Failure to provide adequate information about risks and treatment options

The importance of providing information about the risks of treatment and other alternative options was highlighted in a decision released by Health Assistant and Commissioner Deborah James.

In her decision, Ms James found that a dentist breached the Health and Disability Services Consumers’ Rights Code (the Code) for failing to provide relevant information to an eight-year-old girl and his mother before undertaking a frenectomy procedure. A frenectomy involves the removal of a frenulum and in this case refers to the tissue connecting the lip to the top of the gumline and the tissue connecting the tongue to the base of the mouth, commonly known as the lip and tongue connections respectively .

The girl was diagnosed with tongue and lip ties and was referred to the dentist for a frenectomy. Two weeks after the dentist performed the frenectomy procedures, the girl experienced an episode of uncontrolled bleeding from where the ties were loosened and was diagnosed with a bubble hematoma on the floor of her mouth. . Three days later, the girl experienced another episode of uncontrolled bleeding and required emergency surgery to control the bleeding.

Ms James noted that performing a frenectomy for orthodontic purposes on a child is considered a “grey area” of the practice. She considered that the dentist had not provided the young girl and her mother with adequate information before the intervention.

“In my opinion, a reasonable consumer in these circumstances would expect to be told that there was a lack of clear evidence to support frenectomy for orthodontic purposes, clinical rationales to recommend the procedures despite this lack of clear evidence, and procedure-specific risks, including risks of bleeding and hematoma,” said Ms. James.

She further recommended that the dentist organize an external audit to ensure that adequate informed consent was obtained for the treatment and that the clinical documentation was of an appropriate standard; and undertake further education and training on informed consent and clinical documentation in collaboration with the Dental Council of New Zealand.

Ms James also recommended that the dentist write a written fact sheet about frenectomy procedures, particularly the risks and benefits, and the lack of evidence to support frenectomies for orthodontic purposes.

“In my opinion, for a practitioner to perform a frenectomy for orthodontic purposes safely, the indications and clinical justifications for the procedure must be solid and well documented. The consumer must be fully informed and the practitioner must be able to demonstrate that they have the necessary training, qualifications and experience to perform the procedure safely,” explains Ms James.

Ms James has recommended that the Dental Council of New Zealand consider whether a review of dental surgeon competence is warranted.

The full report of this case will be available on HDC’s website. Names have been removed from the report to protect the privacy of those involved in this matter.

The Commissioner will generally name providers and public hospitals that have violated the Code, unless doing so is not in the public interest or unfairly compromises the privacy interests of an individual provider or consumer.

More information for HDC’s media and naming policy can be found on our website here.

HDC promotes and protects the rights of people using health and disability services as set out in the Code of Rights for Consumers of Health and Disability Services (the Code).

© Scoop Media

About Antoine L. Cassell

Check Also

IMU-838 treatment associated with low rate of confirmed disability worsening in relapsing MS

Recently reported interim data from the Phase 2 EMPhASIS trial (NCT03846219) of Immunic’s investigational agent, …