“Monitor the rate of wear objectively by taking clinical photographs and study casts at regular intervals”


legible and up-to-date notes detailing the severity of any tooth wear, indices used, shared decision-making, actions taken and supplementary care are essential additions to the clinical records – always! Dentists and patients may together choose to simply monitor the tooth wear, and this must be noted in case a claim of supervised neglect is made further down the line. In addition, in the event that a patient cannot or will not make a decision about their own care, it is important to add to the notes that an attempt at shared decision- making was attempted and efforts were made to engage the patient. The patient may request treatment which is justifiable but which differs from your recommendations. In these circumstances, it is particularly important to have a clear record of the discussions regarding the relative merits of each option.


This is a significant issue and to cover everything that is important is beyond the scope of this article, so I would recommend accessing the guidance issued by the Faculty of General Dental Practice relating to note taking1


.


In addition, it is critical to consider risk assessment2 and to monitor the rate of wear objectively by taking clinical photographs and study casts at regular intervals, perhaps every two to three years for future reference. It is also important to consider that, although the NHS


contract requires the contract holder to keep records for up to two years after a course of treatment has been completed, the Consumer Protection Act 1998 allows claims regarding a “defective product” for up to 10 years. Therefore, both NHS and private records for adults should be kept for a minimum of 11 years following the last entry. Always remember the adage: “If it’s not written down,


it didn’t happen”. A dentist who does not have detailed records will be greatly disadvantaged in the event of an accusation that something has gone wrong.


EXCEEDING EXPECTATIONS Even with the very best of intentions, mistakes do happen – nobody is perfect. In fact, NHS figures suggest


that between 1 April 2016 and 31 March 2017, 13,493 complaints were made in England about NHS dentistry, nearly double that for 2015/16, possibly indicating a worrying trend. This may be partly because consumer expectations have risen in recent years, plus experience tells me that patients are more ready to question the care they receive than ever before. As long as you have managed both your risk and that of your patient in terms of issues such as shared decision making, note taking and appropriate referral, you can rest assured you have provided the best possible approach to managing tooth wear and are in a position to demonstrate exactly that should the regulator come knocking.


Professor Andrew Eder is a specialist in restorative dentistry and prosthodontics and clinical director of the London Tooth Wear Centre, a specialist referral practice in central London. He is also emeritus professor at the UCL Eastman Dental Institute. For further information on the work of the London Tooth Wear Centre go to www.toothwear.co.uk


MDDUS INSIGHT / 15


Top: palatal erosion and enamel loss in a 44 year old.


Above: tooth wear in an 80 year old.


Clinical images courtesy of Professor Andrew Eder


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