Patient gets buck teeth after two years' orthodontic treatment by dentist

A young woman who wore plates and then braces over almost two years now needs jaw surgery to correct the buck teeth she was left with. Photo / 123RF

The dentist at the centre of a string of complaints uncovered by the Herald has previously been referred to the Dental Council over treatment that left a young woman with buck teeth.

The dentist was referred by the Health and Disability Commissioner after a complaint by the patient in 2017.

The woman, who only wants to be known as Grace, was 22 when she went to the dentist's Auckland clinic in March 2015 to have her canine teeth straightened.

After two years of treatment, she ended up with a large overbite that experts said would cause speech and diet problems. The Accident Compensation Corporation (ACC) accepted a claim for treatment injury.

The dentist said if the patient had left her braces on he could have corrected the overjet (horizontal overlap) of her top jaw, but Grace said she was in pain and did not trust that the dentist knew how to fix it.

At a meeting to discuss the situation in early 2017, Grace said the dentist seemed to have no clear plan about how to address the problem.

"There were suggestions - a great many - by [the dentist]," Grace told the Health and Disability Commissioner.

"He might try this, he might try that. 'You could wear this,' he said, holding up a thick plastic retainer. 'Bit of an intimacy killer though'.

"And I looked back at him thinking, when exactly was I told that I would have to trial and error such ridiculous appliances?

"When exactly was I told that after two years of treatment I would look like that sloth from Ice Age with his teeth sticking right out, or as my friend tactfully put it, 'horse teeth'? The answer is: Never."

A young woman was left with buck teeth "like that sloth from Ice Age" after almost two years treatment at a dental clinic in central Auckland. Photo / Fox Films

She claims at one point the dentist suggested she jut her lower jaw forward indefinitely.

When she started the treatment, which involved no tooth extractions and an expansion plate, Grace had a 4mm overbite that was not obvious.

However that was not the main problem. It was high, flared, upper canine teeth that she wanted aligned with the rest of her front teeth.

She wore a plate for nine months to expand the jaw before braces were put on.

By January 2017, when Grace sought several second opinions before asking an orthodontist to take the braces off, she had a 7mm overbite.

"My overall facial profile is aesthetically far worse and now a cause of much embarrassment."

An ACC investigation involving a general dentist and a specialist orthodontist found the treatment was "inadequate and had very little chance of ever being successful".

"The clinical records related to the proposed treatment plan were sparse and it was not clear what the aim of the treatment was in this case," the ACC report said.

It said the overbite now affected functionality of the teeth in that they no longer met which would influence speech and diet.

"ACC... agree that there has been a failure to provide treatment in this case that has resulted in a physical injury to the client."

In his response to the HDC the dentist said there were always inherent risks with orthodontic treatment and these were outlined in consent documents the patient signed.

He did not accept any permanent damage had been caused to her teeth and said she never reported pain to him or the practice throughout the treatment.

Grace claims she reported pain to the clinic's orthodontic auxiliaries multiple times because the dentist was "never there".

The HDC decision said the dentist "concedes that when comparing the initial braces fit and progress orthodontic photos, something has clearly happened while the braces were on your teeth to increase the overjet".

But because the braces were removed a range of further treatment options ended, the dentist maintained.

HDC deputy commissioner Meenal Duggal said while she did not disagree with ACC, her expert - another dentist who performs orthodontics - found the treatment was not a departure from expected standards because it was a recognised treatment.

Cath Darroch's complaint to the Health and Disability Commissioner came 12 months after another one about the same dentist that the HDC referred to the Dental Council. Photo / Alex Burton

However Duggal said she was concerned about the length of time Grace was receiving active treatment with no visible gains.

"In this case it shows a lack of overview in failing to see that treatment was not progressing as planned.

"To endure 18 months of orthodontic treatment and end up with, not only no improvement, but a measurable worsening of your presentation, must have been devastating."

She also criticised the dentist for a lack of documented conversations prior to and during treatment and a failure to record measurements for comparison.

Duggal said she would write to the dentist and request the clinic undertake an extensive audit of the records of patients who were undergoing similar treatment and report back to her.

In her decision on September 29, 2017 Duggal said a "busy practice" was not an excuse for poor documentation as the dentist claimed.

"I am also concerned that, having reviewed [the expert's report, the dentist] still considers the departures in his care as 'low level'."

Grace said ACC covered further treatment including more braces through a specialist orthodontist but the overbite remained significant.

She now lives overseas where she says she has been assessed as needing jaw surgery.

She said the ordeal had cost tens of thousands of dollars though she received a $10,000 refund from the dentist after she first complained and later threatened to go to the media.

The dentist said through his lawyer, Harry Waalkens QC, that the matter was referred to the Dental Council of New Zealand. The council found the dentist's practice met the required standard of competence and subsequently resolved to take no further action.