Failure To Provide Adequate Information About Risks And Options For Treatment

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

In her decision, Ms James found a dentist in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to provide relevant information to an eight year old girl and her 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 gum, and the tissue connecting the tongue to the base of the mouth, commonly known as lip and tongue ties respectively.

The girl was diagnosed with a tongue and lip tie and 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 released, and was diagnosed with a bubble haematoma on the floor of her mouth. Three days later the girl experienced another episode of uncontrolled bleeding and had to undergo emergency surgery to control the haemorrhage.

Ms James noted that performing a frenectomy for orthodontic purposes on a child is considered to be a ‘grey area’ of practice. She considered the dentist did not provide the girl and her mother with adequate information prior to the procedure.

"In my view, a reasonable consumer in these circumstances would expect to be informed there was a lack of clear evidence supporting frenectomy for orthodontic purposes, of the clinical justifications for recommending the procedures despite that lack of clear evidence, and of the risks specific to the procedures, including the risks of haemorrhage and haematoma," Ms James said.

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

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

"In my view, in order for a practitioner to perform a frenectomy safely for orthodontic purposes, the indications and clinical justifications for the procedure must be robust and well documented. The consumer must be fully informed, and the practitioner must be able to demonstrate they have the necessary training, qualifications, and experience to carry out the procedure safely," says Ms James.

Ms James recommended the Dental Council of New Zealand consider whether a review of the operating dentist’s 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 privacy of the individuals involved in this case.

The Commissioner will usually name providers and public hospitals found in breach of the Code, unless it would not be in the public interest, or would unfairly compromise the privacy interests of an individual provider or a consumer.

More information for the media and HDC’s 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 Health and Disability Services Consumers' Rights (the Code).

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