Periodontal disease often remains an overlooked side of treatment which patients can sometimes struggle to see the benefit of receiving. Dentists are frequently asked by patients to improve their aesthetics, stop their pain in relation to decay and broken teeth, or indeed extract a tooth which has become loose.
The health of their gums can often be forgotten or even ignored by the patient and unfortunately even by the dentist occasionally if the focus is on other areas of the mouth where the patient is more motivated to receive a particular treatment.
Dental Protection repeatedly sees periodontal cases and claims for compensation specifically focusing upon the failure to provide appropriate periodontal care. The case study below demonstrates some of the common problems faced and how occurrence-based indemnity can benefit clinicians.
Case study
The patient first attended the clinic for examination in May 2013. The dentist advised the patient that they required three restorations following exposure of an OPG radiograph. The patient returned two weeks later and received restoration of these teeth and a scale and polish. Two years later the patient returned with a fractured lower left molar (tooth 36). The dentist restored the tooth and advised a crown was necessary which was agreed by the patient and cemented the following month.
The patient did not attend any further appointments for three more years until September 2018, complaining of discomfort at their upper right second molar (tooth 17). A peri-apical radiograph was taken which showed general bone loss of 60 per cent, deep caries at tooth 17 with a pocket of >8mm at the distal-buccal root. A dressing was placed; however, symptoms did not settle and tooth 17 was extracted two months later, with a suspected perio-endo lesion.
The patient continued their sporadic attendance pattern for the next five years, receiving some simple restorations. In May 2023 the dentist decided to retire and ceased all clinical practice.
Six months later the dentist was then very surprised to receive a request for records from the patient’s lawyers. The patient had not indicated they had been dissatisfi ed by their treatment nor made any complaint to the clinic during the time they were under the dentist’s care. The dentist contacted Dental Protection and was assisted with the release of the records.
A claim for compensation arose relating to allegations that the dentist had failed to diagnose and treat the patient’s periodontal condition throughout the 10-year period the patient was under their care, from 2013 until 2023. After further investigation and request for information, it was discovered that the patient had sought care from a new clinician following the dentist’s retirement and was informed they had generalised periodontitis.
The claim progressed in which the allegations included the loss of tooth 17 and deterioration of the patient’s periodontal condition throughout this 10-year period. The patient requested future maintenance costs and claimed for a shortened life expectancy of their other teeth due to lack of earlier intervention to halt the deterioration of their periodontal condition.
Dental Protection obtained an expert report from a specialist periodontist. Unfortunately, the report confirmed evidence of deterioration of the patient’s periodontal condition and that throughout the time the patient attended with the dentist, there was no periodontal assessment, monitoring or treatment, only an occasional scale and polish.
The radiographs demonstrated horizontal bone loss of around 40 per cent in multiple teeth in 2013 which had increased in the posterior quadrants to approximately 60 per cent with isolated areas of accelerated loss on some posterior molars, including tooth 17 five years later in 2018.
The patient went on to receive further courses of periodontal care with their new dentist to which they responded well and their condition stabilised.
The claim was settled by Dental Protection which included the loss of tooth 17 and remedial treatment to stabilise the patient’s periodontal condition, together with a nominal sum to reflect the deterioration of the periodontium but not loss of other teeth.
The patient’s claim for future periodontal care was rejected. Even if the dentist had diagnosed periodontal disease at an earlier opportunity, the patient will have always required long term treatment which the dentist was not responsible for.
Analysis
The settlement of this claim demonstrates a cautionary tale in the failure to properly assess, diagnose and treat a patient’s periodontal condition throughout the time they are under the dentist’s care. This was regardless of the patient’s sporadic attendance pattern. Even though the patient’s periodontal condition was not caused by the dentist, the inaction and failure to provide advice and periodontal maintenance following routine examinations and other treatments such as simple restorations, was accepted to have led to deterioration of the patient’s condition and loss of the tooth 17.
Occurrence based indemnity
The dentist’s occurrence-based indemnity with Dental Protection was key in assisting in managing the claim for compensation. The dentist had retired from practising dentistry when he received a letter from the patient’s lawyers. As the dentist was in membership with Dental Protection during the time he had provided treatment, he was entitled to request assistance under his terms of membership.
However, had the dentist taken out a claims-made policy, he would be required to arrange run-off cover to remain eligible for assistance each year to manage a claim for compensation even after he had ceased clinical practice. This is not necessary with occurrence-based membership where there are no additional fees if you choose to move to another provider or stop clinical practice. Assistance can be requested at any point in the future as long as you were in membership during the time the treatment was provided.
Key points
During routine examinations ensure an appropriate periodontal assessment is carried out and the necessary oral hygiene advice and periodontal treatment is discussed and provided to the patient.
Ensure you are aware of the differences in claims-made and occurrence-based products and how this may impact you if you wish to consider moving to a different insurer or indemnity provider or if you stop clinical practice in the future.