The DDU was able to support a member who faced a claim from a patient about treatment provided over the course of a year relating to their dentures.

The scene

The patient had attended a DDU GDP member as a new patient, requesting a review of a failing Maryland bridge, a poorly fitting partial denture and a broken LL6. The dentist discussed treatment options with the patient and made a treatment plan for a new lower bridge, a partial chrome denture and a crown for the LL6, all of which was provided over the course of several months.

The claim

In this instance, the patient was acting as a self-representing litigant, meaning they were pursing the claim themselves rather than instructing a solicitor. When it arrived, the claim included all of the treatment provided, as the patient was unhappy with the retention of the denture, the aesthetics and occlusion of the bridge, and pain from the LL6.

After receiving the claim, the member approached the DDU for help. After examining the records and speaking with the member, the claims handler assigned to the case was able to confirm that the member and patient had had a conversation about the different types of dentures available, and the subsequent trade-offs between retentions and aesthetics. The patient had opted for a tooth-coloured clasp that would be more aesthetically pleasing but wouldn't have the same retentive qualities as metal ones.

The patient had sought a second opinion from another dentist, who had found that although the dentures were indeed unretentive (and would possibly have to be remade to improve this), they weren't defective, and their lack of retention wasn't due to any lack of care by the DDU member. Instead, it was down to the compromise between retention and aesthetics that had been explained to the patient in the first place.

The clinical records also confirmed the patient had been involved in selecting the shade of the bridge, and that they had not raised any issues about its shape at any of the appointments with the member or subsequent dentist. They had raised initial issues with the bite that had been resolved with minor adjustments, and they didn't express any dissatisfaction at any subsequent appointments.

The next part of the complaint related to pain the patient was experiencing in their lower left quadrant. Their LL5 had previously been heavily restored, and had since developed further caries, pain and infection. The caries wasn't evident on the initial radiograph the member had taken at the beginning of the course of treatment, and was likely below the gumline when it did occur.

As is typical when assessing a member's case to see if it can be successfully defended, the DDU consulted an independent expert to give an opinion on the treatment provided. Their view was that the member couldn't have been expected to diagnose the caries any earlier than it was. They also held that the patient's lower left quadrant pain originated from the LL5, and not the LL6 that the member had crowned.

...although the dentures were indeed unretentive, they weren't defective, and their lack of retention wasn't due to any lack of care by the DDU member.

The claim also disputed the cost of treatment, which the patient held was too high. The DDU's response reiterated that the member had given the patient an estimate of the costs before the treatment had been carried out, and there was a record in the member's notes of a conversation with the patient that explained the costs in detail. The DDU's expert believed that on this basis, the standard of care provided had been appropriate.

The outcome

The DDU set out all the supportive evidence in a letter of response to the patient, which a dento-legal adviser had reviewed along with the member before it was sent.

Despite it being made clear that the DDU would not be offering any compensation because the evidence firmly supported the member's actions, the patient replied saying they would nevertheless be seeking legal advice to take their dispute further. In the event, neither the member nor the DDU received any further correspondence, and the matter was closed.