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Dental

Sloppy dental care

Dental care consistent with need

A successful complaint resolution meeting

Dentist fails to get consent

Too traumatised to pursue the complaint

A great dental response

Faulty denture results in refund

Differing views on removing orthodontic braces

Ill-fitting dentures

Is this the right child?

Ill-fitting Dentures

The dentist and the wheelchair user

Unsatisfactory care provided by dentist

Sorting out dental care

A persistent tooth problem

Self advocacy for new dentures and new relationship

Dental complaint

Sloppy dental care

Dental Care ~ Right 4 ~ appropriate standards ~ Right 10 ~ complaint process

A consumer had dental work undertaken including a root canal procedure. Approximately a year later the filling over the root canal work was replaced but the consumer continued to experience infections and general poor health including boils. She consulted a number of health professionals at substantial cost. 

Some time later she consulted another dentist who advised the root canal procedure had not been completed and that a permanent filling had been placed over the packing of cotton wool which was now decaying.

After receiving this information the consumer and her family met with the original dentist who acknowledged her error and agreed to liaise with the consumer's current dentist to ensure the consumer would not incur out of pocket expenses. Later the same month the original dentist hand delivered a letter and a cheque for $700.00. In the letter it was stated that the $700.00 would fix the tooth to the level it would have been at had the root canal work been completed at the earlier time. The dentist stated that if the cheque was drawn it would be considered full and final settlement. The consumer sought advocacy assistance as due to the numerous infections and time lapse, the tooth required additional treatment, at a cost of $1900.00. 

Issues

• Root canal was not completed 
• Due to the retained packing and non-completion of the dental work, there were caused years of prolonged infection, and continued poor health, which was a significant financial burden.
• Why was the cheque made out to the consumer, and not to the dental provider, as agreed?
• $700.00 was insufficient to complete the required work.

Desired Outcome 

• To achieve low level resolution and agreement.
• Acknowledgement from original dentist, that her error has caused years of pain, infection and ill health, not to mention a huge financial burden.
• To have the required dental work completed, as agreed, without additional expense to the consumer. That the completion of all required  dental work on the tooth concerned, be considered as a gesture of good will and compensation of the error made by original dentist.
• To finally have good dental and physical health
• To assist in ensuring that an error such as this does not occur for any other consumers

The consumer was made aware of the role of the advocacy service in assisting to resolve the concerns with the parties

The option of taking the complaint directly to the Health and Disability Commissioner or using this avenue if the complaint was not resolved through the advocacy process was also discussed.

The consumer chose to have advocacy assistance to put the concerns in writing to the provider and to request a meeting with the provider with the advocate present to support the consumer

After receiving the letter of complaint, the provider wrote to the consumer and offered to pay for dental work required to rectify the problem.  No meeting was required. The work was completed, and the consumer was very happy with the outcome.

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Dental care consistent with need

Dentist ~ Right 5 ~ effective communication ~ dentures

An older woman contacted the advocacy service because her dentist refused to replace a partial plate which no longer fits. She told her dentist she wanted all her teeth extracted so she could have a full set of dentures.

The dentist advised that he was not willing to extract her teeth and would adjust the plate to fit her gums. In discussing the situation with the advocate the consumer was adamant she wanted her teeth extracted and did not understand why she was not being listened to. After considering the options, the consumer requested the advocate phone and speak to the dentist while she was present. 

The dentist advised no final decision had been made as he was waiting for x-ray results. This was relayed to the consumer who said she still wanted a full denture. The dentist advised that once he had the x-ray results he would consult with his colleagues and get back to the consumer. The consumer was happy with that.

She phoned a few days later to say the dentist had made contact with her and was willing to extract all her teeth so she could have a full set of dentures. She was very happy to have had advocacy support to raise her concerns.

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A successful complaint resolution meeting

Dental Service ~ Right 4 ~ Appropriate standards ~ Right 5 - Effective communication ~  Right 6 ~ Fully informed 

A consumer telephoned the advocacy service to express concern about a dentist, who, over several years, had repeatedly treated the consumer, without success.  

The advocate  met with the consumer to clarify his concerns and ascertain what he wished to achieve by complaining. The consumer said he wanted to maintain a good relationship with the dentist and find a solution to his ongoing dental problems. 

At the consumer's request, the advocate contacted the dentist to ask him to attend a complaint resolution meeting. He replied promptly and said he was happy to meet. 

The meeting was held. The dentist said he felt nervous, as this was his first time working with the advocacy service. The advocacy role was clarified for his benefit. The consumer shared his experiences and said to the dentist that he wanted a result. 

The dentist apologised to the consumer for his repeated disappointing experiences. He acknowledged that communication between him and the consumer had not been 100% clear, as neither party spoke English as a first language.

He explained the consumer's condition and discussed options for future treatment, including risks and benefits. The dentist drew diagrams for the consumer to reinforce visually the points made verbally. 

The dentist gave the consumer the option of accepting a refund, which the consumer could use to get a second opinion from another provider. 

The consumer decided to accept the dentist's offer of a refund and would use the money to seek a second opinion. The dentist emphasized that the consumer was welcome to return to his clinic at any stage. 

The meeting ended with the consumer and provider expressing respect for each other and shaking hands. 

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Dentist fails to get consent

Dental care ~ Right 7 ~ Informed consent ~ Root canal

A consumer went to his dentist because one of his top teeth was painful and sensitive to temperature. He said he left the surgery with a bottom tooth partially treated and now faced the prospect of a $5,000 root canal.

Throughout his time in the chair, he'd gained the impression from the dentist that his situation was to be explored and that she wasn't certain what needed to be done at this early stage. At no stage did she discuss any treatment options and he left feeling that his tooth had been treated in such a manner that he would now have to proceed with a root canal.

After talking through his options with an advocate he decided to write to the dentist. She responded that she stood by her clinical decision and that she would be happy to forward his notes to another dentist. The consumer contacted the advocate after receiving the response and discussed how he might proceed. He chose to write back stating that she hadn't addressed any of the questions outlined in his first letter and he again requested to meet with her advising he would be bringing an advocate for support.

After much dialogue between the two parties at the meeting the dentist acknowledged she had in fact missed the reason for his top tooth being painful. She stood firm on the fact that she'd treated the lower tooth appropriately and explained that if she hadn't treated it, he would have soon had a major problem with it. The consumer accepted that, however, he stood firm on the fact that she had never indicated that she was certain of what was needed for this bottom tooth and had never gained his permission to go down the treatment path she had chosen.

After further discussion they agreed the provider had used the word 'possibly' when talking with the consumer which led to his impression that she was not, at this stage, making a definitive treatment decision. He stated he had expected that he would be given treatment options and said categorically, if he'd known it was going to be a root canal costing thousands of dollars, he wouldn't have agreed to it. 

The dentist said she had been concerned about the consequence of not taking this route but now understood and accepted that this was not her decision to make, it was the consumer's. She apologised for this and agreed that even as a clinician, if she disagreed with the consumer's decision, it was his to make.

They parted with a better understanding on both sides. The consumer was pleased he had sought advocacy support as he felt that while not making a difference for him it would for others in relation to the informed consent process.

Too traumatised to pursue the complaint

Dental care ~ Right 4 ~ Appropriate standards ~ Root canal ~ Pain ~ Right 7 ~ Choice and consent

A consumer told an advocate she had gone to her dentist on the Friday and had a root canal procedure on her front tooth. Following the procedure an x-ray was done that showed the tooth was so long the dentist hadn't managed to get it sufficiently cleaned out. He stated she would need to return after the weekend.

Prior to the consumer leaving the nurse asked the dentist if he was going to give her antibiotics to which he responded no. As she left the surgery the nurse gave the consumer a card that contained the dentist's after hours private home number and said "If it gets bad during the weekend ring him up for antibiotics". 

On Saturday morning the consumer woke in terrible pain. She rang the dentist, spoke to his wife, and arrangements were made to return on Monday. The dentist began treatment on the tooth without anaesthetic. When the consumer became distressed by the pain she was told she should not be feeling anything as the tooth was dead and he continued to work without anaesthetic. She left the clinic feeling traumatised.

The consumer chose to put her concerns in writing as she felt unable to meet even with advocacy support. She requested the dentist send his response to the advocate as she felt that any contact with him would traumatise her further.

Following receipt of the response the advocate contacted the consumer and read her the letter from the dentist. The consumer was not happy and requested another letter be sent outlining the issues she had with the response. Once again she requested the response be sent to the advocate.

A second response was received which was also unsatisfactory. The advocate discussed options including whether the consumer would reconsider her decision about meeting. The consumer advised she would like to take a couple of days to think about what she wanted to do next. When the advocate contacted her a few days later the consumer stated she had decided she did not want to pursue the matter any further. 

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A great dental response

Dental ~ Denture ~ Right 4 ~ Appropriate standards

A consumer contacted the advocacy service for support after receiving a second opinion that her bottom denture had not been made correctly. As a result of this she was unable to wear it.

Prior to getting a second opinion and contacting the advocate, the consumer had attempted to address her concerns directly with the provider.  This had resulted in the denture being ground down and her being given denture glue, which had not been effective. The consumer was clear that what she was seeking was a replacement bottom denture made by another provider and paid for by the first provider.

After discussions with the advocate the consumer decided to have advocacy support with writing to the provider outlining her concerns and clearly stating the outcome she was seeking. She requested the provider respond in writing.

The response she received was not from the original provider, who had left the practice. The new dentist offered to either refund the consumer's money or make her a new denture. As the writer of the response was a more experienced person the consumer elected to take up the offer of having a new denture made and fitted by him.

She was happy that she had been supported by the advocate in writing her letter and the great result she had achieved. 

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Faulty denture results in refund

Dental Technician ~ Right 1 ~ Respect ~ Right 4 ~ Appropriate standards ~ Right 10 ~ Right to complain

A consumer came to advocacy as a result of a formal referral from the Commissioner. When the advocate and consumer met, the consumer explained that since receiving her new denture she could not eat or speak properly as it did not fit. She had approached staff at the practice who were disrespectful when she raised her concerns. After several unsuccessful attempts to have the faulty denture modified, she went to another practice where a suitable denture was made for her.

After considering the options that were available she decided to meet with the dental technician with advocacy support.

At the meeting the consumer talked about the disrespect shown to her when she returned to the practice and the costs involved in having a denture she could not use. The dental technician said that although he would have liked to have continued to modify the denture he accepted that she had lost faith with his service. He made an offer to reimburse her for half of the cost of the denture and for her to return it.

The consumer accepted this and in due course received the reimbursement.

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Differing views on removing orthodontic braces

Orthodontist ~ Braces~ Right 7 ~ Informed choice and Consent

A woman contacted an advocate after her orthodontist refused to remove the braces she had had fitted to her teeth for two years. She was upset by the orthodontist's insistence that he made the decision when the braces were to be removed. She considered her teeth to be straight enough, had paid for her treatment in full and just wanted to be fitted with orthodontic retainers.

After considering the options, the woman chose to have the advocate support her to write to the orthodontist. In her letter she pointed out that Right 7 gives her the right to make an informed decision and that it was her choice to have the braces removed. She went on to say that she knew this was against his advice and that she would not hold him accountable for any future problems.

On receiving the letter the orthodontist arranged to meet with the woman and removed the braces. She was very happy with this outcome.

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Ill-fitting dentures

Right 4 ~ Appropriate standards ~ Dental Technician

A consumer contacted the advocacy service after a lack of response in getting a dental technician to adjust his dentures. Since receiving the replacement dentures he had suffered ongoing discomfort and was unable to eat without experiencing considerable pain.

With the help of an advocate the consumer wrote a letter to the provider requesting a meeting to receive an explanation as well as for the dentures to be reset.

The technician agreed to meet and during the meeting demonstrated the methods used when constructing new dentures. He offered to make the dentures less sharp to make a greater range of bites possible, or alternatively to reset the dentures to the consumer's satisfaction at no additional cost.  The consumer opted for the dentures to be refitted. He has since advised the advocate that he was very satisfied with the outcome and that he would be happy to recommend the Nationwide Health and Disability Advocacy Service to friends and family.

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Is this the right child?

Dental Therapist ~ Right 4 ~ Appropriate standards ~ Rights 6, 7 ~ Fully informed ~ Consent

A 5-year-old girl received dental treatment on two consecutive days without permission or the knowledge of her grandparents who were her legal guardians. The child suffered lip trauma from the dental treatment. The grandmother's enquiries revealed the child had been treated in error and that they had initially been misled by the therapist.

They received a response advising a full investigation would be undertaken and an offer to meet to discuss the matter. The grandmother sought advocacy help to prepare for and attend the meeting with them. At the meeting the provider apologised and advised a full investigation was being undertaken by the Quality Team. The complainant received full details of the treatment provided plus an acknowledgement that the child was mistaken for another and should not have received any treatment. The grandmother requested a written apology from the therapist, and to have all future dental care provided by a private dentist. The meeting concluded with the provider saying they would send the results of the investigation to the grandparents.

Following receipt of the investigation report the grandmother asked the advocate to support them at another meeting with the provider. The outcome from that meeting confirmed that the provider would fund the child to have free dental care with a private dentist outside of the District Health Board's Oral Health Service until the end of year 8. A letter of apology from the therapist would also be sent to the child.

To prevent this happening again, protocols are being developed to ensure the correct child is treated. In the meantime a system has been put in place where the teacher must receive a note from the therapist requesting the child and the teacher must tick a register to confirm the correct child has been sent for treatment.

The grandparents were happy with the outcome of the investigation and that systems had been put in place to ensure the right child received the right treatment in future.

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Ill-fitting Dentures

Dental Technician ~ Right 4 ~ Standard of care ~ Resolution meeting

A consumer contacted an advocate because she had suffered from ulcers and discomfort for nearly a year after getting new dentures. She had been back to the dental technician several times and had recently been told she would need to pay for any future visits. With the advocate's assistance she wrote to the provider requesting a meeting with the Manager. She wanted to discuss her frustrations, check if there was an intention to fix her dentures, and if not, to seek a refund.

The consumer received a call from the Manager agreeing to meet.  The consumer requested the advocate support her at the meeting.

The Manager told the consumer he was unhappy to hear that she had endured a year of suffering as it was his responsibility to see that her teeth fit properly.  He told her that some technicians are reluctant to overdo the grinding down of a plate as it may result in the need for a soft liner which would cost the practice money. He apologised for the number of visits she had made and with her agreement, examined her mouth.

He then advised the technician where to grind the denture down and it was done right away. The consumer put the dentures in her mouth and burst into tears. For the first time in nearly a year, she felt they fitted and that she would be able to eat a steak.

The advocate contacted the consumer after the meeting and was pleased to hear she was enjoying her new teeth and could now eat anything.

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The dentist and the wheelchair user
A woman who had been going to the same dentist for ten years was told that the dentist could no longer treat her as he could not safely transfer her from the wheelchair to the dental chair.   The dentist referred her to the Oral Health Department at the local hospital where they had the facilities to treat someone in their own chair if necessary. 

The hospital sent an appointment for three months' time for an assessment, and advised that an appointment for treatment would not be for at least three months after that. The woman was very concerned as she required immediate treatment.

An advocate discussed the options with her, and it was decided that the advocate would contact the hospital to explain about the woman's mobility issues. The manager said that there was no indication on her referral that the woman had any special requirements and that she would get her an earlier appointment.

The woman was delighted with this outcome.

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Unsatisfactory care provided by dentist

Following a root canal procedure, a consumer suffered months of pain and discomfort which ultimately resulted in a referral to a specialist who completely re-did the procedure and treated an infection.

The consumer returned to the original dentist for treatment on a lower back tooth, using a local anaesthetic. Three days later the side of her face was still numb and swollen with visible bruising. She returned to the dentist who told her she had bitten the inside of her cheek. He also said the filling had not been filed down properly and corrected this. When the tooth continued to cause problems the dentist said the filling had cracked and needed removing, and a temporary dressing was applied. The tooth was filled by another specialist.   

With advocacy support the consumer sent a letter outlining her concerns to the Practice Manager at the Dental Practice. She requested a meeting and advised an advocate would be present for support. The Practice Manager agreed to meet but advised that the Dentist would not be present as he was no longer employed there.  After hearing the consumer's concerns the Practice Manager offered to pay any expenses incurred as a result of the treatment she had received, including the ACC surcharge. The Practice Manager offered her a copy of her notes including her x-rays and apologised on behalf of the dentist who performed the procedures.

The consumer was very happy with the outcome and the support provided through the Advocacy Service.

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Sorting out dental care

A man contacted the advocacy service complaining that he had been to a local dentist and asked to have two painful teeth extracted.  Even though the fillings would need to be very deep, the dentist had 'talked him into' agreeing to have the teeth filled so they could be retained.  The teeth were filled and he paid for the work.

However, within 24 hours the two teeth were very sore and the gum around them red and swollen.  He had taken painkillers as advised but felt it was getting worse. He wished he had had the teeth extracted as first requested but did not want to pay any more money.

When he rang the dental surgery he was told that the dentist had been a locum and was no longer at their practice. The advocate located the dentist and explained the problem. The dentist was holding a clinic that evening at an after-hours surgery and made a time for the consumer to come in to see him.

The consumer later contacted the advocate to advise he was very happy with the outcome - his teeth had been extracted and he did not have to pay any more.

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A persistent tooth problem

A consumer attending a clinic for dental treatment was advised she needed a wisdom tooth extracted and a root canal filling for another tooth. A temporary filling for the root canal fell out two weeks later. It was replaced and the full treatment completed within three weeks. The following week the consumer felt 'the tooth was still not right' and visited the dentist again. He said he should have capped the tooth as he claimed to have advised her in the initial consultation and that the cost of the cap would be $1200. The consumer did not recall being given that advice and as she did not have the funds asked what other options were available. She was offered a replacement filling which she accepted but was not told until after it was done that it would cost a further $200. As she could not afford the fee she was presented with a document to complete which committed her to a payment plan until she had paid what was owed.

She complained to the advocate that she had not been fully informed at her first consultation and that because her care was subsidised and had been paid immediately following her initial treatment that the dentist had displayed an attitude of 'take it or leave it and be grateful for what you have received'. She was also upset that she had not been advised of the additional cost of having the replacement filling and felt she should not have been charged for it as it had disintegrated. She wanted her tooth fixed once and for all.

After considering the options the consumer requested the advocate assist her to write to the provider. The letter was sent and an acknowledgement letter received. Soon after, her tooth played up again and she decided to approach the provider one last time.

The dentist agreed to treat her and the consumer reported that they were able to resolve her concerns at this appointment. She was not charged for the appointment and her account for $200 was waived. The person who presented her with the forms to sign agreeing to a payment plan and the dentist both apologised.

The consumer was very happy with this outcome and felt no further action was required.

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Self advocacy for new dentures and new relationship

Dentures ~ self advocacy ~ broken relationship ~ Right 4, 5 + 6  

A consumer sought advocacy support as her relationship with the dentist making her new dentures had broken down and she did not know what to do. After considering the options, the consumer decided to meet the dentist with advocacy support.

The consumer began the meeting by saying she did not feel listened to and that the communication between the two regarding her new dentures was not working well. She said her dentures were unusable and that when she had raised this with him at their last appointment he had put the blame on her saying she had lost weight, which was not true. The consumer was also upset about being ignored when asking for a copy of his guarantee and the complaints process. 

The provider said he hadn't had a chance to put things right as she hadn't come to the last appointment. He felt she had no need to get advocacy involved - he is proud of his great work and has 20,000 customers who would vouch for this. 

The consumer said she had not felt fully informed throughout the process. She had not been informed of the requirement to make full payment prior to collecting the dentures and when she had attempted to address her concerns she felt she was being brushed aside.

The provider proposed that the consumer leave the dentures with him so he could adjust them to make them fit. He said he would contact the consumer in a couple of weeks for another fitting which she agreed to. The consumer made it clear that if the dentures didn't fit correctly after this process she would seek a second opinion.

The consumer felt she could handle the rest of the process on her own as she now had a clear sense of how to advocate for herself.

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Dental complaint

Dentist ~ Dentures ~ Ill-fitting ~Second opinion ~ Reimbursement

A woman complained that a denture she had been fitted for didn't fit properly. With the assistance of an advocate she met with the dentist to discuss her concerns. The dentist offered to reline the denture; which occurred. This still didn't fix the problem, and in discussing the matter again with the dentist he advised that they could redo the work - at no cost. However he wasn't confident it would fix the problem.

The advocate informed the consumer she had the right to a second opinion from another dentist. The consumer did this and proceeded to get another denture made by the second dentist. She later wrote to the original dentist requesting he eimburse her for the cost of the new dentures, and was fully reimbursed.