A young female patient was concerned about the effect on her appearance of lower anterior crowding. She sought advice from an orthodontically trained partner at her dental practice. After seeking a senior consultant's advice, the dentist offered two treatment options. The first involved extraction of a lower incisor and the second involved stripping interdental enamel from the lower incisors and fitting a lower fixed appliance. The patient was reluctant to undergo an extraction and elected for the second alternative.
The dentist warned her that she might experience some sensitivity from the stripped teeth and that the success of the procedure would depend on a lengthy period of retention.
The dentist used a diamond bur in an air rotor to strip the enamel. The patient experienced severe sensitivity immediately and a local anaesthetic was administered. A week later the patient was fitted with a fixed appliance to align the lower incisors. This remained in situ for six months. Throughout this period she continued to experience sensitivity which she attributed to the appliance.
On removal of the appliance the sensitivity, particularly to cold, remained severe. The patient was supplied with a vacuum-moulded pull-down splint as a retainer for the lower arch. After three months the patient stopped wearing the retainer because she felt it was ineffective. She complained to the dentist that she remained unhappy with the spacing between her lower front teeth and their continued sensitivity.
Negligence alleged
The patient alleged that the choice of tools and techniques and the level of skill applied were negligent. She claimed to have suffered pain, sensitivity and cosmetic embarrassment.
Expert opinion
For the patient, a consultant orthodontist noted:
"There are several aspects of the treatment which were, in my opinion, significantly divergent from good practice and conventional teaching with regard to this technique. First, it is usual practice to align the teeth at least partially with a fixed orthodontic appliance before removing tooth substance from the mesial and distal surfaces of the teeth .... Second, it is never, to my knowledge, advocated that this removal of tooth substance is carried out with a high speed air rotor and dental bur. On the contrary, such an implement would be regarded as very likely to remove too much tooth and in the wrong shape and in a manner which would be hard to control".
The DDU approached a second expert on the dentist's behalf. He agreed that:
"The method used to perform interdental stripping was significantly divergent from good practice and conventional teaching. This has resulted in too much tooth structure being removed, leaving the lower incisors with an unnatural shape which will be difficult to rectify ... The tooth sensitivity the patient reports can be explained by the fact that too much enamel has been removed".
Outcome
With the dentist's agreement, the patient accepted an out-of-court settlement of £6,000 plus costs, with no admission of liability.
This page was correct at publication on 01/02/2002. 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.