Adverse Outcome Report

As a successful practice it is very important to learn from our patients when thing haven’t gone exactly as expected.
As a conscientious and transparent practice we try and publish positives, negatives, possible side effects and alternative dental treatments, so patients can decide before they come in if a treatment is correct for them.  We believe we are one of the only dental practices in the world to do this.

implants, crowns and onlays, veneers, root canal treatments, invisalign, please see other treatment pages for relevant further information.

Here we publish some cases where dissatisfaction was expressed either verbally or implied (unhappy expression).

1.  Dentists running late.  Frequency : occasional. 
This is an unfortunate consequence of when dental pathology (i.e. fractures, decay or gum disease) or dental treatment is more complex than initially thought.  Unfortunately, the dentists must deal with this at the same time and hence can run late.  This means the next patient runs late, but often also means the dental team get a reduced lunch break or none at all or finish very late, thus it is a lose – lose situation and we can assure you we do not like it either, but unlike mechanics we cannot just stop the job in hand and start again tomorrow!  Where possible we try to inform patients before-hand if we are running late.

2.  Tooth sensitivity during ultra sonic scaling. Frequency: occasional.
Ultrasonic scaling while great at removing calculus (tartar) and stains.  Can also be sensitive in certain patients.  The reason for this is two-fold.  Firstly, because the ultrasonic scaler emits cold water, patients may be sensitive to cold, and having cold water sprayed at the teeth may initiate the sensitivity feeling.  Secondly, if the teeth are particularly dirty, and there is alot of tartar, which has been there for some time, after its’ removal the teeth can effectively “breath” again and feel cold and hot foods and drinks which they were previously shielded from by the tartar.

3.  Tooth sensitivity after a filling or crown/onlay/veneer preparation. Frequency: Occasional/rare
It is thought after a drilling dentine tubules are opened up, which transmits sensation to the nerve of the tooth.  This can occasionally lead to tooth sensitivity.  We try to minismise this by using the best bonding agents such as, optibond Fl, please note this costs 400% more than normal bonding agents (but we do not charge 400% more for our restorations or crowns!).

4.  Crown, onlay, veneer de-bond.  Frequency: Rare/occasional
While adhesive dentistry has revolutionised tooth preparations, meaning we not have to drill as much tooth away to form restorations such as crowns, veneers, onlays and restorations.  This results in more tooth structure being saved, which means the tooth lasts for longer and we reduce the need for root canal treatments.  However, It also means that the crown, onlay or veneer may de-bond (i.e. come off)  If this happens we merely bond it back on.

5.  Crown, onlay, veneer, restoration fracture.  Frequency: rare
Crowns, onlays veneers can fracture rarely.  Unfortunately, it is impossible to replicate how the patient bites and grindes in day to day life especially when sleeping.  The fracture may result from a number of reasons, patient eating hard foods, some sort of parafunction (tooth grinding), inadequate thickness of crown, micro weakness in porcelain.  Thus the restoration may fracture.  If in the guarantee period, we merely make another one free of charge!

6.   Cost of treatment.  Frequency: Rare
We try to be very open about our prices and have starting prices on our prices page.  However, we rarely have had comments if the prices are slightly higher than advertised.  We do have a clear disclaimer on the prices page:
Note: This list is meant to be a guide to our charges and is not exhaustive. Some of the charges are starting prices only and the quoted fee can increase for complicated or more complex treatment cases. Highly aesthetic treatments can carry higher fees, which may include laboratory visits for shade/colour matching. Treatment prices quoted can vary between individuals. Fees will generally be higher for our Specialists/consultants and more experienced dentists. A personalised treatment plan and estimate will be provided for you before beginning any treatment and will be based on your individual treatment needs, difficulty and time needed.

What this means in reality is, say a dentist is doing a medium restoration on the upper left first pre molar tooth compared to a lower 2nd molar tooth (at the back).  The later, will be much more complex and take much more time, as access, isolation and actual treatment is more difficult, as we may require a glass ionomer base to protect the nerve or a core to reinforce the tooth structure.  Also, as the patient needs to open wider, for the dentist to gain access to the tooth, the patient will also need more rests to allow the muscles to relax, meaning the restoration will take much longer.  Thus the later will take more time and normally cost more.  Every dentist has their own way of treatment planning patient’s, according to what they have been trained on.  This can be quite confusing for patients as they can be given different treatment plans by different dentists, meaning they are not sure what to do.  We try and justify our treatment plans and give patients full options before they start, so they can choice the option that is right for them.

7.  Teeth not as white as expected after tooth whitening.  Frequency: Occasional
Every patient reacts differently to dental whitening gels.  Some patients can walk out upto 8 shades whiter while a few only improve by only one shade.  We use the same whitening gel on every patient, so this is mainly due to the how susceptible the patients teeth are to whitening.  We state this clearly on the consent form here.  If the in-chair whitening has not had the desired effect, Take-home custom made tooth whitening trays have been found to have good results in these patients (as they hold the gel around the teeth for a prolonged period of time), although there is an extra charge for these customised trays and whitening gels.

8. Severe pain after deep filling or crown.  Frequency: rare
This is known as a dentist’s worst nightmare.  After a deep filing or crown/onlay preparation, the patient develops severe dental pain and the tooth later goes onto needing root canal treatment.  The key here is that the tooth may have been painless before the deep filling or crown preparation and has only started hurting after the treatment.  The patient naturally thinks it may be down to the treatment.  We are still not sure exactly why this happens, but the current thinking is, during tooth preparation and decay (bacteria) removal, the bacteria within the tooth are shook up and infects the nerve or the nerve is traumatised as the preparation is near to it.  This, results in irreversible pulpitis and the future need for a root canal treatment or extraction.  We try our best to avoid this by sealing the dentine tubules with good dentine bonding agents such as Optibond Fl when possible.  However it is not nice for the patient or dentist who may have to do extra treatment which was not in the initial treatment plan.  A question the patient often asks afterwards is “why could the root canal have not been completed before?.”  As a general rule, a dentist would never go to start a root canal without evidence of infection or inflammation as it involves not only extra cost and treatment but also involves irreversibly removing a nerve from a tooth and this then startes to reduce the lifespan of that tooth.

9. Pain after a tooth extraction.  Frequency: Occasional
Sometimes after tooth extraction the tooth socket does not heal as expected.  A localised infection/inflammation known as dry socket may develop.  There is a higher chance of this developing in patients with Diabetes, periodontal disease, smokers and patients with poor oral hygiene or those with delayed healing. This can also happen in patients where the blood clot has come out of the socket after the extraction due to eating, drinking or spitting, the socket then stays empty and the healing is delayed.  It is treated simply by numbing the area, cleaning the socket and placing a medicament into the socket to enable healing and reducing pain.

10. Filling or Crown feels “high”. Frequency: Occasional

The patient normally comes back saying the teeth bite together more on the tooth that was filled or crowned.  We check the bite, aesthetics and inter proximal contacts (flossability) after each restoration in placed.  However, usually the patient is numb, so when they say it feels fine, after the anaesthetic has worn off it may feel slightly high, also the jaw excursions may be different when numb and laying down, which means as the jaw goes from side to side, different parts of the teeth may contact.  Bearing in mind that the mouth is a very sensitive apparatus so even an eye lash can be felt, even if the restoration is 0.2mm high, this can be felt as “high”.  Treatment is simple and quick, the patient returns for a polishing of the restoration!

11. Bleeding after Cleaning. Frequency: Rare

Some patients have a lot of sub gingival (below gum) tartar and plaque causing gingivitis (inflammation of the gums).  To remove this you must go below the gum lines, as the gum is already inflamed this results in bleeding.

This usually resolves within 20 minutes leaving the gums healthier and uninflammed and curasept mouthwash will help.  Once the gums have healed bleeding will subside and you will no longer get bleeding on brushing etc.  Please see our guide on oral health for maintaining excellent oral hygiene.

12. Different treatment plans from differing dental practices. Frequency: Occasional

Some patients may present with a different treatment plan from a different dentist.  At Smile Cliniq, we provide a wide range of treatments from a wide variety of dentists trained in different disciplines, using the latest techniques and materials.  We practice evidence based dentistry wherever possible.  However, we understand that other dentists may offer a different plan, we usually take pictures and show the patient why we have recommended our options with the pro’s and con’s of each option and costs of each treatment.

13. Unhappy with Deposit policy. Frequency: Occasional

Deposit Policy

We will request a deposit for all appointments. If the cancellation is less then 24 hours for general dentist appointments and 48 hours for specialist appointments or if you fail to attend your deposit will be forfeited. This is because we have reserved that appointment for you so someone else might miss out. The amount of deposit depends on the type and cost of treatment. On average is £50 per half an hour.

The Deposit Policy was instigated after an audit of missed appointments (pls see here for report from Finchley practice over the last 4 years).  Between the two practices in 1 year, over 100 hours were lost to patients not attending appointments they had booked.  During this time, not only was the teams’ (dentist, nurse, receptionist) time totally wasted, but more importantly patients in genuine need (pain, broken teeth, etc) were denied appointments as the appointment diary was fully booked.  We have since implmented a deposit policy which has drastically reduced missed appointments and ofcourse we offer a complete refund of the deposit with 24 hours notice of cancellation.

13. Unhappy with AGP policy. Frequency: Rare

The AGP (aerosol generating procedure) fee was institued due to government guidance for the need for extra PPE for dental staff, this included but is not limited to FFP3 masks, full length gowns, air purifiers and the need for fallow time between patients.  This is to prevent the risk of the aerosol from the drill/ultrasonic spreading covid through the practice and infecting both staff and patients.  To counter the added costs and time we have had to add a AGP fee for procdures which generate a AGP fee.  We prefer to do it this way rather than increase charges for all treatments throughout the practice, we have reduced this once when the air purifers were brought in and we hope to reduce this to nothing once the guidance changes.