Years of Malpractice – How Is It Possible?

dental-revelations-blog
Where there is smoke, there is fire. Dentists negligent behaviour should be act upon.

Ever wondered how it is possible that the dentists who are not practicing dentistry up to the standards get caught only after years of practicing the profession? Well you have come to the right place to find out.

Is It the Patients’ Fault?

Nope. Absolutely not.

The patients cannot tell the difference between a good and bad dentist when it comes to the skills of a dentist. Or if the procedures have been done as they should and if they are necessary in the first place. Or if the instruments entering their mouth have been properly cleaned (take a look at my previous post about this).

An average patient can only judge the dentist by the looks of him and the practice, and by the dentist’s chairside manners. The rest is build on a trust of receiving good and adequate care. But every once in a while this trust is broken and the dentist ends up in the headlines.

But please remember that not all the dentists ending up to the headlines are rogue dentists as I have written previously.

Collegiality Gone Bad

Collegiality between the dentists means respect to one another’s abilities to work towards the same purpose. Helping patients. But collegiality has an ugly side as well. It is an unwritten code between the dentists which means one should not interfere or especially under any circumstances critizise a fellow dentist’s work. It is a code one should not break. The hygienists are expected to play by the same rules.

Now, this creates a problem. When a dentist is underperforming, the colleagues hear this from the hygienists and nurses. They see see it from the teeth of the patients who come too see them instead of their regular dentist (e.g. for emergency visit or whilst the regular dentist is on a holiday). They know there is a problem but very rarely they raise questions.

Instead the patient is kept under an illusion that the regular dentist has made the right decisions by distorting the truth.

Distorted truth:

“This decay is in such a difficult area to notice.”

The truth:

“This massive decay is so big that even my half-blind grandmother would find it.”

Distorted truth:

“Your dentist has marked it as an early decay, something to be kept an eye on… it has now grown bigger and needs a filling.”

The truth:

“Your dentist needs to have his eyes checked. This decay should have been filled ages ago. If you are lucky enough, you avoid the root canal treatment.”

Conclusion

It should be every dentist’s duty to report problems in colleague’s way of practicing dentistry. The Code of Ethics by ADA state the following:

Dentists should be aware that jurisdictional laws vary in their definitions of abuse and neglect, in their reporting requirements and the extent to which immunity is granted to good faith reporters. The variances may raise potential legal and other risks that should be considered, while keeping in mind the duty to put the welfare of the patient first. Therefore a dentist’s ethical obligation to identify and report suspected cases of abuse and neglect can vary from one jurisdiction to another

In my opinion, you don’t pull out the biggest guns if you suspect negligent behaviour from your colleague. The dentist in question should be given adequate time to correct the problem e.g. by revising.

The privilege of dentists to be accorded professional status rests primarily in the knowledge, skill and experience with which they serve their patients and society. All dentists, therefore, have the obligation of keeping their knowledge and skill current.

If nothing changes, more severe means should take place. This includes giving warnings and as a last resort filing a complaint to the relevant authorities.

Naturally, if the negligence is severe, one should not hesitate to contact authorities urgently.

The bible of dentistry aka ADA’s Code of Ethics 2016 in full.

If you fancy further reading on the subject, here’s a true story by yours truly. 

Advertisements

Part I: Is It a Skyskraper? No, It’s Your Ego.

Dentalrevelations

On my second post I promised to write about personalities of the staff in dental practices and how they may affect the dental practice and the treatment given to the patient. I’m going to fulfil this promise today. And on my next post. And the next.

I am going to write a series of posts about this topic. Each post will have a viewpoint of one dental professional. Today it will be the hygienist’s.

I’m Not Going to Play with You

As long as there have been dental hygienists there have been dentists who are afraid of losing their living because of them. These dentists either refer only the simple scale and polish to the hygienist or do not refer at all.

They treat the patients with advanced gum disease themselves as it requires more visits. More visits equals more money per patient. And the money is the only motive they have for this silly way of practicing the dentistry.

The problem with these kinds of dentists is that most often the hygienist would have better skills to treat the advanced gum disease than the dentist and this is revealed when the patient sees the hygienist six months later. Often there is subgingival (invisible) calculus still left even though it should have been removed on the first course of treatment. Plus the patient has no clue how to clean her teeth effectively.

Big Ego

It is a fact that the oral and maxillofacial surgeons have a big ego. Or to precise – they have a huge ego. But in my opinion they have all the right to have one. They NEED one to be able to perform all the talent requiring hocus pocus on patients mouth, jaw and face. Plus they don’t use their ego against co-workers or the patients.

But when a dentist has a big ego it rarely is attractive or talent enhancing. I will give you an example from a real life.

A dentist does a check-up for a patient. Then the patient sees a hygienist for a scale and polish. Whilst scaling with curettes the hygienist notices there are potential cavities in three different sites and she checks the patient’s x-rays. The x-rays confirm the suspicion.

The hygienist checks the dentist’s notes for the check-up visit to see if there is a treatment plan to fix these cavities. There isn’t. It appears as if the dentist has missed the cavities when doing the check-up.

The hygienist sends the patient back to see the dentist. When the dentist sees the hygienist’s message about the cavities he acts as if the patient has come in unnecessarily.

“I’m sure there’s nothing there”

he says to the patient. He quickly checks the sites with a mirror, sighs and continues by saying

“One of these suspected cavities is a borderline cavity. We could do a filling for that so that you didn’t come this far for nothing. The other two we can still monitor.”

The hygienist sees a patient for another scale and polish couple of weeks later. She checks the dentist’s notes and realises that only one cavity has been filled. She asks the patient if the dentist has asked her to come back to have the other two to be done. Negative.

The hygienist is baffled. She checks again with her curette the other two suspected cavities. The instrument goes between the filling and a tooth and sinks deep into a soft area – it is a cavity for sure.

The hygienist decides to ask another dentist to come and have a look there and then. The dentist confirms the two remaining cavities and recommends the patient to have them filled.

At this point the patient is very confused. Who is not doing their job properly? Who to believe?

This was just one example. There are plenty more but I won’t write them down as I am not writing a novel. But my point is that when a lower ranking dental professional finds something the almighty dentist didn’t the ego goes before the patient’s best interest.

Not good. Not good dentistry at all and everyone who recognise themselves from this should be ashamed.

But why the dentist did not notice the cavities even from the x-rays? That is completely another story.

Hygienist’s Difficult Role

It is tough to be a hygienist. They often have skills to make the same diagnosis as the dentists but only the dentists have a right to make one. The hygienist must always remember to add a question mark after their findings or the hell will break loose and she is quickly put back to her place by the dentist who kindly reminds her that she has no right to make a diagnosis.

And when she finds something that the dentist missed she will be between rock and a hard place. Especially if the dentist does not agree with her because of the big ego problem. The confused patient often thinks the dentist was right which makes the situation even more difficult.

But the time is on hygienist’s side. She has recorded every finding on the patient’s dental records – with the question marks! She has recorded that she has consulted a dentist. Sooner or later the cavity (or whatever her finding was) will get worse. There will be pain. Or the crown will come off as the cavity has eaten the tooth under it and perhaps so much so that it is beyond repair.

The dentist can only hope the patient do not file a complaint.

Lonely Rider in a Cupboard under the Stairs

Another side of being hygienist is the fact that they are often quite alone in the practice. It is often so that the practice has only one hygienist. This means they don’t have peer support in the practice. Peer support is something that every dental professional would need.

Also the hygienist is given the oldest dental unit in the practice and the smallest room, the one without a window. Or perhaps the room under the stairs. Not sure if the Harry Potter fate has happened for real – perhaps it was just sarcasm from a hygienist that I once knew?

Conclusion

Why do the dentists feel so threatened by hygienists? Why is it hard to be wrong or admit that you have missed something? Why do they need to feel and let others know that dentists are at the top of the command chain?

I’m afraid I do not have the answers. One dentist once said to me that the dentists are non-qualifiers for medical school which means that the dentistry was not their first choice of profession. Are these kinds of dentists letting everyone else suffer for their disappointment?

I will remind you that not all the dentist are like this of course. But in my current workplace two out of four dentists are. That’s 50%. That’s a lot!

I hope practice owners will start to value their hygienist more than before. And get them the brand new dental unit, a saddle chair (or whatever chair the hygienist prefers) and curettes the hygienist wants so that there would be even a small chance to work in an ergonomic position during the treatment. After all they bring in steady flow of cash with very little expenses.

And dear dentists, we are all equal human beings no matter what our profession is.

Morals in Dentistry

blog

It’s time to get serious again. In this post I will get to the bottom problem of the dental industry. The lack of morals and the urge to maximise profit at the cost of the individuals is like a plaque that sticks around before the cure is found. For about half of the dentists I have met fall into that category and that’s a lot considering that we – the health care workers – should be the ones having the highest integrity of all.

What I will do next is give examples of the lack of morals amongst dental professionals. It will be just a (thin) slice of a (big) cake but you will get the idea no doubt. For clarification, all the examples are from real life and witnessed by yours truly.

NHS Dentists

For those who are not familiar with the NHS, it is the UK’s National Health Service. The NHS dentists work under a contract and receive payments for the treatments done.

Before the year 2006 (when the contract was replaced with a new one) the misuse of the system was widespread. The dentists were laughing at the system that was like a gold mine to them. They could easily make an outstanding pay by doing certain treatments that would not raise questions. It did anything but raise questions. The treatments made them look like they were concentrating on preventive care and looking out the patient’s best interest.

A revelation:

The truth is that they did not care about patients. Patient was merely a tool for money making. An example: The dentists made fissure sealants for every patient who did not have them and they made them from first premolar to the last molar. There was no evaluation if the fissure sealant was needed and it was an easy treatment to justify to the patient as it was preventive treatment.

“It prevents you getting a decay…”

Who would say no to that?

Fissure sealant was very quick treatment to do as it could be done in batches (all the premolars and molars from the left side in one go and next the right side) guaranteeing a very productive day moneywise for the dentist. There are probably millions of people in the UK whose teeth are coated with fissure sealants.

Eventough the NHS contract was renewed in 2006, the dentists found new ways of misusing the system.

Root Canal Treatment on Wisdom Tooth… What The?

The most immoral dentists have found a way to make the most out of every tooth – moneywise. Normally the decision to remove a fully erupted wisdom tooth is made lightly if there are any problems like decaying, periodontal problem, malocclusion with the tooth. But more than once I have seen wisdom teeth that have been heavily filled, root canal treated and even have had crowns on them (on top of the root canal treatment).

There is no other explanation to this than a dentist who is practicing dentistry only to gain wealth.

Performing Treatments Without Having the Skills

Some dentists suggest treatments they have no skills to perform and charge the patient as if they were specialists. An example: A dentist recommends periodontal treatment to the patient. The course of treatment consists four 30 minute visits to remove calculus one quadrant per visit and the cost is the same as if a periodontist would perform the treatment. Once the course of treatment is done by this wannabe specialist, the patient goes to see a hygienist for oral hygiene instructions. The hygienist soon realises that there is still lots of subgingival calculus left and therefore the gum disease is still active.

The hygienist does her best to remove the calculus (which she has skills for) and the patient is left under an illusion that nothing is wrong.

It is called collegiality what just happened. Dental professionals covering for each other’s mistakes and malpractice.

Root Canal File in the Root Canal

In our business the equipment can malfunction and instruments can break in use. In these cases it is good practice to tell the patient what happened. For example a curette’s tip can break inside the pocket of the tooth. It can be found from there but the patient needs to know what happened. Some dentist cover these kinds of incidents or mistakes they have made by simply not informing the patient. Now THAT if anything is malpractice.

An example. A root canal file broke inside the patient’s tooth whilst the dentist was performing a root canal treatment. The nurse did not notice the incident until a control x-ray was taken and the file was clearly visible. The dentist did not inform the patient about the broken file or attempt to remove the file.

Conclusion

The dental industry draws in immoral individuals because it has been allowed to happen. It wasn’t until the 21st century when the dental schools started to interview the applicants for the undergraduate programmes of dentistry. Before this the suitability of the applicant’s personality was not measured by any tests. This means there are dentists in the field that should not be dentists.

In my opinion all the dentists who have not gone through the MMI should be asked to have one. If they fail, they should be struck off their profession.

But no test is a fool proof way of finding the bad seeds. The most rotten souls can often talk their way through any obstacles. And the reason why these individuals are drawn to the dentist’s profession is the well known fact that they make rather nice pay (here’s one article about it).

 

 

 

Where it all started

Dental Revelations Blog-2382
Do you know your dentist behind the mask?

There was whispering behind the reception desk when I arrived to work.
“Morning!” I said cheerfully and carried on downstairs to get changed to my uniform.

I was a dental student working as a trainee and was very happy that I was earning little extra on top of my student allowance. There wasn’t many dental practices who took in trainees on those days to work as nurses until they graduated.

I put the uniform on and went upstairs to the reception before setting up my surgery. There were two nurses and a receptionist still whispering as the reception was filling up with that morning’s first patients. I was a newbie but understood that something was going on. Something that made the nurses very annoyed. I heard a word Harry.

One word and I knew what was going on. Eventhough I had been working as a trainee only for a month, I knew almost all the secrets the practice had. Harry was a dentist and a partner of the practice which meant he had lots of freedom to decide how things were run. He was the one who paid our wages. Or to be precise, he made the money that paid our wages but it was the other partner of the practice, Sally who run the payroll. She had no dental education and dealt with all the finances of the practice.

Harry and Sally had been lovers on and off many years and had had this dental practice in the heart of the city for a long time. It was a very popular practice amongst celebrities who had extensive cosmetic treatment done by Harry. Veneers, crowns, implants… yes, implants as well eventhough he wasn’t an oral surgeon. He was a regular dentist who never attended any annual dental show case to revise. Worrying combination.

Now back to that one morning when Harry had once again done something to stir up feelings at the practice.

Harry had arrived to work drunk. Wasted. Pissed. Drunk as a skunk. And it wasn’t the first time. One would think that a dentist cannot work when drunk as they use various instruments that can cause serious damage to the patient, nurse and the dentist himself if used incorrectly. The drill for example, that is used for drilling through the enamel of your tooth – the high-pitched one – rotates up to 400 000 rpm. Imagine it in the hands of a drunkard. Scary as hell in my opinion.

Did Sally or Harry’s colleagues stop him from treating patients? No they didn’t. Neither did I but my excuse is that I was a newbie and didn’t have any say on anything really.

On this particular morning Harry was guided by his trusted nurse Tina from downstairs office which he shared with Sally to upstairs where the surgeries were. Half way up the stairs Tina realised that on her own she’s not able to prevent him from falling so she called help and another nurse came to her aid. Together they managed to steer Harry safely upstairs.

“Not that way!” I heard Tina whisper to Harry who was entering a wrong surgery. Tina pushed Harry from his shoulder to the direction of his surgery where the first patient was already in the dental chair with safety classes and a bib on. Tina sat Harry down to his chair and put a face mask on.

This is as much as I could see what was happening. The patient was treated and she left without complaints. So did the next one. No-one ever complained that the dentist was drunk. Didn’t they notice? They must have as the smell was obvious.

Why didn’t Tina say anything? She had worked with Harry for ages and had seen everything that is going on. How did she put up with this kind of behaviour and malpractice? I got an answer to this question couple of years later (already after I had left the practice) when I found out that Tina was Harry’s mistress. Love is blind, it sure is in many ways.

One day Tina was off sick and I was told to replace her as Harry’s nurse. I soon realised that the nurse was expected to do much more than what nurses normally do. And that was probably how Harry could carry on as he did. When Harry wasn’t able to do the treatment, Tina did it. Thankfully Harry realised that I wouldn’t be able to replace Tina fully. I wouldn’t use turbine (the high speed drill). So he was only hungover on the day when I was working with him. Phew!

What I saw that day, I never forget.

Patient one.

A 70 year-old man who had had two implants done to replace lower front teeth. The plan was to have an implant supported bridge done once the implants were fully integrated to the bone. He came in to complain odd feeling and appearance of the area where the implants were done.

The patient had a very low alveolar bone and the mucogingival junction was almost on top of the alveolar bone. The alveolar mucosa had probably pulled the area where the surgery was performed and opened up the incision. As a result the alveolar bone was exposed.

“Should it be like this?” the patient asked.
“Well it shouldn’t!” I thought.
Harry examined the area quickly and slurred something vague. Then he sent the patient home until the next scheduled appointment. My eyes were as wide as saucers but of course Harry didn’t see them as he was out of the surgery already before the patient was.

Patient two.

A 50 something year old lady who had started a restorative treatment for her lower teeth. The plan was to restore the bite by two rather long bridge. The bridges were going to be cemented today.

Harry fitted the bridges. He had difficulties in getting them in place and he had to use a drill to file away some of the metal of the bridge. Eventually the bridges went in and the patient was asked to bite the teeth together only to notice she wasn’t able to. Only the very back teeth were in contact leaving the mouth quite open. Harry took the high speed drill and started to file away the ceramic.

He drilled off a large area of ceramic and part of the metal structure underneath. I wanted to close my eyes as he was destroying the beautifully shaped cusps of the bridge but then the mouth of the patient would have flooded. So I carried on watching this mad man’s way of cutting corners.

Once Harry was done, he cemented the bridges into their places.

“The bite does not feel right…” the patient said.
“It will feel odd at first. It needs some getting used to.” Harry replied and left the surgery.

The patient left the practice with horrid looking bridges and bite that was not anywhere close being balanced.

I was in shock after that day. I knew this wasn’t going to be my future work place. Not a chance. And it wasn’t.

 

If you are interested to read more on the subject in another blog, visit here.