance. As the patient had been charged for the endodontic treatment Dr W refunded this fee as a gesture of goodwill, in the hope this would assist with the expense of Mrs R’s future treatment. Mrs R accepted the explanation and refund and the complaint was resolved.

Learning points

Dr W’s detailed treatment records assisted him with responding to Mrs R, as it was helpful to pinpoint the dates and advice that had been provided to the patient and align those with the national guidance in place at the time. Furthermore, it was clear to see Dr W’s treatment prior to lockdown had been provided within the accepted clinical standards and could not be criticised.

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