Advice centre

Not only is the prevalence of tooth surface loss (TSL) increasing, but clinicians increasingly find themselves facing criticism and challenges regarding its diagnosis and management.

Sadly the dental surgery environment is not always conducive to effective communication. Often the dentist and other members of the dental team are dealing with a variety of patients, all with different needs, and they may be subject to severe time pressures.

There are many examples in clinical dentistry of treatment which is largely dependent upon the level of co-operation from the patient, and/or the degree to which the patient follows the advice and recommendations of the clinical team.

One of the advantages of keeping careful and detailed records of a patient’s pain history is that it highlights significant changes and developments in the features of the patient’s symptoms which can, in turn, lead the clinician to the correct diagnosis.

New techniques, new materials and perhaps more importantly, a shift in treatment philosophies in recent years has led to a greater emphasis upon minimally interventive, preventive approaches to the management of the early carious lesion. In some key respects new technology has helped, and in other respects it has hindered, this process. In a dentolegal sense, the most likely allegation would be that the clinician failed to recognise, act upon and appropriately manage the small or early carious lesion and as a result it was allowed to develop, causing pain and suffering together with the cost and inconvenience of more extensive (and more expensive) treatment.

People are living longer, and more people are retaining their teeth into later life. Consequently, the overall potential periodontal risk is rapidly increasing. Most allegations of undiagnosed, untreated and under-treated periodontal disease arise when a patient sees a new dentist for the first time. This may result from the retirement of the patient’s previous dentist, or simply because the dentist has left the practice. Sometimes the patient attends a different dentist in an emergency situation, or following the sale of the practice where they have been treated over many years.

In case after case, the question arises of what information a patient was given in advance of their treatment. Obviously, this is material to the quality of the consent obtained from the patient, and yet dentists, hygienists and therapists often find themselves unable to demonstrate with any certainty, exactly what the patient was told, when, and in what terms.

Dentists communicate with their technicians (and vice versa) in a variety of ways, and on a variety of subjects. Yet in the experience of Dental Protection, many valuable opportunities to improve the quality of these communications seem to be missed. Although there has to have been some dialogue, there is often little or no tangible evidence that this was so.