Chronic gum disease ignored

A 56-year old lady was told that she had “gum disease” and could have a dental implant placed when the tooth was eventually lost. Many years later it was lost, but following her dentist’s retirement, her new dentist said that she couldn’t have an implant as there wasn’t enough bone left now. Does she have a case to be answered?

History

The lady in question (Mrs. J) stated that she had a long history of ‘gum disease’ but she went to her dentist’s office as directed, every 3 months for cleanings assuming it was keeping things stable. Her dentist never indicated a deterioration but did say that she might lose some or all of her teeth due to this ‘vulnerability to gum disease’ but that she should keep coming for the cleanings. She agreed, as it made sense; and continued. One tooth at the back bothered her from time to time but although she mentioned it, nothing was specifically said or done.

Sometime later after her dentist retired, her new dentist indicated that she should have the tooth out immediately as it was affecting the adjacent tooth. She agreed but asked if it could be replaced with an implant, as she didn’t want a denture. She was told that due to the action of her long-term gum disease there was no longer enough bone to support an implant. She asked why she hadn’t been told before, but sadly she lost both adjacent teeth.

Investigation

An independent examination, appraisal, interpretation and Expert Witness report highlighted the fact that had earlier intervention been made, timely treatment would most likely have seen enough bone to place an implant, even if involving some bone augmentation (grafting) services. As it was now, her only options were of a removable nature.

The situation unfortunately worsened following the removal of the back teeth she started to experience some jaw joint problems most likely related to the loss of support to the jaw joint from the back teeth. This is not an unusual scenario as 2019 joint, ear and tension type headaches are among the not-uncommon consequences of joint problems (TMD) following back tooth removal (and removal of joint support.

Review

Going to the dentist regularly can be extremely beneficial but can also simply become a routine. There should not only be a clear and practical justification for dental treatment, but also it should be performed to the standard of care expected, and if possible, its progress tracked. In this case it was not tracked, and the results were most undesirable. Sometimes it is difficult in a busy practice to stop and reassess the patient’s needs as if they were new to the practice, however this level of insight is necessary for best care. If legal counsel is taken, a DEW can assist with his knowledge.

Unfortunately, occurrences such as this are not uncommon, and it becomes a question of the duty of,  and the standard of care. If the dentist has simply allowed his patient to remain a fee-paying member of his practice without review and simply “going through the motions”, clearly there is a breach of duty. If there have been inappropriate decisions (or none at all) then there may well have been a breach of duty and standard of care. The new dentist may choose to offer to correct this without cost as part of his transition good will, but he or she may not. Potentially the patient could be out of pocket, or out of luck regarding the dental care they now need.   

Conclusion.

Legal action was commenced against the retired dentist, his insurance company recognized the failure of care and made on offer of settlement. The lawyer requested further information regarding costs which after some investigation I was able to provide regarding who could perform the procedure required. (The x-ray shown reflects the level of bone loss experienced). The lawyer made a counter-offer based on the inadequacy of the initial offer, to cover all of the patients costs including travel to have the work performed, the case was settled out of court. I believe the patient and lawyer were satisfied.

Gum disease is an insidious chronic and usually painless destructive disease which must be screened for regularly and adequately managed when present with careful tracking. Adequate clinical skill, good communication and appropriate referral would likely have avoided this scenario.

Dr Stephen Bray

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