The scene
A third-year student saw a patient who needed a large replacement filling in one of their molars. The student's clinical supervisor during that session advised them that the tooth would also need a crown to protect it. However, the next time they saw the patient and carried out the restoration, another clinical supervisor questioned this approach and said it was better to keep the tooth under observation. The student felt confused and awkward as they didn't want to offend either supervisor.
DDU advice
It's normal for different dental professionals to have different opinions about the best treatment plan, based on their experience, clinical judgment and assessment of risk. The important thing is that the discussion between colleagues is respectful, and that the patient is fully involved in the decision-making process.
The GDC expects dental professionals to provide patients with full information about their proposed treatment, and give them all their options before treatment starts, including the risks and benefits of each (including delaying treatment and doing nothing).
In this situation, the student could talk to the second clinical supervisor about why they didn't think a crown was the best way forward and the tooth should be kept under review. Once they had a clear understanding, they could have an informed discussion with the patient to determine their wishes.
As a supervisor needs to authorise any treatment carried out by a student, they could also seek guidance from their personal tutor before speaking to the two supervisors and the patient.
What happened next
The student discussed the matter with their personal tutor before explaining to the patient that there had been a difference of opinion between clinicians on the best way to proceed. After discussing the advantages and disadvantages of both approaches with the patient, the patient chose not to have a crown but to keep the tooth under review. The student documented this in the patient’s clinical notes.
This is a fictionalised case compiled from actual DDU case files.
This page was correct at publication on 23/11/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Leo Briggs Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 1995-2017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009 Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.