GDC makes clampdown
 

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GDC makes clampdown

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GDC makes clampdown

 

GDC makes clampdown

A landmark judgement has been made by the General Dental Council’s Professional Conduct Committee following the longest hearing in the council’s history. The ruling by the committee has implications for any dentist providing treatment that is not fully supported by current scientific evidence.
The General Dental Council (GDC), whose role is to protect patients, has indicated it will take a hard line against dentists who practise unconventionally without good supporting evidence and in particular, where the treatment is invasive and
irreversible.
In such cases, the GDC will invoke its ethical guidance on misleading claims and unproven treatment – that ‘a dentist should take particular care when employing techniques and forms of therapy which are unproven’.
Francois Rossouw, a general dentist registered in Brentwood, Essex, appeared before the GDC’s disciplinary committee during four different weeks over the course of seven months. The 15-day hearing heard from 11 witnesses and was the longest disciplinary case ever undertaken by the GDC.
Among the charges that were proved were that he ought to have known both that there is no informed evidence-based opinion in the dental profession linking occlusal abnormalities with TMJ disorders or to support the theory that permanently correcting or adjusting the occlusion is an effective treatment for TMJ disorders.
Prior to the conclusion of the case, Rossouw made a commitment not to accept any new referral patients for TMJ treatment, and to restrict himself to conservative measures for any other patients and to offer current TMD treatment patients a second opinion. He was invited to write to the Council every six months to confirm he was sticking to this commitment.
He was not struck off the GDC’s register but instead, the decision on what sanction to take against him was postponed for 18 months. Meanwhile, he was encouraged to contact his local postgraduate dental dean to formulate a personal development plan and to undertake regular practice audit and peer review. A report on his activities would be expected at the resumed hearing.
The case against Rossouw followed a complaint to the GDC by a patient who he treated over a period of nearly seven years. The patient, Anna Hitchcock, consulted Dr Roussouw because she was suffering from headaches and facial pain and he diagnosed internal derangement of the Temporomandibular Joint.
Over the course of her treatment she was prescribed three different removable appliances, one fixed appliance and had various filling materials placed on her molar and upper canine teeth. She paid between £1,500 and £2,000 for the treatment.
Because of the length of time over which the treatment extended, the GDC’s case against Rossouw was based both on the Council’s Red Book and the ethical guidance which replaced the Red Book, Maintaining Standards.
In delivering the summary, the chairman of the conduct committee told Rossouw that the facts found proved against him fell into four categories:
• Inappropriate diagnosis, according to a minority of practitioners and which is not supported by informed evidence-based opinion within the profession
• Failure to obtain informed consent
• Providing inappropriate invasive and irreversible treatment that ran counter to mainstream thinking within the profession
• Failure to provide a written treatment plan and estimate of costs.
The committee chairman said that he failed to consider other causes for the patient’s symptoms and having decided prematurely on a particular diagnosis and treatment, he persisted with a flawed treatment for over six years. This casts, the chairman said, serious doubt over his clinical judgement. He said that Rossouw’s breaches of ethical guidance were ‘extremely serious’ although the committee accepted that he acted with good intentions and was not motivated by desire for financial gain.
Mike Grace, the former editor of the BDJ said that this was landmark judgement by the GDC. It was the first time, as far as he was aware, that the GDC had indicated so clearly that dentists should not be carrying out treatment unless it was backed up by scientific evidence of a high standard.
Dr Stephen Davies, lead clinician at the TMD clinic at Manchester University Dental School and joint author of a BDJ book on TMJ disorders, said he could not comment on the case. However, there were clear examination protocols for patients suspected of having a temporomandibular disorder.
‘The overwhelming evidence is that the treatment of many TMD conditions can be reversible and non-invasive; most dentists would consider
it prudent to use these, at least initially.’

 Posted on : Wed 4th - May - 2005

 

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