The Dangers Of Undiagnosed Periodontal Disease
Has your dentist failed to diagnose or treat gum disease? Find out if you could claim below.
According to the British Society of Periodontology or BSP (bsperio.org.uk) periodontitis is the 6th most common disease throughout the world with more than 45% of adults in the UK being affected by undiagnosed gum disease. An astounding 743 million people worldwide are affected by gum disease at any time!
The BSP state that gum disease affects many aspects of patients’ lives but is often overlooked as it may have very few symptoms in its early stages but that the vital thing about undiagnosed gum disease is that is it preventable and easily treatable if the periodontitis is caught early enough. The BSP studies link oral health to a number of other significant conditions such as Diabetes, Alzheimer’s and Heart health.
Periodontal disease is often called the silent disease and can be present over very long periods of time (years or even decades) without the patient actually knowing about it as the disease progression can be quite painless. That is why it is crucial for your dentist to be checking for the signs of undiagnosed gum disease at regular intervals.
Some “Red Flags” as raised by the BSP are as follows:
Symptoms that you may notice that should raise some concerns:
- Bleeding gums when brushing or eating
- Red or swollen gums
- Bad breath (Halitosis)
- Spacing appearing between your teeth (this can show that the bone supporting the teeth could be on the move)
- Loose or wobbly teeth
- Receding gums
- Sensitivity to cold or hot foods and drinks
Many legal claims are brought against “old school” dentists who fail to check for periodontal disease when it is time for your dental check-up.
The BSP advise that bleeding gums are not a natural sign and generally indicate that there is something wrong. This may be a simple as blood in your saliva when you spit after brushing your teeth. The BSP advise that the most effective form of treatment for periodontal disease is to remove the bacterial plaque from your teeth by brushing but that JUST brushing may not work. The advice and guidance from the BSP is that small headed brushes with medium bristles are advised and that one design eg Oral B -v- Sonicare may not be better than another- a lot is to do with personally preference.
The BSP advises patients to brush twice a day before breakfast and before bed time allowing 30 minutes after you eat. The optimal time for prevention of gingivitis is 2 minutes however if you already have gum disease then you may need to spend longer looking after your teeth.
Daily cleaning between your teeth using what are called “interdental brushes” (such as TePe Brushes) are essential for treating and preventing gum disease. Dental floss or dental tape is also advised especially if you have narrow gaps between your teeth.
As well as your dentist checking for undiagnosed periodontal disease by the use of a BPE or Basic Periodontal Examination at least once every year, most practices nowadays have a dedicated practice hygienist who can (or should) advice as to the correct interdental brush type and size or what type of tape or floss to use and also provide advice on how to use those dental cleaning aids effectively. The BPE gives the dentist or hygienist a quick guide to whether you have any pocketing around your teeth which could be caused by undiagnosed periodontal disease.
A number of legal claims for undiagnosed periodontal disease surround the dentist or hygienist not providing adequate advice upon oral hygiene instruction or how to floss and brush properly or demonstrating to the patient to ensure dental cleaning technique is correct.
The BSP go on to say that mouth rinses do offer additional benefit in the management of gingivitis however they are not a substitute for physically removing the plaque of for the amount of time you should spend toothbrushing. The use of a mouth wash in between brushing may help.
Your dentist or practice hygienist should also stain your teeth at every recall visit to help identify any areas of your mouth that you may be missing when you brush. This is quite common.
The Science behind gum disease courtesy of the BSP
Periodontal disease from the Latin “perio” meaning “around” and “dontal” meaning “the tooth” is another name for gum disease which is caused by bacteria that collects at the gum line as dental plaque.
This plaque needs to be removed by brushing and cleaning between the teeth at least twice a day. If the teeth are not properly cleaned then the gum starts to come away from the tooth forming what a technically knows as “pockets” and the plaque grows down below the gum line which is of course hidden from view. Over time the bone that supports the teeth is destroyed by the secretion of acid from the bacteria in your mouth and the gums shrink and eventually the teeth become wobbly and fall out.
Most people can get a mild form of gum disease but some people are more susceptible than others especially to more aggressive forms of periodontal disease. Severe gum disease especially if you have it at a young age can run in families. There are few factors suggested by the BSP that put people at a higher risk of getting severe gum disease and these include:
- Those under high stress levels
- Those with a poor diet
- Those that are Obese
- Those people of certain medications that can cause a dry mouth
If you are really interested in the complicated dentistry behind periodontal disease- I have an excellent factsheet written by a dentist for me which explains in details how periodontal disease starts and goes on to develop. See the Periodontal Disease Factsheet.
How should a dentist monitor the health of your teeth and gums?
Dentists should carry out regular monitoring of the health of your gums with a combination of treatments, these include medical history, the taking of xrays and crucially by “pocket testing” with the use of a basic periodontal examination or BPE.
When carrying out a BPE the dentist will use a small probe with coloured markings on it. This probe is called a BPE probe and is used to measure the depths of any pockets or areas of detachment between your gums and your teeth. The dentist will gently insert the probe down the side of your tooth and it is used to measure the depth of the gum line and to identify any gum loss or recession on each tooth.
The dentist will also look carefully to see if the probing causes any bleeding and this can help to indicate the extent of any gum inflammation. If your dentist or hygienist fails to carry out a BPE at least once every year, this may be classed as substandard treatment and negligent.
If you are a smoker or you have poor oral hygiene or may have other factors such as diabetes then you might be at a higher risk of contracting gum disease so it is vitally important that you dentist monitors the health of your gums regularly. It is common for those who have gum disease to be seen by their dentist usually every 3 months.
What does treatment of gum disease involve?
The aim of the treatment of gum disease is to reduce bacteria around your teeth and to prevent the periodontal disease from getting worse. Generally, according to the BSP, treatment cannot replace the support your teeth have already lost through undiagnosed gum disease. Whilst bone augmentation is possible, it is painful and expensive.
The BSP say that the common treatment of chronic periodontal disease should include the following:
- Oral hygiene instruction such as the best way to clean your teeth and gums to remove dental plaque. Treatment will only work if you clean your teeth to a very high standard twice a day, this includes inter dental cleaning or cleaning between the teeth using interdental brushes or floss/tape,
- The use of a good quality powered toothbrush with appropriate toothbrush heads
- Removal of the tartar above the gum line which can be removed by your dentist/hygienist
- Removal of bacteria below the gumline by deep cleaning and this can be done under anaesthetic if need be.
- The use of mouthwashes such as Corsodyl mouthwash if prescribed by your dentist.
The BSP suggest that the benefits of periodontal treatment are that you may notice less bleeding when brushing, gums not as sore, teeth becoming less wobbly, less discomfort when eating and ultimately you may keep your teeth longer but success very much depends upon how well you clean your teeth and how your gums respond.
The BSP advise that after periodontal treatment, your gums are likely to bleed more to start with but that this is normal and you should keep cleaning as things will improve. As they become healthier, you may notice that your gums may shrink and that spaces may appear longer between your teeth. As gums shrink your teeth may become sensitive to temperature or sweets things. This usually resolves in a few weeks but that sensitive toothpaste is a good option.
What are the available dental treatment alternatives?
The BSP advise that the results of NO treatment are likely to include:
- Your gum disease getting worse
- Your teeth becoming mobile or wobbly with gaps appearing between your teeth
- Bad breath
- Painful teeth and gums
- You are highly likely to lose your teeth sooner than normal
Removal of teeth may be deemed a suitable treatment option if your gum disease has progressed far enough to be classed as severe. You may with to have replacements for any lost teeth by means of a denture, bridge or implant. Implants are only recommended for those patients who’s periodontal disease in under control and has been stabilised. People find it easier and more enjoyable to eat with natural teeth rather than replacements. Extractions would reduce the time spent treating our gums and allows a painful tooth to be removed quickly. If your front teeth have a poor appearance a denture or bridge may look better.
Periodontal disease and Smoking
If you smoke tobacco, the BSP advise you to give up. Smokers who continue to smoke are more likely to get gum disease, may find their gum disease gets worse quicker, are less likely to get better after gum treatment and are more likely to have their gum disease return.
Legal Tip: What information should your dentist be telling you if you have been diagnosed with periodontal disease?
If you have been diagnosed with periodontal disease then you should be told in clear terms that you understand the nature of the disease, the full extent of the periodontal disease, the risks and benefits of treatment and the methods that you can employ to help yourself such as a strict oral hygiene regime. Following advice , your periodontal treatment such as scaling and polishing, root planning and treatment with antibiotics should be started. A referral to an expert periodontist should also be made at that stage. Whilst there is presently no cure for periodontal disease, early intervention can prevent the disease from spreading or getting worse.
What if your dentist fails to diagnose or treat your periodontal disease?
When diagnosed early enough, periodontal disease can be treated fairly easily especially by a suitably qualified periodontist, often having good results. However, if a dentist has left your periodontal disease untreated, this can have serious consequences including the loss of multiple teeth and damage to the supporting jawbone. If dental patients have neither been treated or referred for treatment and their periodontal disease has become worse as a result, then there may well be a claim for undiagnosed periodontal disease which could be worth many tens of thousands of pounds in compensation.
Material Contribution to Undiagnosed Periodontal Disease
Often in dentolegal cases for failing to diagnose and treat periodontal disease, there is usually an allegation that the dentist has “materially contributed” to the disease. This does not mean that that dentist is wholly responsible for causing the gum disease, but that he or she may have helped it along by not carrying out basic treatment such as BPE examinations or by failing to give smoking cessation advice.
Causation Of Injury
Claims against dentists for undiagnosed periodontal disease are usually complicated by causation type arguments, for example, if a patient is a heavy smoker, it would be argued by the dentists insurer that some of the blame for the disease lays at the door of the patient as he or she would have known that smoking was bad for your health and this may have caused some of the dental injury of which they now complain.
Should you stop seeing your dentist if you make a dental claim?
This is entirely down to personal preference. Most clients once they have reached the stage of making a complaint have lost faith in the dental practice concerned and usually look for another dentist. However, there is nothing to stop you in law from attending the practice for more treatment but the dentist concerned may not wish to treat you or refuse to continue treatment as you have made a complaint against him or her.
In some cases, patients prefer to be treated at the same practice, but by another dentist. However, if you would prefer not be treated by that practice at all, then you are entitled to continue your treatment elsewhere, whether this be NHS treatment or private paying.
If you need treatment whilst your claim is ongoing for example bone grafting and dental implants, then it is important that you continue with this treatment. If the treatment has been required due to the negligence of the dentist, then this is something that can be included in your claim.
How long will it take to make a claim for undiagnosed periodontal disease?
Periodontal claims can be complicated and are often defended by dentists as they are often high value claims. Compensation for undiagnosed periodontal disease are often in excess of £50,000 in damages and for this reason they can take 1-3 years to resolve.
How much is a claim for undiagnosed periodontal disease worth?
The compensation you might received is a very individual matter and each case is assessed on its own merits. Compensation is made up of general damages for pain and suffering, loss of any teeth or damage to jawbone and special damages for out of pocket expenses. Such losses as remedial treatment costs, loss of earnings etc,
What if my dentist has failed to diagnose periodontal disease but has since retired or is no longer at the practice? Can you sue a retired dentist?
Yes, you can usually sue a retired dentist on the understanding that your claim is neither out of time and that the dentist can be traced or tracked down. Dentists have to be registered to practice with the General Dental Council (GDC) who give them a unique practising number and the dentist must have indemnity insurance in place in case they get sued. The insurer will usually assist the dentist even if they are retired from practice – assuming they have indemnity insurance in place at the time they treated you. If they did not, then this is a very serious breach of the GDC guidelines for which a dentist can be removed from the dental register and therefore not able to practice.
Limitation for a claim for undiagnosed periodontal disease is the same as every other claim. The relevant time period is three years from the date of any injury to bring a claim unless you have a later date of knowledge type argument
Undiagnosed Periodontal Disease- The Next Steps
If you want to look into your legal rights of making a dental claim against your dentist for failing to treat gum disease, then as a specialist solicitor with experience in dealing with all types of dental claim in particular gum disease, periodontal disease and gingivitis, I can assess your dental claim for you free of charge and with no obligation.
I will not ask you to pay if your claim should fail and most claims are taken on a No Win No Fee basis. Contact me today to discuss your dental claim and receive a free dental claim assessment.
The usual scenario is that a patient will attend a dentist for a number of years until one day they see a different dentist for some reason (usually at the same practice) who informs them that they have gum disease or periodontal disease. This usually comes as quite a shock! Questions are then usually asked as to why their usual treating dentist did not detect the gum disease. This is where I can help you as a specialist dental negligence claim solicitor.
Are you a victim of dental negligence?
The first step you should take is to contact the dentist that carried out the work and explain the problem or make a complaint. Since dental standards are extremely high, it’s likely they’ll take the matter very seriously and offer a solution to the problem. If they charge for this work and you feel it’s their fault it didn’t work in the first instance, you may be able to make a claim to get them to pay for this treatment.
In some cases, the pain is a result of a natural problem, such as the way your teeth have responded to the treatment.
If it’s an NHS dentist, there are straightforward procedures to making your complaint. If it’s a private dentist, they will likely have their own complaints procedure which they must explain to you when you contact them.
If you cannot get in touch with your dentist to make the complaint, or if you’re against talking to them directly, you can contact either an independent dental expert or our dental law specialist to discuss the next steps.
Need help with your dental pain and suffering? Feel like you’ve been the victim of a negligent dentist? We’re here to help. Fill out our questionnaire form to speak with our dental law specialist for a free, no-obligation consultation on your dental treatment. We’ll help you make and win your claim.