A patient brought a claim against her dentist of 20 years, a DDU member, for the cost of a treatment plan written by an Australian dentist. The patient claimed nearly £7,000 after returning from a holiday in Australia where she had undergone emergency treatment following the fracture of her lower left pre-molar. Subsequently, the Australian dentist had provided her with a detailed treatment plan that included the replacement of 10 crowns.
The patient alleged that her teeth should not have got into this condition and she was claiming the full cost of the remedial work deemed necessary by the Australian dentist. The patient explained that she was shortly to emigrate to Australia and she planned to have all the treatment carried out there.
The member contacted the DDU for advice.
The DDU claims handler sought a copy of the clinical records from the Australian dentist as well as the member. The patient was then asked to attend an independent general dental practitioner (GDP), who provided an expert opinion on the patient’s current condition and prognosis, as well as on the liability of the member.
The expert considered that some of the treatment suggested by the Australian dentist was unnecessary and that other treatment was required because of the inevitable breakdown of crowns that were many years old. However, the expert also considered that some of the treatment required was due to a failure on the part of the member to diagnose and treat decay earlier, and some of the crowns that the member had provided in recent years had failed sooner than would reasonably have been expected.
The member agreed that the DDU should attempt to reach an amicable settlement of the claim.
Meanwhile the patient had returned to Australia and provided the DDU with invoices to show that much of the full treatment plan had been carried out.
The DDU drafted a detailed letter of response, explaining to the patient, a claimant in person, that all dental restorations have a finite lifespan and that as intra-coronal restorations become larger the remaining tooth becomes weaker and the risk of fracture increases. It was this factor that caused the need for the emergency dental treatment in the first place.
In the letter, the DDU reflected the findings of the independent GDP expert and detailed what treatment costs the DDU was therefore including within the settlement proposal and what it was not.
After obtaining the member’s approval, the letter was sent to the patient with an inclusive settlement offer of less than half the original claim. The patient accepted the offer of settlement.
Learning points
The following learning points can be considered:
- It is important that patients do not have unrealistic expectations of their dental health. Ideally their dentist should inform them of the expected lifespan of existing restorations, plan anticipated future treatment and record in the notes what clinical advice has been provided to the patient.
- It is important for a dentist to take appropriate radiographs (when indicated and in accordance with current guidance/standards) in order to be in a position to diagnose and treat caries that may not be apparent on visual clinical examination.
This page was correct at publication on 31/05/2008. 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.