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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