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Fitting of veneers to teeth (03HDC16810)

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(03HDC16810, 8 April 2005)

Dentist ~ Restorative dentistry ~ Veneers ~ Infection ~ Caries ~  Treatment planning ~ Managing complications ~ Referral ~ Appropriate treatment ~ Standard of care ~ Right 4(1)

A 28-year-old man complained that both the initial treatment and the follow-up care provided by a dentist were inadequate and inappropriate. The man had a poor dental history and was a heavy smoker, and went to a dentist requesting that all of his teeth be removed. The dentist advised against this course of action, stated that the teeth were restorable, and recommended that six of the man's front teeth be fitted with porcelain veneers. Veneers were fitted but repeatedly fell off. The man also developed an abscess, which the dentist failed to treat effectively. After nearly two years of repeat visits to the dentist concerning these problems, the man sought a second opinion.

It was held that while the decayed teeth were restorable, the choice of fitting porcelain veneers was inappropriate. The use of crowns would have been more appropriate as they cover a greater tooth surface area and are less likely to detach when bonded to a restorative material rather than tooth tissue.

The treatment plan was also inappropriate. The dentist should have treated the man's caries and eradicated the existing infection before undertaking any veneer work. This was not done, compromising the man's ongoing dental health and the likely success of the restoration work. The dentist should then have monitored the effectiveness of that treatment before commencing the restorative work. If he was unable to treat the abscess, he should have referred the man to a specialist, to ensure that the teeth to which the veneers were being fitted were sound and healthy.

When problems developed with the veneers falling off, and with ongoing serious infection, the dentist did not adequately explore what was causing the problems and so did not manage and treat them adequately. Antibiotic treatment was not working, which indicated the need for specialist referral. Causes for the failed adhesion of the veneers were not explored and addressed.

It was held that in each of these areas the dentist failed to provide dental services with reasonable care and skill and breached Right 4(1).

On 8 August 2005 a charge alleging professional misconduct was filed with the Health Practitioners Disciplinary Tribunal. On 22 April 2005 the Dentists Disciplinary Tribunal upheld a charge of professional misconduct in relation to the care the dentist provided to another patient (see 02HDC16651), then upheld two further charges of professional misconduct on 1 June 2005 (see 03HDC11122 and 03HDC09604). On 12 August 2005 the Tribunal ordered that his registration as a dentist be cancelled, with effect from 1 September 2005. In light of the previous decisions and the Tribunal's orders, the Director of Proceedings considered that it would not be in the interests of the public or the profession to spend further funds pursuing the dentist in relation to the care he provided to the man, and accordingly withdrew the charge on 4 October 2005.

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