Every dentist has surely heard the old adage that if you have ten dentists and a patient in the same room, they will come up with ten different treatment plans for the same patient.
This anecdote may not reflect a situation in a practice which has a relatively stable dental team, but if you are the new dentist arriving in a practice, this can be a potentially significant issue.
Who are you taking over from and what sort of dentistry have they been providing? It is worth remembering that trends in dental treatment do vary from country to country; a multi-unit bridge might be a relative rarity in one continent, but perhaps would be more commonplace in another.
It is very useful to spend some time in a new practice before you begin treating patients - even better, have a chat with the outgoing dentist. This may give you a feel for the type of dentistry the patients have been accustomed to; for example, does the dentist perform what might be termed 'bread and butter' dentistry, or do they favour a different approach, such as amalgam-free dentistry, or perhaps techniques which may be unfamiliar to you, from flexible dentures to restoring implants. A conversation with the dentist, or in their absence, their nurse, would give you some helpful tips in these areas, to help you prepare for the types of clinical issues you might need to manage in the patient list you are about to take over.
When a dentist leaves there will be treatment outstanding, which you as the replacement dentist will be expected to provide. Usually this will be straightforward and should not cause a problem; however, what do you do if you disagree with the treatment proposed, or detect a problem which has not been addressed by the original treatment plan? In a similar vein, how do you inform the patient that they have a periodontal problem, for example, which has not been recorded, or need a radiographic examination, which demonstrates numerous carious lesions undetected by your predecessor?
It is wise to examine any patient that you see for the first time, even if they have recently been examined. This is not to generate fees, but as a registrant you are responsible for your own acts and omissions and therefore you take over the care of that patient. Should you accept the treatment plan of the previous dentist unquestioningly, you could unwittingly place yourself in an indefensible situation, should a patient later complain, or allege negligence. Therefore it is always wise, when first seeing the patient, to carefully check the records, view any recent radiographs, and ensure that a periodontal screening has taken place; if these areas have not been addressed, it is vital that these are carried out, to enable proper assessment of the patient's dental needs.
Amending the original plan
If you find that the treatment plan is incomplete, and that the patient requires treatment in addition to what was initially agreed, you must discuss this with the patient, demonstrating radiographic findings such as caries, periodontal bone loss and periapical pathology. The patient may ask why this was not noticed before, or why they were not advised of this, as they may have been examined relatively recently. These situations can be difficult and require a tactful approach. You could use words to the effect that you cannot comment on what has gone on before, and can only advise the patient of the current situation as you find it. Always carefully note any conversations in the patient record in a neutral, factual way. Ethically, the patient's best interests must always come before that of protecting a colleague, so you must be open and honest with a patient, while avoiding the use of disparaging remarks about previous treatment, no matter how tempting this is, as you can never be fully aware of the circumstances at the time of the treatment. Indeed, the crown margin you are probing may have been constructed by an earlier dentist, which your predecessor offered to replace, to be met with a refusal by the patient. Unfortunately, a tricky situation can be made much worse by an off-the-cuff or ill-judged remark about a previous dentist's treatment, so it is wise to keep your own counsel in such matters.
It is even more important not to 'cover up' findings, as this is not in the patient's best interests and indeed could compromise your own professional integrity, should the patient learn of this at a later date. If you are within a practice, it may be worth flagging up any areas of concern with the practice owner on a confidential basis, particularly if issues are showing on a frequent basis.
Claire Walsh is at Dento-Legal Adviser at Dental Protection