Unerupted canine

A patient alleged that her dentist should have recognised an ectopically positioned canine when she was a teenager

After treating a female patient for 16 years, a dentist faced a claim that he had not provided the standard of treatment expected of a general dental practitioner.

The patient had been treated on the NHS since the age of 10. At 13, the dentist noted that the upper right permanent canine was only partially erupted, although by the following six-monthly consultation it had fully erupted. At that appointment, the dentist took a periapical radiograph of the upper left deciduous canine. He noted that the tooth was in place and the permanent canine was also present, just slow to erupt but requiring no treatment. The patient was by now 14 years old. The dentist asserted that he continued to monitor the situation and provided a restoration when the deciduous tooth became discoloured.

As an adult, the patient consulted an orthodontist and was told that the upper left permanent canine was ectopically positioned and extensive treatment was required. She wrote to the dentist stating that he should have recognised this when she was a teenager, when she could have received NHS orthodontic treatment.

The patient requested £8,000 for private remedial orthodontic treatment. In response, the DDU instructed an expert dentist to provide an opinion on the case. Unfortunately, the expert was not supportive of the dentist's clinical management, specifying that the dentist should have followed up the periapical radiograph taken at age 14 with a further radiograph 6-9 months later and if a permanent tooth has not shown signs of erupting approximately six months after the contralateral tooth had erupted, then it should be investigated.

If there had been no change at the subsequent appointment it would have then been appropriate to extract the upper left deciduous canine, as research has shown the likely benefit of an interceptive extraction. If this did not result in an improvement in the position of the permanent canine, the dentist should have referred the patient for specialist advice and treatment, ideally by the age of 14½ years.

The expert further indicated that if the deciduous canine had been extracted at the appropriate time, then the upper left permanent canine might have erupted uneventfully and no further treatment would have been required.

The patient may then have had an occlusion that was normal, albeit with mild crowding, that could have been accepted or treated with fixed appliances under the NHS at that time.

The expert advised that the patient's private orthodontic estimate was reasonable and that the treatment would now take longer than it would have taken but for the breach of duty.

After considering this report and with the member's consent, the DDU offered the claimant £8,000, which she accepted.

Rubia Sultana-Kabiri
Claims handler

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