I believe a dentist violated my consent
August 27, 2018 8:34 PM   Subscribe

I went in today to have my teenage sealants removed, and nothing else...

I was not informed and did not consent to recieving anaesthetic, yet the dentist syringed away before I could protest. Dentist's assistant was present. After the anaesthetic was administered, I asked why, and was informed that any and all cavities revealed underneath the sealants were going to be drilled out and filled at this appointment. With my face already numb, I gave my consent and had 3 cavities filled.

Adding insult to injury: after the numbness subsided, I discovered that a permanent residue was stuck on some of my teeth, making it impossible to floss between them.

I will of course not be returning to this practice, and will have another dentist fix the sloppy work. Any tips for finding a good dentist? What are my options for holding my former dentist accountable, other than a well written Google review? This dentist and practice had good ratings :(
posted by gray17 to Health & Fitness (23 answers total) 1 user marked this as a favorite
I was not informed and did not consent to recieving anaesthetic

For better or worse, I've never been specifically informed about anaesthesia for dental procedures. I've always considered it assumed for any dental operation.

Any tips for finding a good dentist?

Ask your friends or coworkers.

What are my options for holding my former dentist accountable, other than a well written Google review?

I would suggest a Yelp review; I don't know anyone who actually reads Google reviews given that they generally seem to be randomly assigned by bots.
posted by saeculorum at 8:45 PM on August 27, 2018 [4 favorites]

You wanted the procedure done wihout analgesia (pain relief)? I don't think I've ever had to consent to a dental analgesic syringe.

I think you should make sure that consenting to analgesic is a standard thing- in other words make sure the dentist actually did something unusual or wrong- before Yelping about that part of your experience. You should definitely be able to floss though- the first dentist would probably fix that issue for free (if you had wanted to go back to them).
posted by pseudostrabismus at 9:31 PM on August 27, 2018 [22 favorites]

It'd be one thing if you told your dentist upfront that you didn't wish to receive local anesthesia, and they promised to comply, but reneged at the last minute. But it doesn't sound like you made your wishes clear to your dentist, in any case, so it's a huge stretch to say that your consent was violated. Local anesthesia is a part of the standard of care for many dental procedures, and indeed, your dentist would have done something incredibly irresponsible by forgoing it--and putting you in a good deal of pain as a result. Sure, you can go ahead and try to hold your dentist accountable, maybe leave them a bad Google review or something, but it sounds to me like they didn't do anything wrong. Next time, make your wishes more explicit.

Anyway, is there a reason why you don't want to receive local anesthesia?
posted by un petit cadeau at 10:12 PM on August 27, 2018 [18 favorites]

I believe OP wasn't expecting to have any cavities filled that day, so was also not expecting to get painkillers.

OP, I think the dentist should have absolutely told you that the plan was to fill the cavities after removing the sealants. I'd complain.
posted by Weeping_angel at 10:18 PM on August 27, 2018 [16 favorites]

I would complaign too. I think a dentist needs to fully and carefully explain every part of a proposed treatment before any work begins. Your dentist sounds sketchy to me.
posted by WalkerWestridge at 10:23 PM on August 27, 2018 [8 favorites]

What are my options for holding my former dentist accountable, other than a well written Google review?

Where I live (BC, Canada) you can lodge a formal complaint with the dental profession's regulatory body (the College of Dental Surgeons of BC). Your area will have a similar organization. They may also be able to advise you on normal expectations, which could help you assess your situation.

The BC College of Dental Surgeons has an excellent site about making complaints and standards of practice.

Here are the standards of practice, which include ensuring informed consent and also the code of ethics.

Informed consent means ensuring a patient has never had negative outcomes from use of anesthesia prior to use of the drug.

At very least I think you should tell the dentist how you felt. If this is a misunderstanding, this should result in them taking more care in future.
posted by chapps at 10:55 PM on August 27, 2018 [5 favorites]

While I think a better dentist would explain all procedures up front, I would have assumed that removing sealant from years (in my case, decades) ago would involve enough pain to require local anesthesia. This is not like you went in for a cleaning and the dentist snuck in some cavity fillings at the same time. This seems a routine part of the process that your dentist forgot many patients might not know about. I might leave a review saying patients should be sure to ask this dentist what is involved before getting started, as this dentist doesn’t always volunteer the info.

The sloppy sealant job? I got nuthin’. Yikes. The dentist should probably fix that for free.
posted by greermahoney at 11:06 PM on August 27, 2018 [4 favorites]

I don’t mean to be harsh, but I think you are the one outside normal expectations here, not the dentist. And I don’t think it’s a particularly close call.

If a dentist did a procedure on me that revealed cavities and did NOT take steps to fill them in the same procedure, I would view that as borderline malpractice. Cavities hurt. They are dangerous. They should be addressed quickly. I would be offended if a dentist revealed open cavities in my mouth and didn’t treat them, and I would be very pissed if he then made me come back in for another appointment on another day at another few hundred dollars.

I assume you have filled out a form indicating that you are not allergic to local anesthesia. If you explicitly informed the dentist that you are sensitive to anesthesia and want to be informed before receiving it, then yes, you have a bad dentist and should absolutely switch. Or if you think that you would like a dentist who takes more time to walk you through the procedure before beginning, by all means switch. It is your life, and you should be happy with your dentist. But I will caution you that you should think very carefully about leaving this review and how you phrase it. Saying that someone “violated my consent” has specific and extremely serious connotations. I hope the voices here saying that you may have expectations that are out of line with normal dentistry inform and temper whatever you do write. Best of luck to you—and may you find a happier dentist experience next go round!
posted by suncages at 11:22 PM on August 27, 2018 [56 favorites]

I'm a bit confused. I have to assume x-rays were taken at some point if the dentist knew there were cavities, was anything about the process discussed at the time x-rays were taken, perhaps with a different dentist or assistant, or did this all happen in a single visit?

I've been asked if I wanted to receive gas in addition to an injected anaesthetic, but the anaesthetic was otherwise assumed, though, yes, described as part of the process in early visits though generally left out of discussion in repeat visits if reasonably close in time as the process had been established.
posted by gusottertrout at 11:24 PM on August 27, 2018

“For better or worse, I've never been specifically informed about anaesthesia for dental procedures. I've always considered it assumed for any dental operation.”

Before any work begins I am ALWAYS asked:

1. If I have any changes to my health?

2. If my allergies are only XYZ, as listed in my chart?

3. Additionally, every step of the appointment is explained before it begins.

BEFORE ANY WORK BEGINS WE TALK ABOUT ANESTHESICS. I’m sensitive and require topical for cleanings. We talk about type, reconfirm my allergies to medication (none, as far as I know.) Ditto for shots, and I confirm I will need more than one for fillings, so they make sure to have it prepared before drilling.

I’m sorry this happened and I strongly recommend you do whatever self care you would do after any other type of physical violation or violence - grieve, meditation, massage, therapy session, visit nature, tea with friends, etc.. I don’t know about reporting this, but dentists are licensed, so you might start there with a complaint!


Like I said, this happened to me with two different dentists. Not anesthesia without consent, but being touched in a fucked up way and handled roughly. *shudders* I was extremely upset both times. And violated. You’re totally justified here in your perspective that the procedure should have been discussed, see above.

You want to know how I finally solved this problem? I started going exclusively to dental schools fir my appointments. There’s always two (sometimes three) dentists checking on me throughout the appointment - one student + professors checking their work. They follow a strict protocol overseeing patient care. They are not worried about overhead. The student always does their best and they are exceedingly careful and gentle because they want a goid grade and there is oversight to make sure they relate to patients compassionately.

They care I was treated badly and developed a fear of dentists. They treat me like gold. I’ve met some really great humans and have fantastic healthy and attractive teeth.

Go to a dental schhol with a good rep. This will never happen again.
posted by jbenben at 12:05 AM on August 28, 2018 [5 favorites]

If a dentist did a procedure on me that revealed cavities and did NOT take steps to fill them in the same procedure, I would view that as borderline malpractice.

The thing is, dental anesthetic numbs your whole mouth, which, if you weren’t expecting or planning for that day, could be a huge inconvenience. OP says they went in to have sealants removed, nothing more. Apparently, it’s SOP for this dentist to also fill cavities when removing sealant. OP should have been informed of this before arriving for the procedure. After OP’s mouth was already numb, they were pretty much backed into a corner. They were never given the opportunity to consent. Whether that rises to “my consent was violated”, I don’t know, but it would freak me out.
posted by Weeping_angel at 12:07 AM on August 28, 2018 [7 favorites]

My dentist tells me beforehand what he thinks he might want to do and makes sure I have a printout explaining how much it will be, and what payment plans are available. He also uses a pre-numbing lollypop thing before using a syringe, so there would be ample time to object if the preprinted form hadn't already been a deal. I don't know exactly how I'd describe what your dentist did, but I would say that their communication wasn't up to my personal hopes or standards.

I got my dentist from Yelp reviews. I never thought about going to a dental school like jbenben recommends, but I have gotten health care from medical students before and the phenomena she describes (where the person is being ULTRA careful because they're being graded by a professor) fits with my own experience.
posted by hungrytiger at 1:37 AM on August 28, 2018 [2 favorites]

This sounds well within the range of normal of any dentist I’ve ever seen. I don’t think there will be much you can do in terms of holding anyone accountable for a pretty typical dentist visit.

That said, you absolutely deserve to have the kind of dental care you’re comfortable with. I think at your first appointment with your next dentist it would make a lot of sense to lay out for them that you really want to know the details of the treatment plan, and in particular whether anesthesia is involved, before work begins. That’s a completely reasonable request and a good dentist should be willing to do it, but you may need to spell it out that way to get what you want,
posted by Stacey at 3:12 AM on August 28, 2018 [2 favorites]

In re: the residue, my dentist has always told me to come in if I have trouble flossing or if my bite is funny (it’s hard to tell with a numb mouth), and has always smoothed/ improved the areas at no extra cost. It’s happened once or twice and does not seem to indicate exceptional sloppiness.

It sounds like the dentist may be doing a poor job of explaining the procedures, since everything you describe sounds like what I would expect (the sealants get removed because the thing they're protecting against has happened, and that needs to be fixed) . You could ask for a rundown before they get anywhere near your mouth, or find a dentist that specifically advertises as working with anxious patients, as they tend to talk through the procedures in more detail.
posted by tchemgrrl at 3:15 AM on August 28, 2018 [3 favorites]

I was not informed about the cavity drilling part of the procedure, and thus was not given the opportunity to give informed consent.
posted by gray17 at 3:25 AM on August 28, 2018 [2 favorites]

I think it’s kind of crappy that you felt you were not informed properly, but I’ve also never explicitly given consent for freezing. That said, I’ve never had freezing needles be a surprise to the point where i couldn’t stop the dentist, so that part definitely seems troubling.

But as others have mentioned — you were in for a procedure that by definition exposes cavities. It would almost certainly be worse to leave them exposed to the air at that point. With that in mind, part of the procedure you were voluntarily asking for was getting them dealt with. The dentist should have made this clear, absolutely. But in the grand scheme of dental things that can and do go wrong, this is relatively low on the scale in my and my mouth’s full of dental work’s humble opinion. Find a new dentist, make a yelp review if you want to, and move on would be my take.
posted by cgg at 3:37 AM on August 28, 2018 [2 favorites]

You can contact the regulatory body for dental practitioners in your region and ask them if this is normal/acceptable practise. Depending on what they say you can move forward with formal complaints and bad Google/Yelp reviews, or let it lie.
posted by windykites at 6:14 AM on August 28, 2018 [1 favorite]

I would be upset. I have never had a dentist do any procedure without discussing it with me first. I found an excellent dentist through yelp so you could certainly leave a bad review but I would also contact the dentist office and tell the dentist directly or a receptionist how upset you are. You have every right to be upset. I’m sorry you had this happen to you.
posted by Bella Donna at 7:20 AM on August 28, 2018 [1 favorite]

I'm honestly baffled by everyone who's saying this is to be expected. Nobody should ever be injecting things into your body by surprise. And I have indeed had cavities filled without numbing, so it's not even fair to say that once you consent to a filling (which you hadn't even!), you've consented to numbing. My dentist's opinion was that the injections hurt too and numbing is inconvenient (for me, not him), so if I wanted him to just get it over with, he was willing. It hurt, yeah, but it was my choice and it didn't last long. Maybe for more extensive work that's not a reasonable option, but you still should have been informed. I don't know what you should do, besides not going back there, but I wanted to validate your sense that "inject first, ask later" isn't at all the correct order of operations.
posted by teremala at 7:52 AM on August 28, 2018 [7 favorites]

I think this is both common and highly unpleasant. Like others here, I prefer to not have numbing for superficial drilling like most cavities, and even at my professional and chill dentist, with whom I am generally pretty okay, I sometimes have to head off assistants coming at me with a giant syringe when I'm having something done (not always, though! They remember sometimes!). I also had a couple crowns installed at that office without understanding the extent of tooth prep that went into it and had that same sort of shocked feeling about it - that time I explained that I didn't feel like I'd been adequately informed about the procedure, and the dentist seemed to understand and apologized.

In general though I think dentist office personnel really just like to follow their established procedures, assume the patient trusts them to know what's best and consents to treatment, and hurry back to their yacht christening parties or whatever. I also assume that most dental patients are basically cool with that approach because they want to be numbed for anything and everything (hard to picture people being cool with surprise drilling though).

In a practical sense you probably don't have much recourse. Online review could have some small effect on their future business, and, if detailed enough, maybe inspire a change to their procedures. Maybe there's some official complaint procedure with your state or your dentist's licensing agency but wouldn't expect a lot of results from that. You could contact the dentist's office to talk to your provider about your experience and to say you needed a better explanation of what they were planning, before they started executing it on your mouth. Consider your goals, I guess. You want a punishment? An apology? Or a change in procedure?

As for finding a new dentist, I've had better luck with a small practice with a basic storefront and without a lot of flashy advertising, but I think to a large extent it's a matter of trial and error. When I was looking for a dentist the most telling thing for me was their reaction to my weird snaggle tooth - one pushed treatment, then admitted only when questioned that it was "an aesthetic issue", the other said she can treat it if I want, but if I'm okay with it then she's okay with it (she's my dentist now). I think you need to choose a candidate, schedule a consultation, and see if you like their demeanor. See if they seem to understand and respond appropriately to your unpleasant experience with your former dentist.

But even with a dentist you like and who seems to respect you, you will need to be vigilant for shot-happy assistants and be willing to delay their yacht christening a bit by asking questions before they get in your mouth.

The dental school here is unappealing to me due to long wait times for appointments and lack of personal history with providers.
posted by adiabatic at 9:00 AM on August 28, 2018

I'm a dentist, not yours of course, and I saw this question last night, there is some confusing info here so i will add a few cents.

Your questions are 1) how to find a good dentist. the answer here is to be a good consumer and look around/ask around and then find someone with whom you feel comfortable and with whom you communicate well, since this seems like a communication problem.

The reason this seems like a communication problem begins with "having my teenage sealants removed". This isn't a thing. Dentists don't routinely remove sealants for any reason other than to also remove decay. there is no reason to remove a sealant that is still doing its job. there is no code for it, there is no procedure called removing sealants.

So, you were there to have cavities filled. if you made that appointment, came to it and sat in the chair, you have consented by implied consent, to the things that that procedure entails, which include local anesthetic if the procedure was invasive (involved drilling).

At some point you and the dentist, and their staff, did not communicate well about why you were appointed, and what was being done, especially the local anesthetic part. It's unusual not to have a conversation about whether the patient wants to be numb. My practice always takes a blood pressure reading at the beginning of that part of the visit and that opens the conversation about what local is being used, how long it will last, and how much of the mouth (not the whole thing) will be affected.

Your second question is about accountability and there are routes you can take if you feel malpractice is involved. States have licensing boards and discipline is handed down through the board.

I have miscommunicated with patients in the past and it weighs on me when i do. I don't feel threatened (much) when patients call me on it, because it's something we can all be better at. My recommendation is that, if you are not still angry, you call the practice and explain what you thought was going to happen, and see how they explain what was different than what you expected. Perhaps they can better explain why they did the procedure and then you can decide if you would have actually preferred a different outcome. It will also give you an opportunity to ask them to adjust the fillings if they still prevent you from flossing.

I am sorry you had this experience.
posted by OHenryPacey at 9:12 AM on August 28, 2018 [27 favorites]

To build on what OHenryPacey wrote, what were you told about the procedure? Did a previous xray show decay? Maybe they thought the entire procedure was explained at a previous visit?

Yes, my blood pressure gets taken at appointments. I forgot about that.
posted by jbenben at 6:10 AM on August 29, 2018

I went back to the dentist and handed them a letter I wrote to help me express my thoughts clearly. Dentist (and assistant) read the letter carefully and, though they were confused at first, were able to see things from my perspective after we talked. They told me they thought they had explained the full procedure but apologized for not making it clear enough. They even gave me a mock explanation to make sure we are on the same page for the type of explanation I expect to hear before consenting to a similar procedure -- that is, a 30-second outline of the steps and the reasoning behind the steps. I'm keeping my next appointment. I'm sure we'll communicate better now.
posted by gray17 at 3:16 PM on August 30, 2018 [6 favorites]

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