10 minutes reading time (1936 words)

Fear & Loathing in Dentistry

Fear & Loathing in Dentistry

Fear & Loathing in Dentistry

Fear & Loathing in Dentistry



As a kid, I was scared of riding on the pavement. I lived in the middle of Birmingham and there were always beat policeman around. One evening, I cycled back from Scouts. It was quiet and there were few people about. As I reached my home – on a busy main road – I experienced a sudden surge of bravado and chanced cycling across the pavement to my door, when a copper emerged out of nowhere from an off-licence. He gave me a five minute dressing down regarding how I was endangering human life and how I had disgraced my uniform, then he went over my bike to check my lights and brakes were in working order. From then on, I have had a healthy respect for the rule of law and rules in general. I say ‘healthy.’ It’s more that I’ve lived in fear of breaking the rules ever since.


Despite retirement from practice, I am still a dental nerd. I’m constantly on the lookout for dental stories.

During the week I came across a story in the Portsmouth News in which Dr Phil Gowers, chairman of the Hampshire and Isle of Wight Local Dental Committee said he is now supporting suicidal staff and warned of a rise in the number of dentists contemplating killing themselves as a result of increasing pressures caused by the pandemic. He cited trying to meet ‘patient targets, while dodging the threat of legal action against them by unhappy patients.’

I realised that not a lot has changed since I retired…I say not changed…fears in dentistry seem to have expanded tenfold. I did a quick survey on Twitter the other day and although I only had 123 responses, 85% said they felt more stressed working under COVID restrictions than pre-COVID. Fifteen percent said they felt ‘chilled’ currently.

Before I go on, I had better set out my stall. I LOATHE dental litigation solicitors with a passion. I believe that these solicitors alone have destroyed dental enthusiasm and have handcuffed many professionals to a reluctant career path where their main aim is to remain safe, rather than fulfil their full potential.

A few months ago on my Twitter feed, I speculated that the dental litigation solicitors would doubtless see the inevitable delays in treatments and examinations caused by the pandemic as an opportunity to chase more claims in the relentless pursuit for (in their case) incredibly filthy lucre.

Sure enough, I typed in “COVID and delays in dental treatment” into Google and there were no end of kindly dental litigation firms there ready to take up the good fight. One firm even said you might have a claim if referral to a hygienist was delayed.

I was browsing one well-known dental litigation firm’s website, when a helpful pop-up assistant asked how she could help. A human then came online and enquired how she could help further. I took her intrusion as an implication that her bot colleague was incompetent and not to be trusted. I lied I was about to lose a tooth as a result of treatment being delayed due to COVID and far from my query being dismissed out of hand, I was asked for my contact details. Although the firm didn’t say they would take my case on, they were certainly game for further discussions.


Fear & Loathing in Dentistry


As I remarked on my Twitter feed, these people are acting like vultures. Since whiplash claims were exposed for the shameful scam they were and compensation was rightfully capped, certain members of the lower tier of the legal profession in the UK have been very much focussed on bleeding the dental profession dry, and it seems like COVID is potentially going to feed their frenzy to previously unknown levels.

When I first qualified in the late 80’s, my main legal concern was the GDC. I never entertained for a second, the notion of being sued by a patient through civil litigation. But a few months into practice, late one winter’s Friday afternoon in the Cotswolds, I was treating a patient in his early 40’s.   I had just numbed him up for a filling and was doing a hand scaling (remember those?). I had wiped a bit of calculus off the sickle scaler tip with a piece of gauze and as I approached the mouth for another ineffectual go at scaling, I caught the very tip of the scaler on his shirt. I was more worried that I’d caught his skin, but the patient was deeply concerned about his shirt. I sat him up and he checked his shirt thoroughly. He genuinely asked for a magnifying glass. When it became clear that I hadn’t snagged his shirt in any way, the solicitor said: “Pity. I was hoping to sue you for a new shirt.”

From that point on, I realised that solicitors were people you needed to be a little bit wary of – but even then, I had never heard of a dentist in my little world, being sued. In the late eighties, I was under the impression that any ‘naughty’ dentists were dealt with by the GDC and not your average stripey shirted High Street solicitor. In those days, solicitors always seemed to wear stripey shirts and ostentatious trouser braces.

Despite my slight wariness of solicitors, it still didn’t put me off performing my first apicectomy on one, in practice. I remember reading an Atlas of Oral Surgery the night before the procedure. These days I’d have YouTubed it and clicked the thumbs up emoji if, and only if, it satisfied my insatiable dental bloodlust. The apicectomy went well fortunately and the solicitor never came back with any complaints. I still think it was more luck than judgement.


But then I heard on the grapevine that one of the many dentists I worked for in my early days, had buggered someone’s inferior dental nerve when taking an unimpacted lower eight out. He was sued for giving a patient a permanent numb lip. Apparently, the patient hadn’t recovered sensation after three years. I’d heard that the dentist had to shell out a substantial amount of money as his portion of compensation. His crime was to not read a radiograph with a magnifying glass. He hadn’t seen that the apex of the carious eight was just crossing the ID canal. My former colleague was reportedly also then sent to the GDC, but I lost track of the outcome.

So with that and the experience with my shirty solicitor, I did start to be very much aware of the fact that the legal profession was lurking in the background, although it wasn’t the full on assault dentists are having to parry these days. I mean, radio ads from dental litigators? I once heard an advert for one of these wretched law firms come on the radio when a colleague was treating a patient. You could see the glimmer of intrigue and greed in the patient’s eyes as she took in the content of the ad.


Fear & Loathing in Dentistry


In 1995, I had been in my own practice for a year when I had a letter from a patient asking me to explain why I had ‘scratched’ her upper front teeth. She had been to another dentist who advised her that the only way of aesthetically restoring all six of her stained anteriors was to place private veneers. The dentist had apparently blamed me for abrading the teeth to such an extent that they readily picking up stain. Not only that, he’d suggested she went to a solicitor to get compensation to pay for the veneers – and this was all outlined in the letter! I passed the letter to my indemnity organisation who of course, asked for my notes. Fortunately I had (unusually for me) written quite full notes about the woman’s last visit. She had complained about staining confined to the upper anteriors and my only solution was to give her a polish with our normal proprietary prophy paste and give her oral hygiene advice and told her to avoid chlorhexidine. A few days later, I got a solicitor’s letter and passed that on to the MDU. The adviser told me the dentist was trying it on and after a brief letter drafted by them which didn’t say outright what they thought the issue was, but heavily implied fibbing on behalf of the dentist, I never heard from the woman again.

From then on, I always had my eye over my shoulder and I started the long walk along the litigation tightrope that I continued all through my career, with fear and trepidation. I feel sorry for new dentists and dental professionals at the beginning of their careers. I read tales of despair from dentists still fresh to their careers, talking of giving up the profession they were desperate to succeed in, with a great deal of sadness. For in this hostile world where the threat of litigation and charges by the GDC are ever real, they must feel like they have been thrown in the deep end with a frenzy of great white sharks for playmates.

The dental tightrope seems to be getting longer on a daily basis. Never being a great fan of blasting people with radiation, I remember a time when I worried about doing too many x-rays, then, with practitioners being criticised for not taking radiographs, I worried about doing too few. And that little spot in the mouth that you thought was almost certainly harmless was referred immediately rather than treated with some sort of medicated mouthwash and then reviewed. And as for minor oral surgery – no wonder oral surgery departments get shirty when they get referrals. I used to plunge in immediately with a surgical if I’d left roots behind and did so until retirement. But these days I don’t blame young dentists in the least if they prefer to refer rather than face the potential of a law suit or referral to the GDC if it goes a teensy weensy bit awry. A young colleague of mine went through a few months of worry not so long ago, when a woman tried to sue for a dry socket. A DRY SOCKET! And the solicitor was serious. Perhaps unwisely, I dealt with that one on my colleague’s behalf and the patient went away.

What the answer is, I don’t know. But the whole dental and medical litigation pile-on is getting out of hand. I know a solicitor who had been to a meeting of his local coven a few years ago and the speaker there said that dental litigation was a ‘goldmine’ and that was the thing to get into, and I can hear the braying mob of lawyers from here. The government placed a cap on compensation that could be claimed for whiplash claims. Maybe it’s time for the same to be placed on dental claims?

Did I mention? I loathe dental litigation solicitors.

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