oct ewj 24 online - Flipbook - Page 46
The BPE code indicates the treatment required as
noted in the table below.
feels it will affect her ability to sing and use the saxophone.
British Society of Periodontology guidelines
Upon the advice of her dentist, she has stopped smoking, improved her oral hygiene, and now flosses and
uses inter-dental brushes 2 x daily. Her pocket measurements have reduced significantly, and she now attends every 3 months to see the hygienist. However, it
is too late for a number of her teeth, and she wants to
know whether she has a case for negligence.
Code 0 indicates no treatment is required
Code 1 indicates oral hygiene instruction is required
Code 2 indicates treatment as code 1 plus removal of
all plaque and calculus deposits above the
gum.
The dental records
The records of the practice are very brief with
historical records being typical of the below note:
Exam, c/o bleeding gums
Poor OH, OHI given BPE
121
222
Bitewings: NAD
Diagnosis: Gingivitis Risks, benefits discussed consent
given.
S/P done TCA 6 months
Code 3 indicates pocket chart measurements and
radiographs in the affected sextant,
treatment as code 2 plus root surface d
ebridement (RSD). Pocket charts are
indicated before and after treatment
Code 4 indicates full mouth pocket charts,
radiographs in the affected sextant,
treatment as code 3. Referral to a specialist
may be indicated. Pocket charts are indicated
before and after treatment
Code * This also includes one of the above numbers
as a score. The * indicates involvement of the
furcation of the tooth (where the roots
divide), and indicates treatment according
to codes 0-4. Referral to a specialist may
be indicated.
Pocket charts are indicated before and after
treatment
• Failures to perform the treatment indicated for each
score is a breach of duty.
Above, Radiographs over the years show a progression of bone loss
Brief breaches of duty
Pre treatment assessment and consent
- There was a failure to appropriate screen for
periodontal disease in accordance with BSP (British
Society of Periodontology) guidelines. The records
show scores of 1s and 2s throughout the period of
care, and considering the bone loss noted, there is
clear inaccuracy in the BPE scores.
• It is the dentist’s responsibility to establish a
diagnosis in accordance with the 2017 classification.
The above BPE scores and where relevant pocket
measurements, bleeding on probing and radiographs
are required to establish this diagnosis. Failure to
appropriately diagnose the patient is a breach of duty.
Patient factors
The patient also has a responsibility to ensure they follow advice given, such as recall intervals of attendance,
following oral hygiene advice, smoking cessation, and
management of their general health.
- Considering the assertion of inaccurate BPE scores,
there are failures to perform pocket measurements,
and appropriate radiographs were not taken as not all
bone levels are visible on the radiographs taken.
- There was a failure to record bleeding on probing
after 2018 in accordance with BSP guidelines.
Sample periodontal disease case
The claimant’s summary
42 year old Mrs. A has attended the same practice for
20 years. More recently, she complained of bad breath,
bleeding gums and was starting to note her teeth were
drifting. She was a smoker, smoking 20 a day since the
age of 15, had poorly controlled diabetes, and reports
she was told by her dentist that she had gingivitis and
she was told she should brush better and floss, but was
shocked when she attended a new dentist that she had
severe bone loss and would likely lose her teeth within
the next 5 years which upsets her greatly as she saw
her mother lose her teeth at a young age and struggle
all her life with dentures.
- There was a failure to note bone loss on the radiographs in line with record keeping guidelines (General Dental Council and FGDP guidelines). There was
also a failure to discuss the radiographic findings with
the patient.
- Considering the bone loss, the diagnosis of gingivitis
was noted to be inappropriate as this does not consider the bone loss, and therefore presence of periodontal disease. There was therefore a failure to
diagnose periodontal disease.
- From 2018 onwards there was a failure to diagnose
the periodontal disease in accordance with the 2017
BSP guidelines.
She enjoys singing in her local choir and plays the
saxophone, and does not want to wear dentures as she
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