A dentist who fitted braces on a 12-year-old girl, causing damage that later required jaw surgery, has been told to apologise to the teen.
The mother of the girl complained to the Health and Disability Commissioner after suggesting the dentist provided “negligent and unprofessional care”.
She told the commissioner that the 2014 “treatment was unsuitable as the roots of her daughter’s teeth are short, resulting in the braces causing damage that required further orthodontic treatment and jaw surgery”.
Deputy Health and Disability Commissioner Dr Vanessa Caldwell found today that the dentist breached the teenager’s rights over a two-year period under the Code of Health and Disability Services Consumers’ Rights.
In 2014, the dentist fitted braces on the teen, which were subsequently removed and replaced with aligners. The treatment was then deemed completed.
Referred for surgery three years later
Three years later, a specialist orthodontist expressed dissatisfaction with the orthodontic treatment undertaken by the dentist and recommended the girl have upper and lower braces and jaw advancement surgery.
The orthodontist found two teeth “severely compromised” by mobility and short roots and “severe root resorption” in eight teeth.
She recommended the teenager have upper and lower braces, in addition to mandibular advancement surgery with an oral and maxillofacial surgeon.
In her complaint, the mother said the first dentist should have identified the issues in the X-rays he took in 2014, adding that she was concerned her daughter was not referred to a specialist before the treatment.
“[The mother] said that [the dentist] told her that he was an orthodontist, or possibly led her to believe that, and she would not have taken [her daughter] to him for such a large amount of dental work had she known he was not an orthodontist.”
The dentist did not agree with the mother’s assertion he represented himself as an orthodontist, instead that he was a “general dentist doing orthodontic work”.
‘Dentist breached several rights’
The Health and Disability Commissioner found the dentist breached several rights under the consumer rights code “for failing to refer the teen to a specialist at the outset, and undertaking treatment he was not trained, or sufficiently experienced, to provide”.
Clinical advice provided to Caldwell suggested the dentist “failed to adequately diagnose the orthodontic issues and that they were far beyond his scope of training”.
“Most dentists would think a case with very shortened roots prior to orthodontics should be referred and that it wasn’t, to be extremely ill-advised,” the independent advice read.
Caldwell also found the dentist in breach for failing to keep full, accurate patient records that complied with the relevant professional and ethical standards.
“The absence of clear, well-documented clinical records hindered my investigation into the clinical aspects of this complaint,” she said.
“In addition, more fulsome, detailed clinical records would have assisted the dental practitioners who subsequently provided treatment.”
Additionally, according to the commissioner, “The dentist did not obtain adequate informed consent for the braces.
“Not only was documentation of the informed consent process lacking, but the informed consent discussion took place on the day the braces were fitted. This did not allow adequate time for the teen and her mother to consider the treatment and its risks.”
Noting that the dentist had completed a detailed Dental Council education programme, Dr Caldwell made several recommendations, including urging that he provide a written apology to the teen for the deficiencies in care and therefore breaching her patient rights.
Another recommendation included undertaking a self-audit of his records of 20 patients and having that audit peer-reviewed by a professional body.