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Confirmation of consent

Confirmation of consent

A patient attended her dentist to enquire about having veneers fitted to cosmetically straighten her teeth. The dentist discussed with her options for Invisalign orthodontic treatment, but the patient seemed keen to achieve immediate results.

When the patient attended to have the veneers fitted a month later, the dentist prepared nine upper and lower anterior teeth for crowns, in an apparent change of the treatment plan. The crowns were fitted in stages; four upper teeth first followed by the five lower teeth.

Over the following six months, all five lower teeth developed symptoms indicating loss of vitality. The dentist completed root canal treatment on four of these, and extirpated the pulp on the fifth. The patient also complained that some of the crowns did not fit.

After more than six months' treatment, the patient was unhappy with the outcome and sought a second opinion. The patient was in pain and was not happy with the appearance of some of the crowns provided. Further root canal treatment was carried out on the patient and she sought legal advice.

Her complaint was that she had pain in the lower anterior teeth, and pain associated with sensitivity to hot and cold at UR2/1. She was unhappy with the appearance of her lower teeth and found eating difficult as she felt the lower anterior teeth were bulky.

The DDU instructed an independent general dental practitioner to provide an expert opinion on the dentist's treatment. The expert was critical of the treatment provided, saying that there had been a failure to obtain a history of past orthodontic treatment or trauma to the lower teeth, or to undertake preoperative radiographs or vitality tests of the teeth to be crowned. Most importantly, there was criticism of a failure to obtain appropriate consent from the patient.

The most important issue was the discussion that the dentist had with the patient at the initial consultation. Their evidence differed as to what was allegedly discussed, as did their view of the treatment plan. The dentist asserted that the patient was insistent that he proceeded with treatment as soon as possible and suggested that the patient would have proceeded with the treatment in any event.

The claimant's solicitors intimated that the patient would need replacement of the crowns immediately and also made a claim for future crowns for her lifetime.

As the expert opinion obtained was not supportive of the dentist, we asked the member for consent to settle the claim. An initial offer from the claimant's solicitors of £45,000 was rejected and the claim was subsequently settled for £38,000. The claimant's costs were £60,000.

Taiye Omo-Ikerodah
Dental claims manager

This case highlights the importance of recording the discussions regarding options for treatment, in order to demonstrate that valid consent has been obtained, and of confirming the agreed treatment with a formal treatment plan.

This guidance was correct at publication on . It 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.

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