Heavy is the head: case study of a crown

Mrs K was an oral health therapist working in a private practice. Six-year-old Miss A presented with her mother for a check-up due to her concerns about a possible hole on a back tooth. Examination and bite-wing radiographs revealed that Miss A had a large carious lesion on her 75. Miss A’s mother was very keen to try to keep the tooth until natural exfoliation and, after extensive discussion of the options, it was decided to undertake pulpotomy and restoration with a stainless-steel crown. To ease Miss A into the treatment, a clean and polish was completed that day, and the patient was re-appointed to complete the treatment on the 75.

Miss A returned in the school holidays, accompanied by her father, to complete treatment. The appointment proceeded with no issues and a great final result. Miss A seemed excited about returning to school after the holidays to show all her friends her new “princess crown” tooth.

Mrs K completed her morning of patients and, while writing the records for her final patient, she was interrupted by the practice manager, who informed her that Miss A’s mother was on the phone, wanting to discuss Miss A’s treatment that morning. Thinking this call was likely to check on how treatment had proceeded, Mrs K happily took the call, ready to report how well things had gone.

Unfortunately, Miss A’s mother was not calling for an update. She was calling as she was quite distressed about the appearance of the stainless-steel crown in her daughter’s mouth and to complain that she had not been informed prior to treatment about the lack of aesthetics of the definitive restoration.

Mrs K was somewhat surprised by these statements due to the extensive discussions they had had prior to the appointment as part of the consent process and the mother’s insistence on wanting the best option for the long-term maintenance of Miss A’s tooth. The mother maintained that she did not realise that a stainless-steel crown would look black in her child’s mouth and would never have proceeded had she been aware.

Mrs K felt quite unprepared to respond and so invited Miss A’s mother to come to the clinic for a discussion about the situation, to give them both time to gather their thoughts. She wanted to respond in the best way to ensure a positive outcome for everyone. Mrs K called Dental Protection to discuss what had happened and to get guidance on the best way to proceed.

Miss A’s mother arrived at lunchtime and was invited into the practice manager’s office to openly discuss the situation. Mrs K began by acknowledging that there had been a miscommunication and apologised for the situation they now found themselves in.

The patient’s mother had a chance to collect herself on the way to the clinic and they were able to calmly talk through the options again and the best course of action to ensure a functional, pain-free tooth for Miss A until her tooth exfoliated.

After processing the information, the mother agreed that she wanted the best treatment for her daughter and though not optimal aesthetically, she accepted a stainless-steel crown was the best long-term option. The meeting was concluded with Miss A’s mother feeling “heard” and reassured that her daughter was receiving the best treatment for her overall health and wellbeing.

Learning points

1. It is critical to have a clear and thorough consent process, where even things that seem obvious to you are discussed.
2. Consider the use of written information pamphlets to complement the consent process.
3. This case underlines the importance of inviting an open communication pathway to deal with the resolution of complaints.