Should my Dentist be doing this?

There are 13 dental specialisms in which a Dental Practitioner can register with the General Dental Council (GDC). These include orthodontics, periodontics and oral surgery.

In order to be named on one of the GDC’s ‘Specialist’ lists, an individual must demonstrate higher competence and qualifications in the speciality.

A recent ruling from the GDC forbids the use of a title that may infer that the person is a ‘specialist’ in that area without having completed specialist training on a GDC approved training programme, and the subsequent passing of relevant examinations.

A Certificate of Completion of Specialist Training can then be awarded. If your dentist has not referred you, when the dental work you need carried out is above their personal level of expertise, then they may be breaching the duty that they have to you.

Dental Standards

Principle 7 of the GDC Dental standards 2013 states that all Dentists must ‘Maintain, develop and work within their professional knowledge and skills’. The principle provides that all dental practitioners must ‘know their limits and refer patients as appropriate’.

Unfortunately, here at the Dental Negligence Team we often see the consequences of general dental practitioners taking their specialist interests too far. Sadly some practitioners do not ‘know their limits’ and, when they find that they are out of their depths, such practitioners tend to instead plough ahead resulting in horrifying clinical outcomes for their patients.

Lack of competence and inadequate or no training is one of the most common areas of dento-legal work and is very difficult for a dentist to defend. As with all professional vocations, Dentists must adhere to continuing professional development plans.

Dental specialists must ensure that they have ‘current’ training. If a ‘Specialist’ attended a weekend course in a specialist area 10 years ago, it does not give them the relevant training to put themselves forward as a specialist in the particular area they trained in.

Orthodontics

In order to be a trained orthodontist it takes 3 years of postgraduate training following the successful completion of a 5 year dental qualification.

General Dental Practitioners often have a ‘special interest’ in Orthodontics and go some way in training in this specialist area of dentistry. However, complex and/or extensive orthodontic work should be carried out by a qualified Orthodontist.

Orthodontics is not just the fitting of braces but can involve the movement of the entire jaw. Orthodontics encompasses the moving of vital teeth through living bone using various appliances to improve the function and/or aesthetics of teeth.

As per my previous blog, ‘When Cosmetic Dentistry goes wrong’, models and impressions are needed to carry out orthodontic work.

Models should be taken at the start of treatment and preferably throughout, as a permanent dental record at a precise period of time during treatment. Without models of a patient’s teeth, an Orthodontist can not see where the teeth have come from in order to know where he is going to take them and I have heard of models described by one dental expert as a map.

Rise in Orthodontics; The increase in treatment = increase in problems

In my last dental blog I discussed the rise in the quest for the perfect smile. This rise stretches to orthodontics and the number of adults paying for orthodontic work in comparison to the past 10 years when orthodontics has been focused at treating adolescents.

This in itself holds problems. Adults may have a complex dental history that young children do not have and thus thorough investigations must be carried out to ascertain whether orthodontic work is even appropriate in some cases.

Some people undergo extensive orthodontic work only to find out that a serious condition such as periodontal disease has gone unnoticed. To quote an esteemed dental colleague of the Dental Negligence Team, the effect this has is like ‘Sticking a screw in a piece of rotten wood’!

An adequately trained and experienced Orthodontist would carry out relevant investigations in a patient with periodontal disease and advise them that treatment would not be appropriate for them.

A ‘dabbler’, someone who tries their hand at orthodontics but is not adequately qualified, would not give this advice and instead would carry out expensive work which in fact would be doomed before it was even started.

All part of the plan

Lack of competence and training can also lead to substandard treatment or follow up planning. Therefore even if a ‘dabbler’ carries out an adequate fitting of a brace there should be a treatment plan put in place Even if an unqualified ‘specialist’ carries out work to a high standard they may not provide adequate/correct follow up treatment and advice.

Therefore, any work that they have carried out and the Client has paid for, may not stand the test of time and the patient may subsequently encounter future problems.

Additional risk to the patient

Dentists as individuals must be ‘appropriately……indemnified’. If a General Dental Practitioner carries out work that they are not qualified to do, their indemnity insurer may refuse to provide cover to them.

This means that if a legal claim is bought and the dentist as an individual cannot afford to foot the legal bills, then the patient will be left with bad teeth and no money to pay for restorative work.

Temptation and Limited Exposure

So why does this happen? The temptation for General Practitioner to earn more money (especially in current climate) may lead to poor decisions in relation to their ability to carry out work.

Additionally, those who do have some training get limited exposure to practice their skills due to patients seeking treatment from qualified Orthodontists. The old idiom ‘Practice makes perfect’ is not one you want used when it comes to your face! ‘Dabblers’ get limited exposure to practice skills and so are essentially ‘experimenting’ on their Client’s teeth. Even with the best will in the world someone with out years of experience cannot be perfect at orthodontics.

In summary

A lack of competence and training leads to poor clinical outcomes and potentially irreversible damage for a lot of people. If you are concerned that you may have received negligent dental treatment, in connection with any of the treatments mentioned or in some other way, please contact a member of the Dental Negligence Team, who will be happy to advise you on your particular circumstances.