CASE studies


These studies are based on actual cases from MDDUS files and are published in Summons to highlight common pitfalls and encourage proactive risk management and best practice. Details have been changed to maintain confidentiality


TREATMENT: LONG-TERM NEGLECT?


BACKGROUND: MR B, 32, attends his dentist as a new patient. His teeth are in poor condition and it would appear he has neglected to clean them regularly. His dentist, Mr H, carries out a root canal treatment and advises him to brush at least twice a day and to floss regularly, scheduling a follow-up appointment for six months’ time. Mr B fails to show and attends at the practice 18 months later as an emergency, complaining of bleeding gums. Mr H again advises on good oral hygiene and prescribes an appropriate mouthwash for the infection. A six-month review is booked but Mr B again fails to show. Over the next three years, Mr B attends sporadically and each time the dentist offers advice on good hygiene and explains this is crucial to keep his gums healthy. Radiographs are taken, confirming his teeth are in poor condition and on three occasions (over three years) the patient undergoes extensive scaling. Following each scaling, a six-month review appointment is set but Mr B fails to attend any of them. Mr H also carries out a number of restorations to various teeth during this period. Mr B attends for another appointment, almost five years since his initial consultation, where his teeth appear to have worsened due to lack of brushing. They are cleaned extensively and Mr H again emphasises the need to brush and floss regularly. He sets a six-month review appointment but Mr B cancels and does not return to the practice. Six months later, Mr H receives a letter of claim from


solicitors acting on behalf of Mr B alleging clinical negligence. It is claimed Mr H failed to diagnose or treat the patient’s periodontal disease, failed to carry out basic periodontal examinations, or to offer sufficient oral health advice, and failed to refer him to a hygienist or specialist periodontist. It is alleged this caused Mr B considerable pain and


suffering. It transpires that Mr B has seen another dentist who informed him he has periodontal disease and now requires ongoing periodontal care and possible orthodontic treatment


ANALYSIS/OUTCOME: MDDUS, on behalf of Mr H, disputes the allegations. It is argued that Mr B must bear some responsibility due to his consistently poor oral hygiene and his failure to attend to complete scheduled treatment. MDDUS commissions a report from a dental expert and she


is largely supportive of Mr H’s decision-making. In particular, she agrees with his decision not to make a periodontal referral for Mr B as such treatment would only succeed in patients who can demonstrate a continued good level of oral hygiene.


20 SUMMONS


This could not be established in Mr B’s case due to frequent non-attendance. The expert also agrees that Mr H’s notes suggest he frequently offered oral hygiene advice but Mr B failed to follow it. Mr B’s solicitors do eventually concede that the patient must bear some of the blame, but they insist Mr H was negligent. One major failing is identified, however, in that Mr H appears


not to have begun carrying out BPEs until around two years after his patient first attended. In addition, a review of his BPE charting suggests Mr H may not have noted it accurately. This is confirmed when a comparison is made between BPEs carried out by Mr H and those of a second dentist, and a periodontist five weeks later. Mr H’s scores vary wildly from the other two. Due to the delay in commencing periodontal monitoring and the apparent inaccuracy of his scoring, it is agreed – in consultation with the member – to settle the case for a moderate sum.


KEY POINTS •


•


All new patients should have a basic periodontal examination recorded and appropriate follow-up care arranged.


Ensure accuracy of BPE recording and familiarise yourself with the latest guidance from the British Society of Periodontology.


• Patients who fail to follow oral health advice must bear some responsibility for poor dentition but this does not always excuse the treating dentist.


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