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Provision of dental treatment (14HDC01695)

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(14HDC01695, 13 September 2016)

Dentist ~ Dental service ~ Crowns ~ Root canal ~ Whitening ~ Treatment plan ~ Documentation ~ Rights 4(1), 4(2)

A man consulted a dentist, requesting crowns on his front teeth and a tooth implant to replace a denture on another tooth. The man told the dentist that he wanted "all his teeth fixed" before he travelled overseas in the new year. The man agreed to receive specialist cerec technology treatment, which enabled crowns to be made by the dentist immediately rather than being made at a laboratory.

At the initial consultation the dentist took three pre-treatment X-rays including a posterior bitewing and a periapical film of teeth 11 and 21. At the first treatment consultation the dentist took a further x-ray and performed root canal re-treatment on tooth 21 and placed ceramic crowns on teeth 21 and 11. The dentist did not use a rubber dam when re-treating the root canal. The man said that he left the clinic with two white crowns alongside his remaining "very stained" teeth. The dentist told the man that tooth bleaching would occur after all other treatment had been completed.

At the second treatment consultation, the dentist performed crown work on teeth 14 and 24 and placed an on-lay on tooth 36. The man told the dentist that he was not satisfied with the crown shape, but the dentist advised him to "leave things as they were for a few weeks to allow time for adaptation". The man also asked whether his existing denture (on tooth 22) could be matched to the colour of his new crowns.  The dentist proposed a composite (veneer) be placed on the denture as a temporary solution. The treatment plan was not updated to reflect these discussions.

At the last consultation, restorative treatment was completed and the man's teeth were bleached. The man said that the dentist was not constantly present during the bleaching process, and after bleaching there was still a mismatch of shades between the crowns and the rest of his teeth.  The composite (veneer) placed on the man's denture was described by the man as appearing bulky and unnatural. The dentist said that he used the best professional bleach available to bleach the man's teeth and, in his view, the results were acceptably good.

It was held that by failing to take an X-ray of all teeth that he was planning to crown, and by failing to use a rubber dam when re-treating the man's root canal on tooth 21, the dentist failed to provide services to the man with reasonable care and skill and, accordingly, breached Right 4(1).

By failing to record details of the treatment options discussed, advice given, what he encountered clinically, or further treatment provided, and failing to update the treatment plan, the dentist failed to comply with professional standards and, accordingly, breached Right 4(2).

Adverse comment was made that the dentist did not perform a full mouth X-ray and obtain images of better quality; that he did not recognise the risks of ongoing colour mismatch given the proposed order of treatment, and did not communicate this risk to the man; and that he did not delay crowning of the front teeth until the implant was ready for restoration. 

It was recommended that the dentist provide a written apology and undertake training on drafting treatment plans, documentation, and performing X-rays, with assistance from the Dental Council of New Zealand.

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