With dental negligence often occurring due to the misconception that dentists are money orientated, Paul explores what solicitors should look out for in experts and the reasons why such litigation is on the rise.
Common mistakes other dental professionals make which can lead to claims of Dental Negligence:
Most of the common negligence cases that we see in dentistry are to do with periodontal disease, the lack of diagnosis and lack of treatments, which in turn leads to tooth loss and then the need to replace the teeth, usually with dental implants. Dental implants are a very costly treatment and usually not available in the health service; often if the negligence has led to the loss of many teeth, then the treatment cost can be in the region of £50,000 in order to replace these missing teeth with implants.
The second most common cause of negligence is then due to tooth extraction, where it has not been explained to the patient that there are other options which could lead to the tooth being saved. In this case, the patient has not been fully informed of other treatment options and if they had been fully informed they would have taken another route which would have led to the tooth being treated rather than removed. These options usually include root fillings and crowns. Again, once the tooth has been removed the usual replacement is via dental implants; a single tooth replacement is often in the region of £3,000 to £4,000.
The newer types of dental negligence, which we are seeing more and more, are to do with complex treatments for which the dental practitioner is either inadequately trained or has not given the patient a reasonable estimate of the costs along with the outcome including the pros and cons of such treatment. Here the more expensive treatments include: dental implants, cosmetic dentistry with veneers, etc., and also short-term orthodontics.
I would also suggest that having a nationwide panel of experts who are all trained to the same standard and degree and whose reports have a similar, if not identical makeup, makes life easier for the solicitor and barrister when dealing with a large number of cases.
Patients are very often disappointed when having veneers or crowns placed where the end result does not match their expectations, which can again then lead to a claim. Many dentists often do not complete enough diagnostic work in advance of the treatment so that the end result can be easily previewed by patients and amended as required.
Dental implants have a failure rate and this is often overlooked. The expected failure rate has always been in the region of 5% in the lower jaw and 10% in the upper jaw. More recently, however, there is peri-implantitis disease which has led to an increase in the failure rates in some patients. Again, this is often overlooked during the treatment planning stage. The patients are on the assumption that their implants will last them a lifetime, whilst a reasonable figure would be more in the region of 15 years.
Advice for solicitors when choosing dental experts
The choice of dental expert should be based on the understanding and knowledge of their field and certainly, expertise should be (at least) an established private practitioner who has over 10 years of general dental practice. Alternatively, look for dentists who have gone on to have further education in a particular field, such as gaining a Master’s degree or becoming specialists in Periodontics, Endodontics, Orthodontics, Prosthodontics, General Dentistry and Implantology, or professors or consultants when required.
It is also important to have continuity when choosing an expert and knowing that they have been through adequate training in the expert witness field and have enough experience in that field to write reports which are legible, easy to read and precise, and that they understand a basic knowledge of the legal system so as to help the court reach its opinion if required.
Dentists are seen as easy pickings by the public and solicitors.
I would also suggest that having a nationwide panel of experts who are all trained to the same standard and degree and whose reports have a similar, if not identical makeup, makes life easier for the solicitor and barrister when dealing with a large number of cases. We at T Legal employ experienced general dental practitioners, dentists with Master’s degree in their chosen field, specialist consultants and professors in all areas of general and specialist dentistry and also on a nationwide basis so continuity is guaranteed.
Why is there so much Dental Litigation at present?
Dentists are seen as easy pickings by the public and solicitors. Dentists do not have the same degree of sympathy from the public as doctors do and are often seen as more money orientated. As a result, patients are much more willing to sue “greedy” dentists. This is a misapprehension of course. Most dentists try very hard to do a good job, however, they are often working against the system (NHS). This can lead to “defensive dentistry” where often ideal treatments are not done for fear of failure and litigation.
To give an example . . . A Dentist gets paid the same amount of money for extracting a tooth (10-15 min. appt.) as they do for doing a root canal (60 min. appt.).
It’s easy to see why dentists are put off doing root canals when they can earn 4-5 times as much simply taking the tooth out. If the patient is not offered the root canal then, of course, no consent has been gained and litigation can follow.
Evidence and reports needed in order to carry out your investigation as an Expert
There are different types of reports I do for my legal colleagues including Breach of Duty and Causation, Condition and Prognosis, and Full Negligence (the two combined). I also do more and more screening reports to make sure that the solicitors have a case. Of course, these are part 35 non-compliant, but at least the solicitors have the benefit of my experience before they go headlong into a contentious case.
Professor Paul Tipton is Professor of Cosmetic and Restorative Dentistry at the City of London Dental School and a Specialist in Prosthodontics. He is an experienced expert witness with over 30 years of experience in dento-legal expert witness work. He regularly lectures both internationally and at home with training academies in Manchester, London and Dubai, and is renowned for his one-year Restorative, Cosmetic and Implant Dentistry courser, where over 3,500 dentists have graduated during the last 25 years, and for his numerous articles on Implantology and Cosmetic and Restorative Dentistry.
He is on the editorial board of Private Dentistry Magazine, Restorative and Aesthetic Practice, and the Indian Journal of Prosthodontics, and was a founding director of the British Academy of Aesthetic Dentistry and the British Academy of Cosmetic Dentistry.
In 2014 he was made visiting Professor of Restorative and Cosmetic Dentistry at the City of London Dental School. He is currently the President of the British Academy of Restorative Dentistry (BARD) and is a Fellow of the International Academy for Dental Facial Esthetics (IADFE).
He has assembled a team of leading clinicians and expert witnesses who work with him at T Legal all around the UK, in all of the various fields of Dentistry – from leading Professors and Specialists to experienced private general practitioners. All areas of Dentistry are covered including General Dentistry, NHS and Private, Cosmetic and Restorative Dentistry, Implantology, Oral Surgery, Orthodontics, Periodontics and Endodontics.
Professor Paul Tipton
T: 07786 327978
