A whiter shade of pale

A young male patient attended the dentist and requested tooth bleaching. He had been advised at an earlier consultation that the amount of shade lightening would be limited in view of his age and starting shade, but he wished to proceed with the treatment and further discussions took place regarding the types of bleaching that could be carried out and their relative costs.

Having been advised that shade A1 could be achieved, the patient opted for in-surgery bleaching with additional night-wear trays.

At the consultation, the patient was warned about foods and drinks that could cause staining. At the first treatment visit, a pre-treatment photograph was taken with a shade tab, which showed the patient’s starting shade as D3. The bleaching was carried out, and the patient was given instruction in the use of the night trays and desensitising techniques. After one further treatment session, the dentist determined that the final shade A1 had been achieved. A picture was again taken with the shade tab.

Subsequently, however, the patient contacted the practice and said that he was dissatisfied with the shade reached. He was offered free gel for further night-time applications, some days later the patient wrote asking for a refund of all the fees. The dentist declined to do this as he felt he had achieved the agreed shade.

The patient then complained to the Dental Complaints Service, but mediation was unsuccessful in resolving the complaint. A panel hearing was set up locally, at which both the patient and the dentist put forward their views. At this hearing, the patient also complained that, apart from the dispute over the shade, he felt the dentist had been patronising.

The panel determined that the dentist had achieved the treatment outcome promised to the patient but felt there may have been a breakdown in communication and a misunderstanding between the parties following treatment. The dentist offered the patient a refund of 25 per cent of the original fee, which represented the profit element of his treatment. The patient declined this offer.
The panel, on balance, concluded that there was no case to answer and considered that the refund offer was very reasonable, and endorsed it.

Learning points

The following learning points can be considered:

  • It is important to keep good records, including pre- and post-treatment photographs where appropriate.
  • It is important to seek informed consent and assess the patient for unrealistic expectations about the outcome of treatment, particularly where cosmetic treatment is planned. The consent should be documented.
    Sensitive and careful complaints handling can encourage early resolution of a complaint.

This page was correct at publication on 31/05/2008. 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.