Surprise complaint

The scene

When a patient presented with a chipped LR6, the dentist, a DDU member, recommended a crown, but the patient decided against it at that time. Several months later, the tooth fractured again and the patient was now also in pain from LR7. The member focused on relieving the pain at LR7 and placed a temporary filling in the asymptomatic LR6. Root canal treatment on LR7 was successful, but the patient again delayed having a crown on LR6, due to financial constraints.

After several failed appointments, the patient attended for preparation of a crown on LR6 ten months later. A pre-operative periapical radiograph showed a deep filling but no obvious apical pathology. The tooth remained asymptomatic. The member planned to place a crown, but the patient enquired about filling the space of the missing LR5. After discussion, the member added a small cantilevered pontic and LR6 became a bridge retainer. The bridge was cemented three weeks later.

Over the following year, the patient returned several times complaining of pain on biting on the bridge. After adjustments, the discomfort appeared to have eased and the patient did not mention the bridge again in the next four appointments.

However, the patient began to experience discomfort again a few months later. The member found that some of the porcelain on the bridge retainer had chipped away. He offered to replace the bridge free of charge. A periapical radiograph showed an apical area which would need root canal treatment. He offered to do this at half his normal fee, as a gesture of goodwill.

The patient was very upset and felt she should not have to pay for the root canal treatment at all,  so the member agreed to carry out the root canal treatment free of charge, and to replace the bridge with a single crown, also free of charge, both offers being made purely as a gesture of goodwill. The patient agreed and was happy with the treatment, but she attended as an emergency a few weeks later with severe pain from LR6. The apical area had not reduced so the dentist advised extraction. The patient agreed and this treatment was also carried out without charge. Although the patient appeared to be satisfied with the care provided, the member subsequently received a complaint from the patient.

DDU advice

With the DDU's assistance, the dentist responded to the complaint explaining that a percentage of crowned teeth do become non-vital and require root canal therapy. The LR6 had been checked for vitality and periapical infection excluded with a radiograph before the crown was placed and there was no indication that a crown was not a suitable treatment.

The dentist highlighted all the steps he had taken to help the patient and the extensive treatment he had provided free of charge since fitting the crown. The patient remained dissatisfied and took her complaint to the Dental Complaints Service (DCS).

The DCS suggested a refund of the £500 that the patient had paid for the bridge originally, plus a further sum of £500 for remedial treatment. The DDU again helped the dentist to respond by drafting a letter to the DCS setting out the lengths he had gone to in order to help the patient and confirming the treatment (amounting to £900) that had been provided at no cost.

The outcome

The DCS called a panel hearing, the rules of which preclude DDU representation, but the DDU dento-legal adviser guided the dentist through every step of the process, including what questions he might expect and how to express his responses. The panel found in the dentist's favour, no payment to the patient was recommended, and the case was closed in the member's favour by the DCS.

Sue N'Jie
Dento-legal adviser

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