Short term orthodontics

Miss N attended an examination appointment with a new dentist,unhappy with the appearance of her upper teeth. She informed the dentist that she’d had an assessment with an orthodontist a few years ago and was told fixed appliances were necessary. Miss N wanted a ‘quick result’ as she was getting married in six months and was aware the dentist provided a clear aligner treatment system. The dentist carried out some checks using the clear aligner system programme and informed her about the costs of the treatment, indicating a good result was possible within six months. Miss N was happy to proceed on this basis.

Treatment continued for four months, with Miss N becoming increasingly frustrated at each review by the lack of progress. The dentist queried whether she was wearing the aligners for the prescribed periods of time. Miss N reassured the dentist she was indeed wearing the aligners for the correct periods of time and was anxious to have the treatment finished due to her wedding drawing near. The dentist continued to reassure her and consulted with the clear aligner programme mentor who advised that additional aligners were now necessary.

The dentist relayed this to Miss N at the following review. Although she was extremely disappointed, she still wanted to continue treatment and accepted this would not be finished by the time of her wedding.

A further five months passed and it became apparent that the case was not progressing how Miss N had expected. She also began to experience occlusal problems and had developed an anterior open bite. The dentist accepted that progress had been slow and offered to refer her to an orthodontist.

The orthodontist advised that due to Miss N’s crowding and the skeletal profile, tooth extraction and fixed appliances were necessary in order to correct the treatment.The patient was extremely upset and complained in writing. She alleged that the dentist had misled and misinformed her at the time of the initial examination about the duration of the treatment to achieve the desired result. She requested the dentist refund the treatment fees and cover further costs to continue her care with the specialist orthodontist. Miss N threatened to seek compensation for negligence if she did not receive what she believed to be a fair and satisfactory outcome.

The dentist contacted Dental Protection for advice. A close scrutiny of the patient’s clinical records indicated that these were insufficient and incomplete and therefore it could not be shown that an appropriate examination and subsequent diagnosis had been made, or that a suitable treatment plan had been formulated. As a result, the dentist would be vulnerable in the event of an escalation and further inquiry. The records suggested that treatment options– such as fixed appliances and/or referral to a specialist orthodontist – had not been discussed, which amounted to a failure in obtaining valid consent. A specialist orthodontic report concluded that due to Miss N’s severe crowding, she would always have needed fixed orthodontic treatment to achieve a satisfactory outcome.

Although the treatment was initially an elective procedure, Miss N’s occlusion was now unstable and further treatment was necessary. Dental Protection discussed with the member whether he would be prepared to refund the treatment costs in view of the patient’s dissatisfaction, and he agreed.

With Dental Protection’s advice and assistance a letter was sent to Miss N. It included an apology and the case was resolved by a refund of treatment fees and a contribution towards the additional cost of further treatment with the specialist orthodontic consultant.

Learning points

•Ensure all treatment options – and any appropriate referrals – are offered to the patient, along with the advantages and disadvantages of each, in order to demonstrate a valid consent has been achieved.
• Be aware of your professional limitations and work within the limits of your competence.
• Assess each case carefully to avoid attempting treatment beyond your clinical capabilities, even if the patient demands it.
• Do not agree to unrealistic or impracticable treatment times.