The scene

A member contacted the DDU advice line about a patient who was intent on undergoing extensive cosmetic treatment (the provision of multiple crowns) outside the UK, in order to improve the appearance and alignment of his teeth.

The patient had obtained a treatment plan and quotes from both a UK and an overseas provider for their intended treatment. He had then attended the member to discuss this and to enquire to what extent, if any, this treatment could be provided under NHS regulations.

After a discussion and clinical assessment of the patient, the member reviewed the patient's recent radiographs, which had been taken in preparation for the intended treatment. The patient was to attend for a further discussion following the radiograph review.

The member thought that the proposed treatment was not in the patient's best interests and may be detrimental to his oral health, having the potential to give rise to harm and long-term ongoing treatment needs. The member was concerned about how to communicate his views and concerns to the patient and what future obligation he might have to meet the possible remedial treatment needs of the patient.

GDC Standards

Principle One reminds us that patients 'expect to be listened to and have their preferences and concerns taken into account.'

Standard 1.1.1 states:

You must discuss treatment options with patients and listen carefully to what they say. Give them the opportunity to have a discussion and to ask questions.

Standard 1.4.2 states:

You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation. You may need to balance their oral health needs with their desired outcomes.
If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits and likely outcomes to help them to make a decision.

Standard 2.2 states:

You must recognise and promote patient's rights to and responsibilities for making decisions about their health priorities and care.

During his initial discussion with the patient, the member had listened to the patient's views and intentions regarding the appearance of his teeth.

The member's clinical examination and radiographic review had concluded that the extensive treatment may provide the cosmetic benefit the patient sought. However, he considered that the need for multiple extensive tooth preparation would pose an unacceptable risk to the patient's oral health in terms of possible pulpal pathology and potential need for root canal treatment or extractions.

A request for pearly whites: considerations of patients' best interests

A request for pearly whites: considerations of patients' best interests