Orthodontist breached patient rights by pulling baby teeth from girl's mouth without anaesthetic

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An orthodontist pulled three baby teeth from an 11-year-old girl's mouth without anaesthetic and without seeking the consent of the girl or her mother.

Deputy Health and Disability Commissioner Theo Baker, in a report made public this afternoon, says the orthodontist, whom she does not name, breached the code of patients' rights. She has urged the Dental Council to review his competence.

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The girl's mother had taken her to the orthodontist for him to observe her dental development and determine if work was needed to straighten her teeth.

The orthodontist removed the three baby teeth without first informing the girl and her mother of the intention to do so, and without obtaining consent.

Ms Baker said it is understood the extractions happened very quickly, without time for the mother to intervene. The mother became aware of what he was doing only after he had removed two. She said he told her they needed to be removed as food could get stuck under them, and proceeded to remove the third

A dental assistant told the investigation that the orthodontist had found the three baby teeth were loose and causing problems with the adult teeth underneath.

The orthodontist said: "Based on my experience and clinical assessment of the state of [the girl's] teeth, I considered I could remove them quickly and painlessly and that this would be the preferred course of action.

"I made a judgment call that administering an anaesthetic and discussing the issue with [the girl] prior to removal would cause her greater distress, as would delaying the removal by referral to a general dentist. It should be noted that the administration of an anaesthetic in itself can cause pain and distress and be upsetting to a child ..."

The mother said the assistant held her daughter down for the removal of the third tooth. The orthodontist "abruptly told her to lie back down, she didn't do so [and] the assistant physically forced her down by the shoulder, making verbally insensitive comments, and I quote 'Aww, it doesn't hurt' [and] 'Oh look we've got waterworks now'."

But the orthodontist told the investigation: "I do not accept that [the girl] was spoken to in an inappropriate way. My assessment of the assistant's comments and my own was that they were directed towards trying to normalise the removal and distract [the girl] so as to minimise any discomfort or distress.

"I also do not accept that [the girl] was forcibly held on the chair. The assistant was gently guiding [the girl] to remain lying down while I quickly completed the final removal. The whole extraction took less than two minutes and I was anxious not to prolong matters for [the girl]."

Ms Baker said the code of rights is clear that patients should be given information on treatments proposed and must agree to treatment before it is commenced.

She said children under 16 can give their own consent to health care if they have sufficient maturity and understanding of the proposed treatment, otherwise authority lies with the parent/guardian. In this case it wasn't necessary to decide if the girl was legally capable of giving consent as the orthodontist did not seek consent from either the girl or her mother.

Dental Association president Dr John Boyens backed Ms Baker's decision, saying caregiver consent was required for elective dentistry and as "situations allow" in emergencies.

" ... discussion of extractions in front of and including the child can lead to increasing the tension and to a lack of co-operation. Nevertheless a child must be given the opportunity to express their views and these must be taken into account [under the] Care of Children Act ... "