Expert Witness Journal Issue 63 October 2025 - Flipbook - Page 56
This becomes di昀케cult to apportion the negligence
percentage to each of the dentists involved in the
case.
and they su昀昀ered harm/losses as a result (causation)
and that harm was foreseeable and not to remote.
The key issue is what the standard care pertaining
to the time for that particular clinical situation was
and whether the dentist did something a reasonable
dentist would not have done alternatively did not do
something a reasonable dentist would have done in
that particular situation. This is the ‘Bolam Test’ and
still a relevant standard that applies some 60 years
after the judgment was handed down.
The periodontal disease types of negligence cases
that we see in Dentistry are due to a lack of diagnosis
and lack of treatments which has in turn led to tooth
loss. These teeth then need to be replaced, usually
with dental implants. Dental implants are a very
costly treatment and usually not available in the
health service and often, should the negligence have
led to loss of many teeth, then treatment cost can be
in the region of £50,000 in order to replace these
missing teeth with implants.
The Bolam test is applied in law to assess whether or
not the defendant in question has committed a breach
of duty, and is guilty of negligence. It clearly states
that a dentist is not deemed to have been negligent
if he/she has acted in accordance with a practice
accepted as proper by a responsible body at the time
the event occurred.
Tooth Extractions
The second most common cause of negligence is 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. If they had been fully
informed they would have taken another route which
would have led to their tooth being treated. This
is often the result of the extraction being an easier
but not always better option to complex restorative
treatments to save the tooth. Again, once the tooth
has been removed the usual replacement is with the
dental implant and a single tooth replacement is
often in the region of £3,000 to £4,000.
The law does not expect the dentist to be aware of
every recent development in medical science but
they would however expect that the procedure or
technique has become well proven and well accepted
before it is adopted.
The GDC however expect clinicians to provide good
quality care based on current evidence.
Cosmetic Dentistry
More recently, we are seeing complex cosmetic
treatments for which the dental practitioner is
either inadequately trained for or does not provide
the patient with a reasonable estimate of the costs
and outcome, alongside 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.
Causation
Proving negligence is only half the battle though.
Once negligence has been identi昀椀ed, the claimant
then has to prove causation. This is why the experts
report is required.
Identifying causation is the most important factor
in a case and is often overlooked by some experts.
Each expert must understand that it is not enough
to simply just to deal with liability, for the case to
have merit. The claimant must prove that the patient
would have had a much better prognosis but for the
defendant’s negligence.
Patients are very often disappointed when having
veneers or crowns placed, as the end result does not
match their expectations which can again lead to a
claim. Most dentists often do not complete enough
diagnostic work in advance of treatment, so that the
end result can be easily previewed by patients and
amended as required.
The but-for test is used to identify causation. I.e. but
for the negligence, the resulting outcome would have
been far better/ the injury would not have occurred.
Thus the negligence in question made a material
contribution to the severity of the injury.
If a defendant is deemed to have been negligent, but
the resulting damage would still be the same, then
there is no case as causation has been disproved.
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 these rates. Again this is often overlooked during
the treatment planning stage. The patients have
the assumption that their implants will last them a
lifetime.
Periodontal Disease
Negligence cases take the most amount of time,
are often highly complex and can involve multiple
dentists over a period of time during which the
patient was treated. This is especially in the area of
periodontal disease where lack of care, treatments
and diagnoses may have been going on for a decade
or more; the patient has seen multiple dentists who
have continued to misdiagnose the disease process.
EXPERT WITNESS JOURNAL
Prosthodontics
My specialty of Prosthodontics deals with the
replacement of teeth and this can be via crowns,
veneers, bridges and implants. Prosthodontics would
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