FORENSIC CASE

 

Forensic dentistry case book 4: Non-maleficence in dental practice, "primum non nocere"

 

 

H Bernitz

BChD., Dip (Odont)., MSc., PhD. (Pret). Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria. Tel: 013 2826419. e-mail: bernitz@iafrica.com

 

 

A light aircraft flying in bad weather collided with the side of a mountain in southern Kwa- Zulu Natal. The pilot and passenger were carbonised in the fire that ensued after the impact. The bodies were brought to the Medico-legal mortuary in Pretoria for identification. Both had intact dentitions with multiple dental restorations, despite being severely burnt (Figure 1).

 

 

Relatives of the two deceased provided the names of the dentists who had treated the victims of the crash. The wife of deceased #2 informed us that her husband had been busy with a dental treatment plan and that he had a follow up appointment to have the rest of his teeth "fixed". The two dentists were contacted and ante- mortem records were duly collected by the South African Police Services. The ante-mortem records of deceased #2 recorded that the 17 had an old occlusal amalgam filling and three newly placed composite resin fillings on the 14, 15 and 16. This information was used to positively identify deceased #2. The radiological examination of the dentition during the post mortem examination showed no signs of additional caries or any other recognisable pathology. Figure 2 shows the fillings in the first quadrant and the sound dentition in the second quadrant, perhaps putting into question the need for further "fixing" of the dentition.

 

 

Although no steps were taken against the dentist, it seemed highly likely that the fillings in teeth 14, 15 and 16 had been placed in healthy teeth, and that a similar over-servicing was scheduled for the second quadrant. Radiological examination confirmed that the teeth in the rest of the dentition were indeed sound.

 

DISCUSSION

Over-servicing of patients is regarded as unprofessional conduct by the Health Professions Council of South Africa.¹ The principle of non-maleficence which is based on the Hippocratic maxim "primum non nocere" (first, do no harm) is considered to be more important than to do good. The information provided by his wife and the physical examination of the entire dentition made the placing of composite resin fillings on 14, 15 and 16 rather suspicious, although actual over-servicing would have been difficult to prove. Had the individual not died in the aircraft accident, the same fate would quite possibly have befallen the rest of the extremely healthy dentition.

 

Reference

1. Health Professions Council of South Africa. Health Professions Act 56 of 1974. Available from: http://www.hpcsa.co.za

 

 

Notice: All names and places have been changed to protect the next of kin