Dental case study – Special needs oral care

Dr J is a general dentist who works at a dental practice in rural Victoria. In October 2018, a 12-year-old female (Jasmine) presented at the clinic with her grandmother, after being referred by the girl’s GP because of a complaint of recurrent pain in her left cheek. Jasmine was very uncooperative, did not respond to verbal commands and had difficulties communicating in English. Her grandmother also had difficulties communicating in English, as it was not her first language. Jasmine was so unsettled during the consultation that she could only be examined while sitting with her grandmother holding her. Upon examination, Dr J determined Jasmine needed one extraction and a filling and decided that the dental treatment would be completed under general anaesthesia.

Following protocol, Dr J reviewed the referral sheet issued by Jasmine’s GP and noticed that the practitioner had not ticked the box indicating restrictions to undergo specific treatments but instead, had handwritten something illegible which Dr J failed to clarify.

Dr J rang Jasmine’s mother (appointed guardian) to obtain informed consent for the extraction and filling, which was readily given over the phone. General anaesthesia was induced via inhalation and the dental treatments proceeded uneventfully.

A week later, Jasmine’s father (divorced from Jasmine’s mother and soon to undergo a Child Custody Final hearing process) made a complaint to the practice as he believed Jasmine’s dental treatment had been inappropriate and threatened to take the matter to the Dental Board. Jasmine had suffered a traumatic epileptic episode a day after her consultation with Dr J, which the father believed was due to the stress and trauma experienced by the girl during the consultation.

Dr J was taken aback by the complaint, as he had no clue of Jasmine’s medical history and wondered what complications a simple extraction would have.

Reason for complaint, claim or investigation       

Jasmine’s father alleged that Jasmine had been diagnosed with severe autism at the age of 3 and had a history of acute stress-sensitive seizures and bruxism. After the dental treatment, Jasmine had experienced excruciating pain at night and had an episode of epileptic seizure and therefore needed to be taken to the local hospital. Jasmine’s father also alleged that appropriate consent had not been given, as he claimed that Jasmine’s mother did not recall giving authorisation to the procedures over the phone.

Clinico-legal knowledge      

  • Treating patients with special needs
  • Obtaining informed consent from parents and guardians
  • Maintaining contemporaneous health records

Questions to ponder

  • What were the material risks involved in this case?
  • What do you think Dr J could have done differently to avoid criticism and allegations of sub optimal care including inadequate consent?
  • What are the implications of Jasmine’s parents’ marital status and legal standing regarding this case?

Relevant DBA code of conduct skills and competencies

4.5 Informed Consent

3.3 Shared decision making

3.2.3 Maintaining adequate records

4.9 Patients who may have additional needs