Xanthoula Maitou, Dentolegal Consultant at Dental Protection, looks at a case where a patient asks a dentist to reverse treatment provided by another dentist.
Patient Mr X was a long-standing patient of Dr Z’s NHS practice, and had attended since he first moved to the area 15 years ago. Dr Z was a member of Dental Protection.
Mr X was a regular attender with very good oral hygiene and no periodontal problems. A few years prior he asked if it was possible to improve the appearance of his upper anterior teeth, UL12 and UR12, purely for cosmetic reasons. Dr Z offered him a range of options at the time, including porcelain veneers, but Mr X finally declined due to cost.
About six months after COVID-19 restrictions were lifted, Mr X attended the practice for a regular exam appointment.
During the examination Dr Z discovered that there were four porcelain veneers placed at UR12 and UL12. Mr X confirmed that, about one month before, he had visited a private dentist that was recommended to him by a friend. He made the decision at the time to go ahead with the veneers, but he did not like the appearance of them anymore and he requested that Dr Z change them. He appreciated that Dr Z offered to do them in the past, but he had saved some money as he was not spending it going out in lockdown and he found the other dentist rather persuasive. He said that he still liked Dr Z and he wanted to carry on being his patient.
Dr Z examined Mr X and took radiographs. There was no pathology associated with the existing veneers; the fit and function was very good. The reasons for replacement were purely aesthetic, as Mr X did not like the shape at the incisor edge.
Dr Z offered to replace the veneers on a private basis as there was no reason to do this within an NHS course of treatment, since they were clinically sound. He also suggested that it might be an idea for Mr X to go back to the private dentist that originally placed them to request the change.Mr X was disappointed that there would be extra private cost to replace these and that this treatment could not be provided on the NHS. He wanted some time to think about it, and he would contact Dr Z in the next few hours after discussing this with his partner, to see if they could afford the costs.
Why did Dr Z contact Dental Protection?
Dr Z, after Mr X left the practice, contacted our telephone advisory line at Dental Protection, in anticipation of Mr X coming back to get advice on how to manage the situation. Dr Z wanted to know if he had acted appropriately so far.
He said he was upset that such a long-standing patient would decide to go and have treatment by someone else when he made it clear that he could have provided the same treatment. Dr Z would have preferred for Mr X to go back to his private dentist.
He was also annoyed that the patient had suggested that this could be provided as an NHS course of treatment, and he wanted to know if he was correct in his advice.
How did Dental Protection assist?
The Dental Protection adviser who spoke to Dr Z suggested taking his emotions out of the equation and to try and see the situation objectively.
This was an NHS patient of the practice that came to Dr Z for a regular exam. He was happy with Dr Z treating him and wanted to carry on being his patient. There had been one occasion where he was persuaded by another dentist to have private treatment, which it now appeared he wanted to replace for purely aesthetic reasons.
It would not be considered inappropriate for Dr Z to charge for this treatment, as it would be on a private basis. It was not clinically necessary treatment to be included on an NHS course.
Dr Z correctly advised Mr X that he could address his concerns to the previous dentist and see if they could assist. It would be best for Dr Z to distance himself from anything more relating to this approach and leave the patient to decide on how they would want to proceed.
What happened next
Mr X contacted Dr Z later that day. He wanted to have a short discussion. Dr Z took the advice on board, as was suggested by Dental Protection, and he was confident in handling the conversation with the patient.
Mr X apologised for effectively complaining to Dr Z and he made the decision to approach the private dentist instead with his aesthetic concerns for these veneers.
The conversation ended on good terms.
Mr X continued to be a patient of the practice. The veneers were replaced by the private dentist, but Dr Z did not ask details of how that treatment was provided.
- Try to treat your patients as you would if they were a new patient of the practice and do make an accurate assessment of their condition, without emotion that may cloud your judgement, even if they have received treatment elsewhere at some point.
- Also, try not to be critical of other clinicians’ treatment but be accurate and clear in your assessment and the issues you may find. Be mindful when suggesting a treatment plan to include all appropriate options for the patient to decide.
- Patients are entitled to appropriate and necessary treatment and there will be instances where there are clinical and therapeutic reasons for the treatment to be considered on an NHS basis.
- It is appropriate to signpost the patient to the dentist that provided the treatment in question. On many occasions you will not know the full picture and your colleagues will be likely happy for the opportunity to rectify something that the patient has concerns about and re-establish a good rapport with the patient.
- And finally, do not be afraid to contact Dental Protection for any assistance with complaints or to receive further advice if needed.