TS v SG and others 2018 (Out Of Court Settlement)

£52,000 Compensation

The claimants claim surrounded issues with her deciduous teeth which she recently discovered required surgical intervention.

In a nutshell, the claimant was told that her orthodontic issues should have been dealt with when she was much younger at the age of 10/11 years.  The Claimant had just turned 21 when she was made aware of her problems.

The claimant was told that had the Defendant dentists at her practice treated her properly then the complications that arose would have been avoided.

The Claimant attended a dental practice in South Shropshire and was seen by at least two different dentists at the practice.  The clinical notes state that the claimant attended at the age of 14 and 15 where it was noted “made need ortho”.  A watch was placed on all four second deciduous molars (E’s).  The claimant was referred to a Consultant Orthodontist at the local hospital at the age of 20 years.  She presented with a Class ii division ii incisor relationship with a class I skeletal patter with a decreased FMPA complicated by infra occluded upper and lower second deciduous molar teeth and impacted UL5, LR5 and LL5.

The claimant complained of pain from her impacted teeth and an OPG confirmed that the second deciduous molar teeth were ankylosed preventing the eruption of UL5, LR5 and LL5.  The position of LR5 was unfavourable and noted as distally angulated.  The Claimant was informed by the consultant orthodontist that due to her age it was unlikely that the second premolar teeth would erupt if her baby teeth were extracted.

The following treatment options were given to the Claimant:

  1. Accept and no treatment (with risks of root resorption due to the impacted teeth)
  1. Extraction of ULE, LRE and LLE to allow for eruption of the impacted premolar teeth (it was explained to the claimant that this was unlikely as these second premolar teeth were fully developed and unlikely to erupt).
  1. XLA of URE, ULE, UL5, LR5, LRE LLE and LL5 and the spaces restored with prosthesis. It was explained that extraction would lead to large amounts of bone loss particularly in the LR5 area.
  1. Orthodontic treatment

After taking specific instructions from the Claimant as regards her intentions for corrective treatment, she was not willing to undergo prolonged corrective orthodontic treatment and decided that she would endure multiple extractions of seven of her teeth with prosthesis, namely dental implant retained crowns.

A letter of claim was duly drafted and sent to the dentist in question who in turn instructed their defence organisations to assist them with the claim.

Some of the allegations of negligence put forward were as follows:

  1. Failed to record any BPE score at any time;
  2. Failed to record any index of Orthodontic Treatment Need to assess the need and eligibility of the claimant for NHS orthodontic treatment at any time;
  3. Failed to provide the claimant with any written treatment plans or associated costings;
  4. Failed to take any radiographs at any time to assess the claimants orthodontic dentition;
  5. Failed to note anything about the presence or absence of the permanent second molars at the age of 14;
  6. Failed to note anything about the presence or absence of the permanent second molars at the age of 15;
  7. Failed to note anything about the presence of the E’s at age 15;
  8. Failed to inform the claimant of any orthodontic abnormality when she was aged 14 or 15;
  9. Failed to provide any interceptive orthodontic treatment to aid the development of the claimants dentition;
  10. Failed to take any radiographs to assist in any diagnosis or investigation;
  11. Failed to extract URE at age 14 allowing spontaneous space closure in the URQ;
  12. Failed to make any timely referral to an orthodontic specialist practitioner for further assessment or treatment;
  13. Failed to provide an orthodontic treatment under the NHS whilst the claimant was under the age of 18 now leaving the claimant having to pay privately for future treatment.

Damages were put forward in the letter of claim for pain and suffering for the delayed extraction and/or loss of URE, ULE, UL5, LR5, LRE, LLE and LL5.  Damage to the jawbone was also claimed for.

Special damages included extraction costs, implants costs and implant crown replacement costs.

In relation to causation of injury, it was argued in the letter of claim that had the defendant dentist made a proper assessment of the claimants orthodontic condition to include radiographic assessment, the on the balance of probabilities treatment would have been introduced earlier and the problems that she faced would have been avoided.

The Claimant was subsequently referred for medical evaluation to an independent Consultant Orthodontist, to prepare a report on condition and prognosis. In his report the expert stated that based on his clinical examination & review of the records the Claimant was currently in a situation where she had been left with retained deciduous teeth in all 4 quadrants (URQ ULQ LLQ LRQ). The deciduous teeth had started to submerge and there was a very large vertical occlusal space between the upper and lower deciduous molars due to the submergence of these teeth. The claimants expert noted that there was a failure to achieve a satisfactory occlusion on those teeth.

The claimant expert also stated that there were retained and un-erupted permanent second premolars in the ULQ LLQ LRQ quadrants and those teeth, due to the retention of the deciduous teeth have become displaced especially the LR5 and LL5.

The expert opined that the Claimant would require orthodontic treatment to the UR6, UR4, UL4, UL6, LL6, LL4, LR4 and LR6. He stated that the orthodontic treatment would be used to push the teeth apart and create space for a prosthesis in the UR5 region and that the orthodontic treatment will also allow space creation for the un-erupted teeth LL5.

The expert evidence also stated that the LR5 would require uncovering surgically and placement of a gold chain to allow attachment. It was however, possible that those teeth may not move as they could be ankylosed and the risk of ankyloses was difficult to predict although he would estimate this to be less than 50%.

Proceedings were duly issued in the County Court Money Claims Centre on 16 April 2018 in order to protect the Claimant’s position as to limitation. Counsel was duly instructed to settle the Particulars of Claim and the Claimant’s extensive Schedule of Loss.

In order to finalise the Schedule of Loss further evidence was required from an Orthodontist to prepare a report on surgical treatment and treatment costs. Accordingly, an independent expert in orthodontics based in Birmingham was instructed to prepare a report on the same. In his report the expert orthodontist provided a report providing full details of what treatment was required and the costs of the same. The report was duly sent to Counsel to finalise the Schedule of Loss.

Upon receipt of the Particulars of Claim and Schedule of Loss proceedings were duly served upon the defence organisations acting for the Defendants.

After service of the Court documents, Dental Protection Limited put forward an offer on behalf of the defendants in the sum of £45,000, which the Claimant rejected and put forward a counter offer in the sum of £52,000. Dental Protection Limited accepted the offer and a Consent Order was duly filed at court and sealed.

Payment of dental compensation in the sum of £52,000 was quickly made which brought the matter to a successful conclusion.

Alex Bodza is a specialist dental negligence solicitor based in Shropshire.

alexbodza@dentalclaim.co.uk

01694 722 134

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