A patient in her 70s had been treated by the same dentist, a DDU member, since the early 1980s. During that time, she had attended twice yearly for normal dental consultations, including scale and polishing and treatment of any other dental problems. There was no indication that the dentist was aware that the patient’s periodontal condition was a cause for concern during that time. However, when the patient was seen by another dentist in the practice in 2005, the condition was diagnosed and the patient referred to a specialist periodontologist.
Radiographs taken by the specialist showed that the patient had extensive periodontal bone loss around many of her teeth. He noted that, based on the patient’s age, the periodontal disease had been relatively slow in progressing. He estimated a 20-40% probability that up to eight posterior and anterior teeth could be lost in the future. The specialist’s advice was immediate removal of third molars and that the patient would need implants for most of the teeth that would be lost in the future.
The patient contacted her dentist demanding that he arrange the specialist care she now needed. He carried out extraction of three teeth, new crowns and a bridge, as well as non-surgical periodontal therapy. Thereafter the patient continued to receive supportive periodontal treatment including scaling and polishing and oral hygiene instruction.
The following year, the patient brought a claim for clinical negligence against the dentist, proposing a settlement sum of over £18,000 which included the cost of future implants and periodontal treatment.
The DDU obtained a general dental expert opinion on breach of duty. This was not supportive of the dentist’s clinical management. However, an expert in periodontology, instructed by the DDU to report on the patient’s condition and prognosis and opine on causation, did not agree that the patient had significant bone loss, as had been alleged.
The expert found that the patient had responded remarkably well to simple, non-surgical periodontal treatment and that her oral hygiene was generally of a high standard. Indeed, he believed that the removal of the residual calculus and improving plaque control in the areas identified was, on the balance of probability, more than likely to lead to further stabilisation of the periodontium, reduction of pockets and elimination of disease activity.
The expert also thought that the delay in providing treatment had not significantly affected the long-term prognosis. Overall, he believed – contrary to the remedial treatment advised by the claimant’s solicitors and experts – that the prognosis of the patient’s remaining teeth was good and that she did not require extractions or implants. The expert’s recommendation was for regular six monthly appointments with a specialist in periodontics in addition to an appointment with a general dentist/hygienist for any additional non-surgical treatment.
The case was eventually settled for £6,000 damages to reflect pain and suffering and for the additional cost of the patient’s attendance with the hygienist. The claimant’s costs were £14,000.
This page was correct at publication on 01/08/2010. 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.