The scene

A patient had been attending a practice for over eight years when he started to be seen regularly by the practice hygienists, both of whom were DDU members. They contacted the DDU after separately receiving a claim from the patient some ten years after they first saw him.

The claim alleged that in the preceding years the hygienists had failed to diagnose and effectively treat the patient's periodontal disease, which led to the avoidable loss of his teeth and subsequent remedial treatment.

DDU response

The hygienists immediately contacted the DDU for advice and support in dealing with the allegations, and a claims handler was assigned to their case, gathering evidence and information in order to address the allegations.

The DDU instructed an expert who examined radiographs taken before the patient started seeing the DDU members, and advised the patient's solicitors that his teeth were in a poor condition when he first saw the hygienists. These radiographs showed the patient had already lost a considerable amount of periodontal bone by that time, and that the prognosis of several teeth was very poor.

The DDU's expert reviewed the clinical notes and confirmed that when the patient was first referred to the practice hygienists he received appropriate treatment, including root surface debridement and regular oral hygiene instruction.

The patient's solicitors alleged that when the patient attended four years after first having seen the hygienists, the first DDU hygienist failed to recognise the deterioration in his periodontal condition or to recommend a referral to a specialist.

The patient saw the first DDU hygienist on four separate occasions that year, and the clinical records confirmed that the examinations included recordings of BPE scores and, where indicated, six point pocket charting. The DDU disputed that it was the first DDU hygienist's responsibility to make a referral to a specialist, as he was working under prescription from the dentist.

The DDU's expert confirmed that the radiographs taken that year showed that the prognosis of the teeth in question was very poor at that point, and their extraction then could have been easily justified.

The DDU asserted that there was no evidence to indicate the treatment provided by the first DDU hygienist led to the deterioration of the patient's teeth. Furthermore, the periodontal disease was so severe by the time this treatment was provided, several teeth were likely to be lost in any event.

The patient's solicitors alleged that second DDU hygienist failed to ensure that a referral to a specialist dentist was made.

Our expert confirmed that the second hygienist had advised the patient that a specialist referral was needed and, importantly, recorded this in the notes. The expert thought that it was then up to the claimant to make the appointment with the dentist. The DDU advised that it was not the second DDU hygienist's responsibility to ensure the patient acted in accordance with the advice given, and maintained there was no liability on the part of either of the hygienists.

In light of the DDU's robust response, the patient's solicitors subsequently advised that he was no longer pursuing the claim against the hygienists, and the matter was closed.

Failure to diagnose and treat periodontal disease

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