Cosmetic dentistry – when might negligence have caused your injury?

Whilst many dental practitioners in the UK provide outstanding treatment, there are instances where patients are left spending sums trying to remedy injuries, or poor results, caused by these practitioners.

Here, we go through some types of cosmetic dentistry treatment and examples of when a patient may suffer negligent treatment.

• Implants
• Veneers
• Crowns
• Teeth Whitening
• Making a claim

Implants

You may have had an implant placed due to the loss of one or more of your teeth. Whatever the case, if it has failed you will want to know whether the treatment you have received was negligent.

Negligence may have occurred if:

1. The practitioner did not have the necessary training to carry out the procedure. It is important that, before undertaking implant treatment, a dentist has developed competence in procedures involved in the clinical assessment, treatment planning and the placement and restoration of implants. This can be developed through training. Before treatment, you should ask your dentist whether or not he/she has undertaken the necessary training to place implants.

2. The implant fails and you require further treatment including removal and replacement. This may be because x-rays and impressions of your mouth may not have been properly taken during the pre-operative assessment stage or if there was a failure to advise you to have minor grafting to help hold the implant in place.

3. Lack of informed consent. The treatment options must be fully communicated with you to ensure you understand any contraindications and/or material risks in the recommended treatment plan. You must be told the advantages and disadvantages of implant treatment and give consent at every stage of implant placement and restoration. There is a risk that implants may not fuse properly with the bone in your mouth and this risk is higher in those who smoke, so you should be advised to quit before treatment. You should be advised if the risk of failure is higher than normal in your case which will enable you to make an informed decision concerning your treatment.

Prof. Robin Seymour, a specialist in dentistry, explains what Dentists should say to their patients when consulting on implants:

“Assessing a patient for an implant is now becoming an increasingly important part of dental practice as many Dentists are now undertaking such procedures. Patients often require the need for implants for two reasons: aesthetics and to improve eating and chewing function. The latter invariably involves the placement of implants in the posterior parts of the mouth. In many cases, implants can avoid the need for dentures.

Once the patient’s needs have been identified, their suitability for implant placement is assessed. A full medical history is taken, followed by a detailed examination of the patient’s oral health. Patients need to be reminded that implants like teeth need to be kept plaque free. A failure to comply with this can result in a condition known as peri-implantitis which can lead to implant failure.

If the patient’s oral health is satisfactory then radiographs will be taken of the implant site(s). Often a CT scan is required to assess the quantity and quality of alveolar bone. A CT scan is essential if implants are planned  to replace posterior teeth. If they are requiring implants to replace upper posterior teeth then usually a sinus lift and bone graft is required prior to implant placement. Again, the Dentist will be able to advise on the need for this additional procedure.

Implants are readily placed under local anaesthesia and many Dentists also provide sedation. Most implants require time for them to integrate into alveolar bone (a process known as osseous-integration which can take three to six months). Once integrated into bone, the implant surface is recovered and is now suitable to be restored with either a crown, provide bridge support or a fixture to aid denture retention. Provided the patient keeps the implant site plaque free they can expect it to last for up to 25 years.”

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Veneers

Veneers are supposed to ensure that you have a bright and consistent smile, often covering stains or chips to your teeth. So, if they go wrong, it can be a real blow to your self-esteem.

Negligence may have occurred if:

1. The veneers are poorly fitted and you require further treatment to fix it. A ‘Trial Smile’ should be advised where possible as this allows you to “try out” your new smile before you have the final veneers fitted. Essentially it is a temporary smile fitted over your teeth for a few days which allows you to inform your dental practitioner whether or not you are happy with the proposed treatment and whether any adjustments need to be made before the final veneers are fitted.

2. Over preparing your teeth for veneers which results in veneer fracture, and/or veneers being broken beyond repair. If your teeth are over-prepared for veneers this can make the bonds weaker and unsuitable for treatment. As a result, you may have to get your dentist to repeatedly bond the veneer back on when it falls off but within another few months, it falls off again. Another example is when too much tooth substance is removed so that dentine is exposed or removed. If you have increased sensitivity in the area and the gums feel tender to touch then you should get this checked out by your dentist and/or a second opinion to identify whether too much tooth tissue was removed.

Prof. Robin Seymour, a specialist in dentistry, explains what Dentists should say to their patients when assessing veneers with a patient:

“Veneers are made of thin sections of porcelain and provide a covering of the tooth surface. They are often placed on anterior teeth to improve appearance. Veneers have advantages over crowns in that they require minimal tooth preparation. This reduces the risk of pulpal changes.

If a patient seeks veneers then a full dental examination is required as veneers can lead to gingival problems, especially if they are of a poor fit. As veneers are invariably required for aesthetic reasons then sufficient tooth material must be removed to support such restorations.

Veneers will permanently change a tooth’s appearance and it is important that the patient is happy with these changes. A trail smile will help the patient to confirm that they are happy with the final appearance.

Patients should be advised that teeth supporting veneers should be kept plaque free, especially at the veneer margins. Veneers can fail (become debonded from the tooth surface) and fracture as they are only made of thin sections of porcelain. If a patient has been provided with veneers and participates in contact sports then they may benefit from a mouth guard.

Veneers have a life expectancy of 12-15 years.”

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Crowns

Crowns are an ideal way to repair teeth that have chipped, broken or have been weakened by tooth decay or a very large filling.

You may have experienced negligence if:

1. Poorly fitting crowns causing decay and infection of the underlying tooth.

2. Failure to treat decay before placing a crown. Your dentist should take a radiograph before you are advised to have a crown. If decay is present, it is important that you are made aware and that you get this treated before a crown is placed, as it could cause infection and affect the prognosis of your tooth.

Prof. Robin Seymour, a specialist in dentistry, explains what Dentists should say to their patients when assessing crowns with a patient:

“There are a variety of reasons why a Dentist may recommend to a patient that they need a crown. These include aesthetic reasons, and function. In general crowns are provided for anterior teeth for aesthetic reasons and for posterior teeth that are heavily restored and at risk from fracture.

Dentists will often take radiographs of teeth that require to be crowned to ensure that the remaining tooth structures are sound and there is no evidence of pulpal changes.

Preparing a tooth for a crown does require the removal of tooth substance and this can affect the tooth’s vitality. Patients should be warned of this risk.

Once the crown preparation has been completed and the impression taken, the tooth is fitted with a temporary crown whilst the final restoration is being made. This can take a few weeks.

When the crown is ready to be fitted, it is essential to ensure that the aesthetics are satisfactory and the fit is excellent. Any adjustments to the bite (occlusion) should be made before the crown is finally cemented into place. Patients should be entirely happy with the crown in terms of appearance, fit and bite before leaving the Dental Surgery. As with veneers, crowns have a life expectancy of 12-15 years.”

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Teeth whitening

Teeth whitening can’t make your teeth brilliant white, but it can lighten the existing colour by several shades. If you have sought treatment from a trained professional, as only trained professional dentists and hygienists are permitted to use products with higher concentrations of hydrogen peroxide, it can be upsetting when injury has occurred as a result.

Tooth whitening, if performed negligently, can result in:

1. Burning and blistering of the gums and lips

2. Permanent tooth and gum damage

3. Ingestion of hydrogen peroxide, which is a toxic chemical and can be extremely dangerous. You may have found yourself being severely ill if you have swallowed some, and so a dental practitioner should take steps to prevent this which includes placing a properly fitting mouth-guard.

Prof. Robin Seymour, a specialist in dentistry, explains what Dentists should say to their patients when assessing tooth whitening with a patient:

“This is now a popular dental procedure and a variety of kits are available for professional tooth whitening. Before a patient undertakes a tooth whitening procedure though, it is essential to ascertain their expectations. Although tooth whitening kits can lighten a tooth’s appearance by several shades, they do not produce brilliant white teeth that can be provided by veneers. A clinical photograph before and after treatment is useful to show a patient what changes can be achieved.

Tooth whitening also does not mean that teeth will be stain resistant, especially if the patient has a heavy intake of tea, coffee and red wine. Thus supplementing professional tooth whitening with a tooth whitening toothpaste will help to ensure that patients’ maintain their tooth appearance.”

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Making a claim for dental negligence

If you have read the above and think you have a claim for dental negligence, you can find out more about the process of making a claim right here.