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I want to be slightly non-specific about this story for obvious reasons of confidentiality.

Recently one of the dentists in the practice asked me to come down the stairs while I was in the middle of a meeting in my office.

They were asking me to jointly see a patient with them who had attended for an implant consultation. The patient was in their 30’s.

So for the purposes of this blog it doesn’t matter whether the patient was male or female, nor where they came from.

The patient was nice, we got on well but before I entered into the surgery the dentist who had asked me to see them had described it as a “car crash”.

Some years ago, while the patient was in their early 20’s, they had been treated by a clinician who would be regarded or could be regarded as being an expert in their field.

While it is obvious that we all have cases which go wrong and present later as problematic issues this, blog is about how we look after patients who find themselves in these circumstances and how we consider the possibility of these circumstances arising before we treat the patients at all.

This is the principle of advocacy and the person who advocates for individual patient rights and their care.

To briefly describe this case is to say that the patient underwent a full arch reconstruction of the lower jaw, the reasons for this seem to be quite valid but the execution of the treatment was, at best, poor and at worst, well, something worse than that.

The upper arch was untreated but subsequently has been treated by another dentist who has provided a fixed full upper bridge on four teeth!

So the patient finds themselves in their 30’s having been systematically let down by the system and in the likelihood of being turned into some sort of “dental cripple” for the next 50 or 60 years.

It’s the interaction or the reported interaction with the first clinician which is the one that interested me the most (I know what the second clinician is like and they’re no longer working within the profession).

The first clinician, the one who could be held up to be an expert, has not only provided treatment in which on immediate reflection would be far from perfect, but has failed to secure or assist the patient in securing long term and ongoing maintenance treatment and care for the restoration that was provided.

This has now led to a situation where I could lift the full arch bridge out of the lower patients mouth, implants and all, leaving nothing behind to put anything else in.

Without some sort of Harry Potter magic, this patient is likely to be confined to complete dentures in the lower arch.

It might be possible to interact with maxillo- facial surgery to provide a person in their 30’s with some extraordinary distraction bone grafting treatments of high risk or any other bone augmentation, which may or may not work and this may be the route that is taken

but it is the starting point and the lack of insight to the things that are important which have let this patient down the most.

I am yet to see whether the initial clinician will receive the patient back for re-treatment or assistance (the patient maintains they have been “discharged” and are not allowed to go back).

The sad thing is, that this seems to be happening again, again and again.

Above all else we are the advocates for these people.

Regardless about what consent laws say, and regardless of what the General Dental Council say or do, at the base of it all as a foundation of everything that we do, you must first see yourself as a responsible advocate.

Blog Post Number - 2178