Professor Paul Tipton is an internationally acclaimed Prosthodontist and Professor of Restorative and Cosmetic Dentistry, who has worked in private practice for more than 30 years. He is the Founder of Tipton Training Ltd, one of the UK’s leading private dental academies, as well as past president of the British Academy of Implant Dentistry. He works at T Clinic in Manchester and London together with other specialists and expert witnesses. He speaks to us on his role as an Expert Witness in the Dentistry industry.
Throughout your years of experience as an expert, what common mistakes do other dental professionals make which does have the potential to lead to losses?
Most of the common negligence cases that we see in dentistry are to do with periodontal disease and lack of diagnosis and lack of treatments which has in turn led to tooth loss and then the need to replace the teeth, usually with dental implants. Dental implants are a very costly treatment and usually not available in the health service and often, should the negligence have led to loss of many teeth, then treatment cost can be in the region of £50,000 in order to replace these missing teeth with implants.
The second most common cause of negligence is due to tooth extraction where it has not been explained to the patient that there are other options which could lead to the tooth being saved; if they had been fully informed they would have taken another route which would have led to their tooth being treated. Again, once the tooth has been removed the usual replacement is with the dental implant and a single tooth replacement is often in the region of £3,000 to £4,000.
More recently, we are seeing complex treatments for which the dental practitioner is either inadequately trained for or does not provide the patient with a reasonable estimate of the costs and outcome, alongside the pros and cons of such treatment. Here, the more expensive treatments include dental implants, cosmetic dentistry with veneers, etc., and also short-term orthodontics.
Patients are very often disappointed when having veneers or crowns placed, as the end result does not match their expectations which can again lead to a claim. Most dentists often do not complete enough diagnostic work in advance of treatment, so that the end result can be easily previewed by patients and amended as required.
Dental implants have a failure rate and this is often overlooked. The expected failure rate has always been in the region of 5% in the lower jaw and 10% in the upper jaw. More recently, however, there is peri-implantitis disease which has led to an increase in these rates. Again this is often overlooked during the treatment planning stage. The patients have the assumption that their implants will last them a lifetime.
How have you seen dental education change over the years? Do you think that this has affected the occurrence of legal cases?
Dental education has changed massively over the years and I have been involved in it very closely with my company Tipton Training. We have trained dentists over the last 20 years both in the UK and abroad in some of the complex issues of the newer techniques in dentistry. Due to government cutbacks and lack of funding, often some of the newer graduates are graduating from dental school without basic knowledge and without having performed some of the basic dental tasks. This then leads to a lack of confidence on the dentist’s part which can be reflected in the quality of treatment that is provided.
How would you deal with negligence, whiplash and general accident cases differently? Do any of those have different requirements when producing a medico-legal report?
Negligence cases take the most amount of time and are often highly complex, involving multiple dentists over a period of time during which the patient was treated. This is especially in the area of periodontal disease where lack of care, treatments and diagnoses may have been going on for a decade or more; the patient has seen multiple dentists who have continued to misdiagnose the disease process. This becomes difficult to apportion the negligence percentage to each of the dentists involved in the case. The most important factor which is often overlooked by some experts is the issue of causation and understanding that it is not enough just to deal with liability, for the case to have merit. General whiplash and accident cases are far easier and are reflected in the fact that the reports are cheaper to produce and are often of a more factual nature.
What advice do you have for solicitors when choosing dental experts?
The choice of dental expert should be based on the understanding and knowledge of their field and certainly, an established private practitioner who has over 10 years of general dental practice. Alternatively, dentists who have gone on to have further education in a particular field, such as Master’s degrees or Specialists in Periodontics, Endodontics, Orthodontics, Prosthodontics, General Dentistry and Implantology, and finally to Professors or Consultants when required. It is also important to have continuity when choosing an expert and knowing that they have been through adequate training in the expert witness field and have enough experience in that field to write reports which are legible, easy to read and precise. It is essential to understand a basic knowledge of the legal system so as to help the court reach its opinion if required. I would also suggest that having a nationwide panel of experts who are all trained to the same standard and degree and whose reports have a similar, if not identical makeup, makes life easier for the solicitor and barrister when dealing with a large number of cases. We at T Clinic employ experienced general dental practitioners, dentists with Master’s degree in their chosen field, Specialist Consultants and Professors in all areas of general and specialist dentistry and also on a nationwide basis so continuity is guaranteed.
I am a Specialist in Prosthodontics and also a Professor of Restorative and Cosmetic Dentistry in the City of London Dental School. Prosthodontics is that speciality which deals with the replacement of teeth and this can be via crowns, veneers, bridges and implants. Prosthodontics would also include treatment of the temporomandibular joints and bite. This treatment is often wholly performed by dentists who have inadequate training in the field of occlusion (bite). Being a specialist in Prosthodontics and a Professor of Restorative and Cosmetic Dentistry gives me an overall view of all the fields involved in Restorative, Cosmetic and General Dentistry which is essential when writing reports and coming to opinions as to plans and treatments.
Professor Paul Tipton, a Specialist in Prosthodontics is one of the UK’s most respected dentists and has pleasure in welcoming you to T Dental, part of T Clinic. As Clinical Director he has developed a leading dental practice to provide the highest level or oral care.
Specialist in Prosthodontics
Clinical Director, T Clinic