Case study: Treatment abroad

BACKGROUND Mr T has been on extended holiday in Europe and attends his local dental surgery back in England. A few months ago he had dental treatment at a surgery near his holiday flat. This involved having an upper molar extracted and placement of a three-unit bridge fixed to the adjacent teeth.

One of the abutment teeth was already root filled with a post. The other tooth required root canal treatment but the dentist was unable to complete the procedure and recommended specialist endodontic treatment back in the UK. The bridge was temporarily cemented but has now come off.

Mr T is asking his UK dentist – Dr U – to re-cement the bridge permanently without further endodontic treatment, and she is very concerned by this request.

Dr U contacts MDDUS for advice on the matter. She is reluctant to become involved in the remedial treatment as she worries this will mean taking on responsibility for an already complicated matter. On the other hand she does not wish to refuse a patient needing dental care, even of a temporary nature.

ANALYSIS/OUTCOME

An MDDUS dental adviser responds to Dr U via email. He advises that there is obvious risk with a three-unit bridge with one retainer being root filled and the other requiring endodontic treatment. The fact it has already been decemented suggests potential problems, including preparation of the abutment teeth and occlusal issues.

The bridgework does need to be reinstated on a temporary basis to protect the abutment teeth, and best practice would certainly suggest that the patient requires definitive endodontic treatment prior to any consideration of permanent bridge cementation.

Dr U is advised to ensure that the patient retains ownership of these problems and that before any treatment is offered, Mr T is adequately and thoroughly consented with a clear explanation of the options and risks. She is further advised to confirm these points to Mr T in writing and to keep detailed clinical notes of discussions.

In the end, Dr U informs Mr T that she is not prepared to fix the bridge with permanent cement. She explains that this could increase the possibility of abscess development, as well as necessitate future removal of the bridge to allow completion of endodontic treatment, potentially causing it to be rendered not fit for purpose with a new bridge being required.

Mr T agrees to the treatment plan and a referral is made for specialist endodontic treatment.

KEY POINTS

• No dentist is obliged to carry out treatment that they judge is not in the patient’s best interests.
• Ensure patients fully understand treatment options and all relevant risks.
• Refer the patient should necessary remedial treatment be beyond your competence/experience.