Honest assessment

BACKGROUND: Mrs P has recently registered with a new dental practice and attends for a check-up. In the chair she complains of slight mobility in a post-retained crown at UL2 though no pain. The dentist – Dr L – confirms movement in the crown but decides it’s not loose enough to remove without endangering the root. She advises Mrs P to return if the tooth becomes a problem and takes a radiograph of the area to record the morphology of the roots.

Later, reviewing the radiograph, she notes root treatment in the tooth short of the radiographic apex, together with two posts in-situ, one not in the canal and deviating very close to what appears to be a perforation.

Dr L is unclear what to tell the patient regarding the tooth. She does not feel it is something she can keep from her but is also concerned it will reflect badly on the patient's previous dentist. Saying nothing could make her complicit if an iatrogenic issue compromises the long-term viability of the tooth.

The dentist contacts MDDUS for advice and forwards copies of the radiograph.

 ANALYSIS/OUTCOME: An MDDUS adviser checks the image and finds it difficult to determine if a perforation has occurred. There does appear to be intact tooth substance between the end of the post and the root margin but there is also thickening of the periodontal ligament in the region of what may be a suspected perforation.

He reminds Dr L of GDC guidance on the duty of candour which states that all practitioners must be honest and open with their patients. He suggests that the dentist meet with Mrs P to advise her of the radiographic findings and potential problem with the tooth. The patient could be encouraged to request a copy of her records from her former practice in order to chart the care provided. In any case, it is then up to the patient to decide if she wants to pursue a complaint.

KEY POINTS

• The GDC states healthcare professionals must be open and honest with patients when something goes wrong with their treatment or care.
• That duty overrides any personal and professional loyalties among colleagues.