Apr 13, 2023
The rise of clinical negligence claims has been a hot topic of conversation amongst UK dentists in recent years. In a poll of over 1100 dentists, 89% fear being sued by patients, while 74% suggest the threat of litigation affects how they practise, with many making far more referrals than they used to.
Of course, fear isn’t without foundation. One leading dental organisation states that UK dentists are twice as likely to receive a dental negligence claim as ten years ago. This is fuelled by a combination of tighter sanctions placed on NHS staff, plus the growth of no-win no-fee law firms that are increasing awareness and driving up the number of clinical lawsuits.
So, as a practising dentist, can you do anything to protect yourself against a dental negligence claim?
Here are 5 top tips:
Tip #1 – Be open and transparent
As dentists, we have a professional responsibility to be open and honest with patients. So, before any treatment starts, patients must understand their treatment options, including the benefits, costs, and risks involved.
It’s imperative to provide patients with information in a way they understand while giving them sufficient time to decide what they want to do.
If treatment doesn’t go according to plan, it’s essential to:
- tell the patient,
- apologise,
- offer a remedy to put matters right (if possible); and
- explain fully the short and long-term effects of what has occurred.
Note: NHS Resolution (formerly the NHS Litigation Authority) state that offering an apology is not the same as admitting liability and suggest that this is always the right thing to do.
Tip #2 – Document everything
Diligent record-keeping goes a long way to preventing a successful malpractice lawsuit. As long as regular protocols are followed and high standards of patient care are delivered, meticulous dental documentation is your first line of defence against a dental negligence claim.
If you use abbreviations and acronyms, ensure they are common knowledge or can easily be explained.
And, if you have to make corrections, the golden rule is never to obliterate an entry. Instead, run a line through it, initial it and make the re-entry.
Professional liability insurers have long asserted that errors or inadequacies in patient records have prevented them from successfully defending a clinician against a malpractice lawsuit. Therefore, always ensure diligent record keeping and never leave anything to chance.
Tip #3 – Thorough follow-up protocols
Patients have numerous reasons for missing an appointment but maintaining good rescheduling protocols is essential for dentists where possible litigation is concerned.
When an appointment is missed, it creates scope for a patient to suggest a poorly timed diagnosis. Unfortunately, an untimely or late diagnosis is one of the most common types of claims filed against dentists.
Initiating sound follow-up procedures ensures that every patient who has missed or cancelled an appointment has been contacted. Doing so offers a further layer of protection against a dental negligence claim.
Why?
Because it highlights the fact that the patient has refused to show rather than placing the onus on the timing of any diagnosis.
Tip #4 – Refer when necessary
As mentioned earlier, the rise in dental negligence claims across the UK has caused many dentists to rethink how they practise, resulting in an uptake in referral cases.
This isn’t necessarily bad, especially when dentists are unsure whether to treat a particular case or refer out.
Don’t be tempted to use your existing knowledge and skill to treat a case if you think the outcome may differ from normal. If in any doubt, seeking advice or referring the patient to a specialist is the right thing to do.
When a treatment fails, it isn’t uncommon for litigious patients to suggest that a specialist could have resolved their problem. So, always err on the side of caution.
Tip #5 – Taking prompt action when things go wrong
In the latest year of reporting (2022), 21 million people sought NHS dental treatment, and around 14,285 (0.06% of cases) ended in complaints. While only 22% of these complaints directly resulted from clinical treatment, it highlights that things can and do go wrong.
When patients are unhappy with their treatment, ensure fast action is taken to provide the best possible outcome.
Firstly, apologise and explain the situation. Take ownership of the problem immediately and assure patients you will rectify the situation.
Where applicable, offer appropriate remedial treatment at no further cost and/or give a goodwill gesture. These steps, although relatively simple, are often enough to ease patients’ concerns, lessening the risk of a dental negligence claim.
So, there you have it; 5 top tips to protect yourself against a dental malpractice lawsuit.
At the Dental Defence Society, we have your back. With an executive committee of dental professionals, we’re acutely aware of the everyday challenges facing the UK’s dentists in 2023 and beyond. So, if you face a complaint, a negligence claim or a legal issue, we can help.
With 24/7 access to dento-legal advice and assistance from highly trained professionals, our team provides ongoing support and tailored indemnity packages that allow you to do your job without worry.
Want to know more?
Get in touch today.
Mar 20, 2023
Whether a child can give their own consent to dental treatment is determined by their competency as well as age. When children lack competency, the law allows individuals with parental responsibility to provide consent until children can make their own decisions.
Although it is a legal and ethical obligation to obtain valid consent for treatment, many dental professionals are not fully aware of the legislation around these issues and may need further clarification and legal advice, especially in complex situations such as a dispute about treatment between parents who are separated or divorced. In all cases, the overriding consideration must be the best interests of the child.
Consent in children
The principles of consent are set out by the General Dental Council in Standards for the dental team. Dental professionals must obtain and document valid consent, which is voluntary and informed, before starting treatment and at all stages of the patient’s care through on-going discussions.
Before treating a child, it is essential to consider whether they have the capacity to give consent:
Young people aged 16 or 17 years can give consent and are presumed, like adults, to have the capacity to make decisions about their treatment unless evidence shows otherwise.
If a child aged 16 or 17 years does not have the capacity to decide, treatment that is in their best interests may proceed with consent from someone with parental responsibility (and if necessary, without parental consent). However, legal advice should be sought if there is any doubt.
Children under the age of 16 years can consent to treatment if they are judged to be Gillick competent. This means they have sufficient maturity, intelligence, and competence to fully understand the treatment information; they should also be able to retain and weigh that information to make and communicate their decision. Competence must be assessed for each individual child as appropriate for their age and according to the procedure since the capacity to consent may differ depending on the child’s health and development as well as the complexity of treatment and its potential risks.
Note that written consent is required when treatment involves conscious sedation or general anaesthetic, and in these cases, it is often appropriate for both parents to be involved in the consent process.
Where a child under 16 years is not competent to give consent, a person with ‘parental responsibility’ can consent on their behalf, if the dental treatment is in the best interests of the patient. Even so, children should be involved in decisions about their care as much as possible.
In an emergency, if waiting for parental consent would put a child at risk, treatment may be given in the child’s best interests, but limited to what is reasonably required to deal with that emergency.
Who has parental responsibility?
When a child cannot give their own consent, it is important to clarify who holds parental responsibility. The definition of ‘parental responsibility’ is set out in law, with subtle differences between UK nations: Children Act 1989 (England and Wales), Children (Scotland) Act 1995, The Children (Northern Ireland) Order 1995.
Parental responsibility could be held by:
- The mother – all biological mothers acquire parental responsibility at birth.
- The father – if named on the birth certificate, married to the mother, or given parental responsibility via the court.
- Adoptive parents once the process of adoption is complete.
- The child’s legally appointed guardian.
- An individual with a residence order concerning the child.
- A local authority designated to care for the child.
- A local authority or individual with an emergency protection order for the child.
Since there can be difficulty establishing who has parental responsibility, it is wise to ask for written confirmation of this when a new patient under the age of 16 is registered and with any change in circumstances. Note that parents cannot relinquish their parental responsibility, even if divorced or separated, although a court may remove or restrict parental responsibility.
Dilemmas that may arise
The issues of consent and parental responsibility can lead to ethical dilemmas for dental professionals, particularly where there is disagreement between the involved individuals. It will help if providers have knowledge of the legislation and tactfully communicate with parents and carers about who is expected to attend appointments with the child.
The following sections highlight some potential dilemmas and points to consider in each case. Further guidance on balancing competing interests to obtain valid consent to treatment is available from the General Medical Council. We encourage members to seek legal advice from Dental Defence Society if in doubt.
Where a child consents and their parent disagrees
If a competent child gives consent to treatment, parents cannot override this if a dental professional considers the treatment to be in the child’s best interests. However, in some cases, a court can override the consent, if that is judged to be in the child’s best interests.
It is good practice to encourage competent children to involve those with parental responsibility in important decisions about their treatment, unless it would not be in their best interests. Remember that where a child has capacity, their consent must be sought before sharing their medical information with those who hold parental responsibility.
Where a competent child or a parent refuses treatment
If a competent child refuses treatment that would be in their best interests, dental professionals should usually abide by the child’s decision even if their parent supports the treatment. In such cases, they should document all discussions as they seek an agreement.
In some situations, the child’s refusal can be overridden by the courts or those with parental responsibility, but legal advice should be sought. The potential harm of overriding the child’s wishes must be weighed against the benefits of treatment, and other professionals may need to be involved.
If a parent refuses the treatment of a child who lacks capacity, it may be helpful to request a second clinical opinion. A parents’ refusal can be overruled by the courts if the treatment is in the best interests of the child, so dental professionals should take legal advice if necessary.
Where consent is disputed by parents who are separated or divorced
Only one person with parental responsibility is required to give consent for treatment of a child. Despite this, if two people with parental responsibility disagree over consent, it is best to pursue an agreement before treatment. If the parents are separated or divorced, communication may be more difficult, so caution is required.
If no agreement can be reached, legal advice should be sought. A second clinical opinion may help to resolve the situation, or the courts may be involved to decide in the patient’s best interest.
If you need dento-legal support regarding the treatment of children, and issues of consent and parental responsibility, please do not hesitate to contact us at Dental Defence Society.
Jan 31, 2023
HMRC have announced that their guidance regarding the tax status of dental associates will be withdrawn, effective from 6 April 2023.
Until that date, the guidance means that dental associates engaged on an approved British Dental Association (BDA) or Dental Practitioners Association (DPA) contract are considered to be self-employed for tax purposes, as long as the terms of the contract are followed. Their income is assessable under trading income rules and not as employment income, and the dentist is liable for Class 2/4 National Insurance contributions (NIC).
Once the guidance is withdrawn, HMRC advises that the “status of new and ongoing Associate Dentist engagements should be considered in line with ESM0500 and CEST”. So what does this mean in practice?
How will dental associates’ tax status be determined after 6 April 2023?
Following a review, HMRC announced in September 2022 that the guidance for dental associates will be withdrawn from 6 April 2023. From this date, dental practices and associates will be required to consider the tax status of all new and ongoing dental associate agreements on a case-by-case basis, in line with ESM0500 and using the online test tool, CEST. HMRC will no longer rely solely on the use of BDA or DPA contracts to demonstrate that associates are self-employed.
The CEST tool will help to determine tax status (employed or self-employed for tax purposes) and whether the off-payroll working (IR35) rules apply to a contract. These rules are intended to avoid tax avoidance and ensure that workers who operate as employees pay similar tax and NIC to employees. HMRC says it will stand by all CEST determinations if the information provided remains accurate.
What determines self-employed tax status?
The details of the working relationship between the practice owner and the dental associate govern whether a dental associate is viewed by HMRC as self-employed, a worker or an employee. Key factors are control, the right to substitute, financial risk, and mutuality of obligation.
A self-employed dental associate may be a sole trader or act through a limited company. They will have clinical independence, choice regarding their working hours and income, and the right to provide a locum substitute and offer additional private work. They will bear financial risk in operating their business, usually paying a licence fee for use of the practice’s equipment and surgery. They will also process their own accounts and tax, have their own professional indemnity insurance cover, and will not receive benefits of employment like paid holiday.
Does withdrawal of the HMRC guidance mean that dental associates’ tax status will change?
For most dental associates, with contracts that reflect their independent work within a practice, the guidance withdrawal will not change their self-employed status. According to the BDA, HMRC has stated that they see the development as a change to their guidance, rather than a change to the self-employment status of dental associates. The National Association of Specialist Dental Accountants and Lawyers (NASDAL) has also concluded that the majority of dental associates will see no change to their self-employed status.
However, there may be some situations, particularly in private practice, where a dental associate who was previously classified as self-employed may be viewed as a worker after 6 April 2023. The BDA advises that a primary consideration is likely to be whether the dental associate is viewed as working for the patients or for the practice. NASDAL advised that there could be concern for dental associates whose working arrangements are subject to greater control than normal.
The BDA has updated its model associate agreements, with two versions available: for associates engaged on a self-employed basis, and for associates engaged as a worker.
What do practices and dental associates need to do?
Dental practices and associates should prepare for the change by checking associate agreements and using the anonymous CEST tool to determine tax status in each individual case. It is important to retain a hard copy of the CEST conclusions. The agreement should reflect the reality of the working practice. In some cases, it may be preferable for an associate to be engaged as a worker. Specialist advice can be sought if the situation is unclear or if there is disagreement.
If HMRC successfully challenged a dental associate’s self-employed status, additional tax would be due. The practice would need to put the associate on the payroll, deducting tax and NIC under the PAYE system, and pay Class 1 employers NIC on their salary. To minimise the risk of incurring additional tax liabilities, every dental associate should be engaged on an appropriate contract from 6 April 2023.
For help with reviewing dental associate agreements, employment status, or responding to queries raised by HMRC, please contact us at Dental Defence Society.
Dec 20, 2022
Dental tourism is booming as difficulties in accessing affordable treatment in the UK push patients to seek deals abroad. People may be tempted by companies marketing the ‘quick fix’ or ‘perfect smile’ on social media, often as part of an all-inclusive holiday package.
Although many dental practices abroad offer high-quality treatments, unfortunately this is not always the case and follow-up care can be inadequate. Patients booking cheap deals may be unaware of the long-term costs for their oral health and finances.
Dentists across the UK are seeing a rise in patients with complications resulting from dental tourism. This raises questions regarding the ethics, practicalities, and dento-legal aspects of managing the care of these patients. What are the responsibilities of UK dentists in this situation?
Common complications of dental treatment abroad
Cheaper dental treatments and shorter waiting times are key driving factors for patients to travel abroad, but these may come at a price. In a British Dental Association (BDA) survey, 95% of responding UK dentists had seen patients who travelled abroad for treatment; 86% had treated patients who developed problems as a result.
Patients with crowns and implants fitted abroad were particularly likely to need follow-up care at home in the UK. The most reported problems were failing or failed treatment (86%), pain (76%) and poorly executed treatment (72%).
Why is dental treatment abroad risky?
Within the UK, patients undergoing dental treatment are protected by strict regulations. Patients going abroad may find that dental standards are less stringent. For example, there may be different qualification requirements, lower standards of product quality, and less robust infection control measures. Language difficulties and lack of regulation may mean that informed consent is lacking, and misleading advertising may be more common.
When treatment is done during a brief trip abroad, additional concerns are shortened recovery periods (especially for dental implant treatment), continuity of care, and the potential need for costly ongoing maintenance care. Patients may not understand the long-term implications.
If things do go wrong after travelling abroad, it can be difficult for patients to bring legal claims and seek redress for complications, especially if there is no regulatory body in the country. They may face difficulties in communication and additional travel for legal proceedings. Furthermore, the cost of remedial treatment, often exceeding £1000, can outweigh any savings on the initial treatment.
How to manage follow-up care in the UK
What should you do if a patient visits for follow-up care after treatment abroad? This is a potentially complicated situation requiring careful consideration of the dento-legal risks. Management options will depend on the urgency of the problem, the skills and experience of the dental team, the cost implications, and the specifics of the treatment performed abroad.
Given the huge variability in techniques and components used in dentistry, especially when implants are fitted, the patient’s treatment may be unfamiliar. You may need to contact the dentist abroad for more details if the patient agrees. However, obtaining and understanding dental records from outside the UK can be time-consuming and confounded by language difficulties, while replacement components may be unavailable in the UK.
As always, you should follow the GDC Standards and Guidance and ensure that you are appropriately indemnified for all procedures carried out.
Key steps and considerations include:
- Fully assess the patient and ask about the treatment they received abroad.
- Discuss your findings, the management options, and any cost implications with the patient. Ensure that they understand and provide consent for any procedures performed.
- If it is in the patient’s best interests and they give consent, contact the dentist who did the work abroad for more details.
- Treat acute pain or infection as a priority.
- Consider the risk of litigation before commencing any remedial work. Contact Dental Defence Society if you need advice.
- If the complications are beyond your skill set and out of your scope of practice, refer the patient to a specialist with the experience required.
- If the patient wishes to make a complaint about the care they received abroad, advise them to discuss that with the dental company that provided their treatment, their travel insurer, or the regulatory body in the country where the treatment was done.
- Document all assessments, discussions, contacts with the dental team abroad, decisions made, procedures carried out, and advice given regarding ongoing maintenance.
Advice for your patients before they travel
If your patient tells you that they are considering travelling for dental treatment abroad, talk to them about the important factors to be aware of before they book. You can also discuss the alternatives, including payment options that may make treatment in the UK more affordable for the patient.
The NHS provides a useful checklist for patients thinking of going abroad, and the GDC also provides advice about what to expect and what risks are involved. For information about health regulators and professional bodies in other countries, patients can visit www.healthregulation.org.
If you need professional advice about managing complications in patients returning from dental tourism, please contact us at Dental Defence Society.
Nov 4, 2022
Dental implants are the gold standard to replace missing teeth. For many patients, they provide a more comfortable and well-fitting alternative to dentures and bridgework. Their durability also means they provide a secure anchor for restorations and/or dentures for many years.
The success rate is high, but because implant dentistry can take many months, and involve several invasive procedures as well as high costs for the patient, dentists are at risk of litigation if things go wrong. Not all patients are suitable candidates, and a small percentage of dental implants do fail.
The most common pitfalls that lead to complaints and claims are related to consent, planning and treatment execution. This article looks at how such problems can be avoided.
Gain appropriate training
To perform implant dentistry safely and ethically, dentists must complete further training. Different training routes are available, allowing dentists to provide implant treatment within general practice or to specialise in implant surgery or prosthodontics.
The College of General Dentistry (CGDent) guidance, Training standards in implant dentistry, explains the required training and the standards that must be met by training courses. Note that this guidance is also a reference point for the General Dental Council (GDC) when considering patient complaints about the competence of dentists providing implant treatment.
Following completion of an appropriate training course, dentists are expected to be mentored by an experienced clinician. The complementary Mentoring in Implant Dentistry: Good Practice Guidelines explains the requirements.
Follow GDC standards
Dentists performing implant treatment should follow the GDC’s Standards for the Dental Team, with particular attention to:
Working ‘within their knowledge, skills, professional competence and skills’.
- Any practitioner without the appropriate training should refer patients requiring implant dentistry to somebody who is trained and competent; this may be a specialist in oral surgery or restorative or prosthodontic treatment.
Communicating effectively with patients and obtaining valid consent.
- The patient should receive a treatment plan, with sufficient information about the treatment options, benefits, risks, likely prognosis, and costs, in a format that they can understand.
- Dentists must seek consent for every stage of the implant process, so it is important that they continue to discuss with the patient the progress of ongoing treatment and record this meticulously in the notes.
- Dentists should also spend time with the patient to ensure they understand and agree to any post-procedure advice (for example, diet, analgesics, and good oral hygiene), since non-adherence to the advice could increase the risk of complications or dissatisfaction.
Work with colleagues in a way that serves the interests of patients.
- Implant dentistry often involves a multidisciplinary team, so communication between colleagues is fundamental to success. All the involved team members may be liable to some extent if a claim is made.
- If different practitioners perform the surgical and prosthodontic aspects of implant treatment, they must agree on the treatment plan and document who is responsible for each aspect of treatment.
Keep complete and accurate patient records.
- Diligent record keeping is essential and helps if problems occur that subsequently lead to complaints or litigation. Maintain a record of all discussions with patients and colleagues regarding dental implant treatment, as well as any imaging, models, and documentation. It is highly recommended to have photographic records as well.
Perform a thorough patient assessment
The initial patient assessment is crucial to identify and record conditions that could complicate treatment. Successful treatment also depends on the patient’s bone to allow osseointegration of the implant which cannot be predicted, thus discussions must be recorded in the notes as well as ensuring the patient has copies of the consent process and all information related to treatment. Any failure to do so could be a cause for litigation if complications occur.
Assessment should include:
- Relevant health conditions and patient factors that are associated with increased risk of implant failure, including: smoking, diabetes, untreated caries or periodontitis, bruxism, age, chemotherapy or radiotherapy, and therapy with bisphosphonates or corticosteroids. These cases require caution and alternatives to dental implants may be preferable.
- Bone and soft-tissue condition: deficiencies may need to be addressed before implant surgery. Bone structure determines many aspects of treatment, from selection of the implant design to the surgical approach, type of reconstruction, the need for bone grafts, and the healing time between stages of treatment.
- Retained roots at the implant site: these usually need to be removed before implant surgery. More complex cases may require invasive surgery under sedation or general anaesthetic, and potential complications include injury to the adjacent teeth, bone or nerves. This makes implant treatment a longer and more complex process, so it is essential to discuss the risks and benefits with the patient.
- Testing for implant allergy or sensitivity.
Agree a plan for treatment
To maximise the chance of long-term treatment success, and reduce the risk of complaints, dentists should prepare a comprehensive treatment plan based on the patient assessment and treatment goals. This should be in writing and agreed with the patient and any other practitioners involved in their treatment.
The plan should include any pre-implant treatments (such as bone augmentation or treatment of existing oral health conditions), all stages of implant surgery and prosthetic placement, healing times, the design and positioning of the implant and selected prosthesis, and post-procedure care.
Use of imaging and wax-ups can assist the treatment planning and help the patient to understand how the prosthesis will look, giving them a chance to discuss any concerns before treatment starts.
Know how to manage complications
Most dental implants are successful, and many complications are minor and easily treated. For example, patients should be advised how to treat any minor swelling, bruising, pain, and bleeding that may occur in the first few days after treatment.
However, dentists who provide implant treatment must also be appropriately trained to manage less common, but potentially serious complications. These include implant site infection, peri-implantitis, failure of osseointegration, mechanical or technical failures, nerve damage, and sinusitis.
At Dental Defence Society, we offer indemnity packages covering implant dentistry and 24/7 dento-legal support. If you provide dental implant treatments, please contact us to discuss your needs.
Sep 26, 2022
Dental patients wanting to straighten their teeth are increasingly choosing short-term orthodontics (STO) to improve their smile. The appeal is that STO usually means using braces or clear aligners to straighten the front 6 or 8 teeth within 4–9 months, in a process considerably less invasive and time-consuming than conventional orthodontic treatment.
Suitably trained general dental practitioners (GDPs) can provide STO but they need to know the limitations and risks involved. Unfortunately, litigation resulting from STO procedures has increased in recent years. However, GDPs can reduce the risks by staying within the scope of their skills and experience, managing patient expectations, and practising in accordance with guidance from the General Dental Council (GDC).
Short-term orthodontics: not a ‘quick fix’ for all
STO can produce satisfying results for certain patients who wish only to align their front teeth, but it is necessary to consider the pros and cons of the different options available, enabling patients to make an informed choice. A wide variety of STO systems are available to suit a range of budgets and treatment scenarios, so dentists need to understand their patients’ wishes and be able to advise them on the most suitable treatments to meet their individual needs.
Full assessment of a patient’s oral health and dental structures is a fundamental part of treatment planning for STO. Not all issues can be fixed by STO and for some patients, especially those with complex problems, conventional orthodontic treatment will be a more appropriate solution in the long term. Used inappropriately, STO risks creating worse problems that need further costly and time-consuming treatment.
The importance of managing patient expectations and enabling informed consent
Patient demand for cosmetic STO may sometimes be based on unrealistic expectations, driven by societal pressures, social media hype and misleading advertising. This makes it especially important for GDPs to communicate directly and effectively with patients to fully engage them, manage their expectations and obtain valid informed consent before and throughout treatment.
The GDC sets out the full requirements for obtaining valid informed consent, key points including:
- Obtain valid consent before starting treatment, explaining all the relevant options and the possible costs.
- Although a signature is important, it is the discussions with the patient that determine whether consent is valid.
- Make sure that patients (or their representatives) understand the decisions they are being asked to make, and document this. Provide sufficient information in a format that they can understand and consider whether the patient is able to make decisions about their care.
- Make sure that the patient’s consent remains valid at each stage of investigation or treatment. The consent process should be part of ongoing communication with the patient. Document specific consent for the procedure during each appointment and for any changes to the planned procedure.
- Consent can be withdrawn at any time; in this case, ensure patients understand the risks or consequences and that they are responsible for any resulting problems.
GDPs providing STO need to make sure that patients understand the limitations of treatment and accept their own role in the treatment contract to gain the best outcomes and avoid damage to their dentition; for example, the need for good oral hygiene, regular attendance at appointments, and requirement for life-long use of retainers to prevent relapse.
Patients should be aware that:
- Teeth will not move rapidly, due to the need for remodelling of supporting tissues. The speed depends on biological factors and may vary from the manufacturer’s claims.
- Orthodontic treatment is associated with a risk of adverse effects and complications, including periodontal damage, pain, root resorption, tooth devitalization, temporomandibular disorder, caries, speech problems and enamel damage.
- Underlying oral health conditions may impact on the overall success of alignment.
At the American Association of Orthodontists 2017 Annual Session, Dr Laurance Jerrold, a specialist in dental risk-management education, presented template forms containing a comprehensive list of considerations for obtaining informed consent; although developed for a US audience, UK GDPs may also find this a useful resource for further reading.
Dento-legal concerns with direct-to-consumer short-term orthodontics
As patient demand has grown, some companies have started to provide direct-to-consumer treatments, so-called ‘DIY orthodontics’. Patients often consider using such services because they offer attractive prices without the need for multiple dental appointments.
Dentists may be asked to confirm suitability of a patient for direct-to-consumer treatment, sometimes remotely. However, to reduce the risk of dento-legal issues, it is wise for dentists to avoid commenting on the specific STO appliance; instead, they could explain to the patient why it is important to discuss the treatment options and potential risks with a qualified, registered dental practitioner.
Dentists have a responsibility to adhere to the GDC’s guidance and Standards for the Dental Team. In May 2021, the GDC issued an updated statement on direct-to-consumer orthodontics. Crucially, this makes it clear that:
- Such services can only be performed by GDC-registered dentists and dental care professionals.
- Full assessment of the patient’s oral health is needed to form clinical judgements about any proposed orthodontic treatments. “At present, there is no effective substitute for a physical, clinical examination as the foundation for that assessment.”
- The responsibility for a clinical judgement lies with the prescribing dentist.
The GDC also provides the following resources:
Indemnify against risk in STO
The GDC states: “Dental professionals also need to ensure that they are appropriately indemnified. Those who do not comply with the Standards for the Dental Team, indemnity requirements and authoritative clinical guidance put patient safety, and their registration, at risk.”
GDPs can minimise the risk of problems if they perform STO within the scope of their own expertise and obtain valid informed consent, discussing with the patient all the treatment options, including referral to an orthodontist, as well as the risks, limitations and a realistic timeframe.
As always, treating dentists should keep detailed patient records and note the reasons for any deviation from established practice and guidance. In the event of litigation, this documentation can provide evidence of informed consent and appropriate management of treatment.
Please contact Dental Defence Society for expert advice if you face a complaint or claim or if you have any questions about indemnity requirements for STO.
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