hearing heard in public prior moreira, hugo manuel

PRIOR MOREIRA, H M Professional Conduct Committee – Apr – Dec 2021 Page -1/29-

HEARING HEARD IN PUBLIC

PRIOR MOREIRA, Hugo Manuel

Registration No: 199909

PROFESSIONAL CONDUCT COMMITTEE

APRIL – DECEMBER 2021

Outcome: Suspension for 6 months with immediate suspension (with a review)

PRIOR MOREIRA, Hugo Manuel, a dentist, LMD Lisbon 2008, was summoned to appear before the Professional Conduct Committee on 26 April 2021 for an inquiry into the following charge:

Charge (as read on 26 April 2021 and as amended on 27 April 2021)

“That, being a registered dentist:

1. Between 16 January 2017 and 15 May 2019, you failed to carry out a sufficient diagnostic assessment, in that:

a. On the four occasions contained in Schedule A1, between 16 January 2017 and 5

b. February 2019, you:

i. did not carry out or record a pain history; and/or

ii. did not carry out or record special tests to diagnose the source of pain.

c. On 16 January 2017, you failed to capture a radiographic image of LR8 which was suitable for diagnostic purposes.

d. On the 11 occasions contained in Schedule B, between 23 January 2017 and 5 February 2019, you failed to retake a radiograph of LR8 despite a continued report of pain in this area and evidence of gross caries.

e. On 18 September 2017 and 28 November 2018, you failed to assess or record Patient A’s:

i. periodontal diagnosis based upon Basic Periodontal Examination (BPE) scores and radiographs; and/or

ii. periodontal risk; and/or

iii. oral health status related to smoking an alcohol use; and/or

iv. caries risk; and/or

v. oral hygiene; and/or

vi. non-carious tooth surface loss; and/or

vii. diet and its impact on Patient A’s teeth.

f. On 18 September 2017 and 28 November 2018, you failed to provide adequate advice to Patient A in regard to her oral health or failed to record the advice provided to Patient A in regard to her oral health.

1 The schedules can be found at the end of this document


g. On 18 September 2017 and 28 November 2018, you failed to identify or record:

i. apical pathology on LL5; and/or

ii. periradicular disease on LR6.

h. On 8 January 2019, you failed to identify or record apical pathology on LL5.

i. On 18 September 2017 and 28 November 2018, you failed to review radiographs from April 2016 or record information regarding your review of the radiographs from April 2016.

j. On 18 September 2017 and 28 November 2018, you failed to recognise the need for new radiographs.

k. On 28 November 2018, you failed to record a review of previous radiographs and record assessment of need for new radiographs.

l. On 11 October 2017, you failed to diagnose or record non-carious tooth surface loss on UL1 despite Patient A complaining of a broken edge of UL1 and previous dentists recording this condition.

m. On 11 October 2017, you failed to establish aetiological factors of non-carious tooth surface loss on UL1 or discuss aetiological factors of non-carious tooth surface loss with Patient A.

n. On 22 March 2018 and 23 April 2018, you failed to diagnose and treat pulpitis in LR8.

o. On 8 January 2019, you failed to diagnose and treat chronic abscess in LR8.

p. On 15 March 2019, you failed to diagnose and treat an acute apical infection in LR7.

2. Between 16 January 2017 and 15 May 2019, you failed to provide an adequate standard of care to Patient A, in that:

a. On the four occasions contained in Schedule C between 16 January 2017 and 20 April 2017 you failed to treat Patient A’s pain in LR8, by:

i. not extracting the tooth; or

ii. not arranging for root canal treatment (RCT); or

iii. not referring Patient A for extraction; and/or

iv. not placing a sedative dressing until the provision of a RCT or extraction.

b. On 23 January 2017, you carried out the restoration treatment on LL5 by:

i. attempting to re-cement an amalgam filling; and/or

ii. filling the tooth with glass ionomer which was not appropriate material in the circumstances.

c. On 23 March 2017, you carried out the restoration treatment on LR8 by filling the tooth with a composite filling, when alternative treatment would have been appropriate, specifically:

i. extracting the tooth; or


ii. arranging for RCT; or

iii. referring Patient A for extraction; and/or

iv. placing a sedative dressing until the provision of a RCT or extraction.

d. On 11 October 2017, 8 January 2018 and 25 March 2019, you carried out the restoration treatment on LR6 which was not suitable treatment in the circumstances.

e. On 24 January 2018, 19 April 2018 and 28 November 2018, you failed to identify that LR8 was unsuitable for restoration and filled the tooth with a glass ionomer, when alternative treatment would have been appropriate, specifically:

i. extracting the tooth; or


iii. referring Patient A for extraction.

f. On the four occasions contained in Schedule D, between 22 March 2018 and 5 February 2019 you failed to treat Patient A’s pain in LR8 by:



iii. not referring Patient A for extraction.

g. On 8 January 2019 and 5 February 2019, you carried out the restoration treatment on LL5 and LL6 by filling the teeth with a glass ionomer which was not appropriate material in the circumstances.

h. On 5 February 2019, 20 February 2019 and 15 March 2019, you failed to treat Patient A’s pain in LR7 by:


ii. not arranging for root canal treatment; or

iii. not referring Patient A for extraction; and/or

iv. not placing a sedative dressing until the provision of a root canal treatment or extraction.

i. On 5 February 2019 and 15 March 2019, you advised that Patient A use a salt water mouthwash to treat pain in LR7 and LR8 which was inappropriate and/or ineffective.

J. On 20 February 2019, with regard to the RCT on LL5, you:

i. failed to discuss or record the risks and benefits of RCT with Patient A; and/or

ii. failed to discuss or record the likely success of RCT with Patient A; and/or

iii. failed to take a radiograph before starting the RCT; and/or

iv. left LL5 “open to drain”.

k. On/or before 25 March 2019, with regard to the RCT on LR7, you:


i. failed to discuss or record the risks and benefits of RCT with Patient A; and/or

ii. failed to discuss or record the likely success of RCT with Patient A.

l. With regard to RCT on LL5 and/or LR7, you failed to obtain informed consent in that you did not discuss the risks and benefits and/or the likely success of RCT with Patient A.

m. On 25 April 2019, you undertook RCT on LR7 which was not adequate, in that you:

i. failed to fill the distal canal adequately leaving voids; and/or

ii. did not remove gross caries in the mesial of the crown.

3. On 18 September 2017 and 28 November 2018, you failed to carry out or record sufficient treatment planning with regard to either the filling or extraction of:

i. LR6;

ii. LL5;

iii. LL6;

iv. LR8.

AND that, in consequence of the matters set out above, your fitness to practise is impaired by reason of your misconduct.”

On 26 and 27 April 2021 the Chairman made a statement regarding preliminary matters. On 30 April 2021 the Chairman announced the findings of fact to the Counsel for the GDC:

“Mr Prior Moreira

You are present at this hearing of the Professional Conduct Committee (PCC). You are represented by Mr Matthew McDonagh of Counsel, instructed by BTO solicitors. Mr Sam Thomas of Counsel, instructed by the GDC’s In-House Legal Presentation Service, appears for the GDC.

The hearing is being held remotely using Microsoft Teams in line with the GDC’s current practice.

Preliminary matters

On 26 April 2021 Mr McDonagh tendered admissions on your behalf to a number of the heads of charge that you face. The Committee noted the admissions. The admissions are set out below.

On 27 April 2021, during the course of the GDC’s case on the facts, Mr Thomas applied to amend some of the heads of charge in accordance with Rule 18 of the General Dental Council (Fitness to Practise) Rules 2006 (‘the Rules’). Mr McDonagh supported the application on your behalf. The Committee accepted the advice of the Legal Adviser. The Committee determined to accede to the application. The heads of charge were amended as set out below.


FINDINGS OF FACT – 30 April 2021

Background to the case and summary of allegations

The allegations giving rise to this hearing relate to the standard of care and treatment that you provided to a patient, who is referred to for the purposes of these proceedings as Patient A, in the period of 16 January 2017 to 15 May 2019.

Patient A first attended on you on 16 January 2017 for the purposes of an emergency appointment in connection with toothache. You remained responsible for the patient until 20 May 2019, at which point the patient saw another dentist for a second opinion. Patient A saw other dentists in the period in which you were caring for and treating her.

The GDC brings a number of specific allegations against you, which may be summarised as follows.

The GDC alleges that you failed to carry out a sufficient diagnostic assessment of Patient A in the overall period referred to above. The GDC contends that, in particular, you did not carry out or record pain histories and special diagnostic tests on four specific occasions; that you failed to capture a suitable radiographic image of the patient’s LR8 at the first appointment that you had with her; that on 11 occasions you failed to retake a radiograph of that same tooth despite the persistence of pain and gross caries; that you failed to provide adequate oral health advice or record such advice; that you failed to identify or record apical pathology at the patient’s LL5 at three separate appointments and failed to identify or record periradicular disease at the patient’s LR6; that you failed to review existing radiographs or record such reviews, including recognising the need for new radiographs; that you failed to diagnose or record non-carious tooth surface loss at the patient’s UL1, and establish or discuss aetiological factors of such loss; that you failed to diagnose and treat pulpitis and subsequent chronic abscess at the patient’s LR8; and failed to diagnose and treat an acute apical infection at the adjacent LR7.

The GDC also alleges that you failed to provide an adequate standard of care to Patient A in the overall period of 16 January 2017 to 15 May 2019.

It is specifically contended that, on four occasions between 16 January 2017 and 20 April 2017, you failed to treat Patient A’s pain at LR8, including by not extracting the tooth, not arranging for root canal treatment (RCT), not referring the patient for extraction, and not placing a sedative dressing until RCT or extraction. The GDC also alleges that you failed to treat pain at the same tooth on a further four subsequent occasions. It is also alleged that you did not carry out the restoration of LL5 adequately. The GDC contends that you carried out restoration treatment at the patient’s LR8 when alternative treatment would have been appropriate, and on three further dates when such treatment was not appropriate, and that you also carried out restoration treatment at the patient’s LR6 on three separate occasions when such treatment was not suitable.

It is also alleged that you carried out restoration treatment at the patient’s LL5 and LL6 with glass ionomer, when such material was not appropriate. The GDC further alleges that on three occasions you failed to treat Patient A’s pain at LR7, including by not extracting the tooth, not arranging for RCT, not referring the patient for extraction, and not placing a sedative dressing until RCT or extraction. You also face allegations that on two occasions you advised Patient A to use a salt water mouthwash to treat pain in LR7 and LR8, with such advice being inappropriate and ineffective. It is also alleged that, with regard to RCT at the patient’s LL5, you failed to discuss or record the risks, benefits and likely success of RCT


with Patient A, that you failed to take a preoperative radiograph, and that you left the LL5 ‘open to drain’. With regard to RCT at the patient’s LR7, it is alleged that you failed to discuss or record the risks, benefits and likely success of RCT with Patient A. The GDC alleges that, as a result, with regard to RCT at LL5 and LR7, you failed to obtain the patient’s informed consent. The GDC also contends that your RCT at Patient A’s LR7 was inadequate.

Finally, the GDC alleges that you failed to carry out or record sufficient treatment planning with regard to either the filling or extraction of four teeth, namely LR6, LL5, LL6 and LR8.

Evidence

The Committee has been provided with documentary material in relation to the heads of charge that you face, including the report of the GDC’s expert witness, namely Ms Patricia Thomson; the witness statement, documentary exhibits and dental records of Patient A; and a witness statement provided by you.

The Committee heard oral evidence from Patient A, from Ms Thomson, and from you.

Committee’s findings of fact

The Committee has taken into account all the evidence presented to it, both written and oral. It has considered the submissions made by Mr Thomas on behalf of the GDC and those made by Mr McDonagh on your behalf.

The Committee has accepted the advice of the Legal Adviser. The Committee is mindful that the burden of proof lies with the GDC and has considered the heads of charge against the civil standard of proof, that is to say, the balance of probabilities. The Committee has considered each head of charge separately, although some of its findings will be announced together.

I will now announce the Committee’s findings in relation to each head of charge:

1. Between 16 January 2017 and 15 May 2019, you failed to carry out a sufficient diagnostic assessment, in that:

1. (a) On the four occasions contained in Schedule A, between 16 January 2017 and 5 February 2019, you:

1. (a) (i) did not carry out or record a pain history; and/or

Admitted and proved in respect of not recording; not proved in respect of not carrying out

The Committee finds the facts alleged at head of charge 1 (a) (i) not proved in respect of not carrying out a pain history. The Committee finds the facts alleged at the same head of charge proved in respect of not recording the same on the basis of your admission.

Patient A’s evidence to the Committee is that she could not recall you asking about her pain history at the four appointments specified at Schedule A. The evidence of the GDC’s expert witness, namely Ms Thomson, is that you ‘may have failed’ to take a pain history on the basis there is no record of any pain history. The Committee notes that you admit that you did not make a record of Patient A’s pain history, but that you contend that you did carry out a pain history.


The Committee considers that, judging from Patient A’s records, it is more likely than not that there was some discussion about Patient A’s pain. The Committee has not been presented with sufficient evidence to demonstrate that you did not take a pain history on the dates specified.

In approaching this head of charge, and the other heads of charge set out below, the Committee notes your good character and that you have admitted many of the alleged failings in your practice and have not sought to make excuses. You have candidly stated that your record-keeping was poor. Against this background the Committee accepts as credible and plausible your account that you did take such histories, albeit that you did not record your taking of those histories. The Committee accepts that it was your standard practice to take such histories, and it does not infer from the absence of a record of a pain history that you did not carry out a pain history. The Committee also rejects the GDC’s submission that the absence of a structured approach to your subsequent treatment of the patient demonstrates that you did not take a pain history, as it considers that this does not provide proof of you not taking a pain history.

For these reasons, the Committee finds the facts alleged at head of charge 1 (a) (i) not proved in respect of not carrying out a pain history. The Committee finds the facts alleged at the same head of charge proved in respect of not recording the same on the basis of your admission.

1. (a) (ii) did not carry out or record special tests to diagnose the source of pain.

Admitted and proved in respect of not recording; not proved in respect of not carrying out

The Committee finds the facts alleged at head of charge 1 (a) (ii) not proved in respect of not carrying out special tests to diagnose the source of pain. The Committee finds the facts alleged at the same head of charge proved in respect of not recording the same on the basis of your admission.

The evidence presented to the Committee is that on 16 January 2017 you took a periapical radiograph of the patient’s LR8 at which she had complained of experiencing pain. A further radiograph was taken on the last date specified at Schedule A, namely 5 February 2019. The Committee is mindful, however, that there are other special tests that can be conducted. Your evidence to the Committee is that it was your usual practice to conduct special tests, including tender to percussion (TTP) tests and response to cold stimuli. You stated that you conducted these tests for Patient A. Patient A’s evidence is that sometimes you squirted air or water on her teeth, which suggests that you may have undertaken special tests on this occasion.

The Committee considers that the GDC has not demonstrated to the required standard that you did not undertake special tests to diagnose the source of Patient A’s pain. The Committee again accepts as credible and plausible your account that you did carry out such special tests, albeit that you did not record your carrying out of those tests. The Committee does not infer from the absence of a record of these tests that you did not carry out such tests.

For these reasons, the Committee finds the facts alleged at head of charge 1


(a) (ii) not proved in respect of not carrying out special tests. The Committee finds the facts alleged at the same head of charge proved in respect of not recording the same on the basis of your admission.

1. (b) On 16 January 2017, you failed to capture a radiographic image of LR8 which was suitable for diagnostic purposes.

Admitted and proved

The Committee finds the facts alleged at head of charge 1 (b) proved on the basis of your admission.

1. (c) On the 11 occasions contained in Schedule B, between 23 January 2017 and 5 February 2019, you failed to retake a radiograph of LR8 despite a continued report of pain in this area and evidence of gross caries.

Admitted and proved

The Committee finds the facts alleged at head of charge 1 (c) proved on the basis of your admission.

1. (d) On 18 September 2017 and 28 November 2018, you failed to assess or record Patient A’s:

1. (d) (i) periodontal diagnosis based upon Basic Periodontal Examination (BPE) scores and radiographs; and/or

Admitted and proved in respect of failing to assess

The Committee finds the facts alleged at head of charge 1 (d) (i) proved in respect of failing to assess on the basis of your admission.

Having found that you failed to assess Patient A’s periodontal diagnosis, it follows that you could not record that which you did not do.

1. (d) (ii) periodontal risk; and/or

Admitted but not proved in respect of failing to record; proved in respect of failing to assess

The Committee finds the facts alleged at head of charge 1 (d) (ii) proved in respect of failing to assess the patient’s periodontal risk. The Committee considers that it follows from its finding at head of charge 1 (d) (i) above that, as you did not assess Patient A’s periodontal diagnosis, you could not have assessed the patient’s periodontal risk.

Having found that you failed to assess Patient A’s periodontal risk, it follows that you could not record that which you did not do.

1. (d) (iii) oral health status related to smoking and alcohol use; and/or

Admitted and proved in respect of failing to record on 18 September 2017; not proved in respect of failing to assess; and admitted but not proved in respect of failing to record on 28 November 2018

The Committee finds the facts alleged at head of charge 1 (d) (iii) not proved in respect of failing to assess.

You accept that you did not record Patient A’s oral health status related to


smoking and alcohol use. Your evidence is that you did, however, assess the patient’s oral health status as a matter of routine. The Committee accepts your evidence as credible and plausible. The Committee has not been provided with the patient’s medical history form, and the Committee is therefore not able to be satisfied that you were under a duty to assess the patient’s oral health status related to smoking and alcohol use. The Committee heard from Patient A that she did not recall the appointments in question. For these reasons, the Committee finds the facts alleged at head of charge 1 (d) (iii) not proved in respect of failing to assess.

The Committee finds the facts alleged at this head of charge proved in respect of not recording the patient’s oral health status relating to smoking and alcohol use in respect of 18 September 2017 on the basis of your admission. However, although Ms Thomson’s written evidence suggested to the contrary, the Committee notes from the patient’s records that you did in fact make an entry in respect of 28 November 2018 concerning the patient’s medical and social history, which the Committee understands relates to the patient’s oral health status, including smoking and alcohol use. The Committee therefore finds the facts alleged at head of charge 1 (d) (iii) not proved in respect of you not recording the patient’s oral health status relating to smoking and alcohol use in respect of 28 November 2018.

1. (d) (iv) caries risk; and/or

Admitted and proved in respect of failing to record; not proved in respect of failing to assess

The Committee finds the facts alleged at head of charge 1 (d) (iv) not proved in respect of failing to assess.

The expert evidence of Ms Thomson is that ‘caries risk is based on an examination of oral hygiene’, amongst other factors. The Committee notes from the records that you made of these appointments with Patient A that you made entries concerning the patient’s oral hygiene. This is suggestive of you having assessed the patient’s caries risk. Your evidence is that you did assess the patient’s caries risk as a matter of routine, although you accept that you did not record that risk. The Committee again accepts your account as credible and plausible. The Committee is also mindful that Patient A stated that she was not able to recall the appointments in question. The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not assess the patient’s caries risk.

The Committee finds the facts alleged at this head of charge proved in respect of not recording the patient’s caries risk on the basis of your admission.

1. (d) (v) oral hygiene; and/or

Admitted in respect of failing to record; but not proved in respect of failing to assess or record

The Committee finds the facts alleged at head of charge 1 (d) (v) not proved in respect of failing to assess.

As set out at head of charge 1 (d) (iv) above, the Committee notes from the


records that you made of these appointments with Patient A that you made entries concerning the patient’s oral hygiene. This is suggestive of you having assessed the patient’s oral hygiene, including the need for a scale and polish. Your evidence is that you did assess the patient’s oral hygiene as a matter of routine, although you accept that you did not record that assessment. The Committee again accepts your account as credible and plausible. The Committee is also mindful that Patient A stated that she was not able to recall the appointments in question. The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not assess the patient’s oral hygiene.

The Committee also finds that you did make records of the patient’s oral hygiene despite your admission to the contrary, and despite the evidence of Ms Thomson to the effect that you did not make a record of your assessment of the patient’s oral hygiene relating either to toothbrushing or interdental cleaning. In fact, the Committee notes that you did make records of the patient’s oral hygiene concerning toothbrushing and interdental cleaning on both occasions.

The Committee therefore finds the facts alleged at head of charge 1 (d) (v) not proved in their entirety.

1. (d) (vi) non-carious tooth surface loss; and/or


The Committee finds the facts alleged at head of charge 1 (d) (vi) not proved in respect of failing to assess.

Your evidence to the Committee is that you did assess the patient’s non-carious tooth surface loss as a matter of routine, although you accept that you did not record those matters. The Committee again accepts your account as credible and plausible. Further, there is an entry in the patient’s notes concerning an appointment in the intervening period on 11 October 2017 about the patient’s enquiry about veneers, which you advised would not be wise at that time. You also recorded that a filling was not indicated as there was a high chance of the filling breaking. The patient is recorded as having accepted that. These contemporaneous entries support your account that you assessed the patient’s non-carious tooth surface loss. The Committee is also mindful that Patient A stated that she was not able to recall the appointments in question. The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not assess the patient’s non-carious tooth surface loss.

The Committee finds the facts alleged at this head of charge proved in respect of not recording the patient’s non-carious tooth surface loss on the basis of your admission.

1. (d) (vii)

diet and its impact on Patient A’s teeth.



The Committee finds the facts alleged at head of charge 1 (d) (vii) not proved in respect of failing to assess.

Your evidence to the Committee is that you did assess the patient’s diet and its impact on her teeth as a matter of routine, although you accept that you did not record those matters. The Committee again accepts your account as credible and plausible. The Committee is also mindful that Patient A stated that she was not able to recall the appointments in question. The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not assess the patient’s diet and its impact on her teeth.

The Committee finds the facts alleged at this head of charge proved in respect of not recording the patient’s diet and its impact on her teeth on the basis of your admission.

1. (e) On 18 September 2017 and 28 November 2018, you failed to provide adequate advice to Patient A in regard to her oral health or failed to record the advice provided to Patient A in regard to her oral health.

Admitted but not proved in respect of failing to record; not proved in respect of failing to provide adequate advice

The Committee finds the facts alleged at head of charge 1 (e) not proved in respect of failing to provide adequate advice.

Your evidence to the Committee is that you did provide adequate advice to the patient with regard to her oral health, although you accept that you did not record those matters. The Committee again accepts your account as credible and plausible. The Committee is also mindful that Patient A stated that she was not able to recall the appointments in question. The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not provide adequate advice to Patient A with regard to her oral health. The Committee is also mindful of its findings at head of charge 1 (d) concerning your assessment of some of the aspects of oral health.

The Committee is particularly mindful of its finding concerning your assessment of oral hygiene as referred to at head of charge 1 (d) (v), given its significance as ‘one of the most important prognosticators of oral health’ as stated by Ms Thomson. The Committee considers that, as you assessed oral health, it is more likely than not that you did, as you maintain, discuss those matters with Patient A. For instance, in respect of oral hygiene, you recorded that you advised the patient about tooth brushing and interdental cleaning at both appointments in question.

The Committee also finds that you did make records of the patient’s oral health despite your admission to the contrary, and despite Ms Thomson’s evidence that you did not give Patient A any advice regarding oral hygiene. The Committee again notes that you recorded that you advised the patient about tooth brushing and interdental cleaning at both appointments in question.

1. (f) On 18 September 2017 and 28 November 2018, you failed to identify or record:

1. (f) (i) apical pathology on LL5; and/or


Admitted and proved in respect of failing to identify

The Committee finds the facts alleged at head of charge 1 (f) (i) proved in respect of failing to identify apical pathology on the basis of your admission.

Having found that you failed to identify apical pathology, it follows that you could not record that which you did not do.

1. (f) (ii) periradicular disease on LR6.


The Committee finds the facts alleged at head of charge 1 (f) (ii) proved in respect of failing to identify periradicular disease on the basis of your admission.

Having found that you failed to identify periradicular disease, it follows that you could not record that which you did not do.

1. (g) On 8 January 2019, you failed to identify or record apical pathology on LL5.


The Committee finds the facts alleged at head of charge 1 (g) proved in respect of failing to identify apical pathology on the basis of your admission.

Having found that you failed to identify apical pathology, it follows that you could not record that which you did not do.

1. (h) On 18 September 2017 and 28 November 2018, you failed to review radiographs from April 2016 or record information regarding your review of the radiographs from April 2016.

Admitted and proved in respect of failing to review

The Committee finds the facts alleged at head of charge 1 (h) proved in respect of failing to review radiographs from April 2016 on the basis of your admission.

Having found that you failed to review those radiographs, it follows that you could not record that which you did not do.

1. (i) On 18 September 2017 and 28 November 2018, you failed to recognise the need for new radiographs.

Admitted and proved

The Committee finds the facts alleged at head of charge 1 (i) proved on the basis of your admission.

1. (j) On 28 November 2018, you failed to record a review of previous radiographs and record assessment of need for new radiographs.

Admitted but not proved

The Committee finds the facts alleged at head of charge 1 (j) not proved. Although you admitted to this head of charge, the Committee considers that this head of charge is a tautology given its findings above at head of charge 1 (h) and 1 (i).


1. (k) On 11 October 2017, you failed to diagnose or record non-carious tooth surface loss on UL1 despite Patient A complaining of a broken edge of UL1 and previous dentists recording this condition.

Admitted and proved in respect of failing to record; not proved in respect of failing to diagnose

The Committee finds the facts alleged at head of charge 1 (k) not proved.

As set out above at head of charge 1 (d) (vi), your evidence to the Committee is that you did assess the patient’s non-carious tooth surface loss as a matter of routine, although you accept that you did not record those matters. The Committee again accepts your account as credible and plausible. The entry in the patient’s notes concerning the appointment on 11 October 2017 stated that the patient enquired about veneers, which you advised would not be wise at that time. You also recorded that a filling was not indicated as there was a high chance of the filling breaking. The patient is recorded as having accepted that. These contemporaneous entries support your account that you assessed the patient’s non-carious tooth surface loss. The Committee is also mindful that Patient A stated that she did recall some discussion at this appointment about veneers and their inappropriateness, albeit that she could only recall that she was told that it would be a waste of money, or words to that effect. The Committee therefore considers that the GDC has not demonstrated to the required standard that you failed to diagnose non-carious tooth surface loss on UL1.

The Committee finds the facts alleged at this head of charge proved in respect of not recording the patient’s non-carious tooth surface loss at UL1 on the basis of your admission. Although there is some evidence from the notes that you were aware of the non-carious tooth surface loss, this is not properly or explicitly recorded in the patient’s notes.

1. (l) On 11 October 2017, you failed to establish aetiological factors of non-carious tooth surface loss on UL1 or discuss aetiological factors of non-carious tooth surface loss with Patient A.

Not proved

The Committee finds the facts alleged at head of charge 1 (l) not proved.

The Committee has found above that you did assess and diagnose non-carious tooth surface loss. Your evidence is that the cause was grinding, although you did not record that possible cause. You also stated in evidence that you advised against a filling, as well as against veneers, and this is further suggestive of you having been of the view that grinding was a cause of non-carious tooth surface loss and of having discussed that factor with the patient. The Committee again accepts your evidence as credible and plausible.

Ms Thomson’s evidence was that there was no evidence of grinding on the available radiographs, although she accepted that the radiographs were not conclusive. Your evidence is that your visual intraoral examination indicated grinding. In any event, the Committee understands this head of charge as relating to whether any aetiological factors were identified, and not whether the factors identified were correct. Patient A’s evidence is that at some point she


recalls you asking her whether she suffered from acid reflux, which might result in acid erosion of the tooth, although she could not recall the date of the appointment or appointments at which you asked her. The Committee is therefore not able to conclude that you did not discuss aetiological factors of non-carious tooth surface loss at UL1, and the Committee again accepts as credible and plausible your evidence that you did so.

The Committee therefore considers that the GDC has not demonstrated to the required standard that you did not establish aetiological factors of non-carious tooth surface loss at UL1, or discuss such factors with Patient A. Accordingly, the Committee finds the facts alleged at head of charge 1 (l) not proved.

1. (m) On 22 March 2018 and 23 April 2018, you failed to diagnose and treat pulpitis in LR8.

Admitted and proved

The Committee finds the facts alleged at head of charge 1 (m) proved on the basis of your admission.

1. (n) On 8 January 2019, you failed to diagnose and treat chronic abscess in LR8.

Admitted and proved

The Committee finds the facts alleged at head of charge 1 (n) proved on the basis of your admission.

1. (o) On 15 March 2019, you failed to diagnose and treat an acute apical infection in LR7.

Proved

The Committee finds the facts alleged at head of charge 1 (o) proved.

The Committee notes that you made an entry in the patient’s notes at the earlier appointment that took place on 5 February 2019 concerning sensitivity and swelling at the patient’s LR7. You took a radiograph of the patient’s lower right quadrant and, having noted periradicular radiolucency at the LR7 and adjacent LR8, you identified that fillings were required. At the appointment on 15 March 2019, you noted swelling on the right side, but diagnosed recurrent pulpitis rather than an acute apical infection. Indeed, you specifically recorded that the patient did not have an infection. The Committee therefore finds that you did not diagnose an acute apical infection. The Committee prefers this evidence to your subsequent written witness statement in which you state that you were aware of the infection, as it considers that your contemporaneous written record is likely to be more reliable.

The Committee also notes from your evidence that you did not treat the infection at that appointment. The Committee accepts the expert evidence of Ms Thomson that you were under a duty to diagnose and treat the infection.

The Committee therefore finds the facts alleged at head of charge 1 (o) proved.

2. Between 16 January 2017 and 15 May 2019, you failed to provide an adequate standard of care to Patient A, in that:


2. (a) On the four occasions contained in Schedule C between 16 January 2017 and 20 April 2017 you failed to treat Patient A’s pain in LR8, by:

2. (a) (i) not extracting the tooth; or

Not proved

The Committee finds the facts alleged at head of charge 2 (a) (i) not proved.

Patient A attended four appointment in the above period, namely 16 January 2017, 23 January 2017, 23 March 2017 and 20 April 2017. Those four dates are specified at Schedule C.

Patient A complained of pain at the LR8 in January 2017, and indeed had complained of intermittent pain from that area since 2013.

The first of the four appointments on 16 January 2017 was an emergency appointment. Decay was noted at LR8 and, as referred to above, a radiograph was taken of the lower-right quadrant. Your evidence is that you attempted to save the tooth at that appointment, and that that was a reasonable course of action, rather than extracting the tooth. You admit that it would have been appropriate to extract the tooth at the subsequent three appointments, although you would not have undertaken the extraction yourself. Ms Thomson stated that the tooth was doomed, and that you should have extracted the tooth, or referred for extraction. Ms Thomson also entertains the possibility that you might have decided to attempt RCT, although she was doubtful as to the prospects of success. Ms Thomson states that a referral for extraction to a specialist clinic would have been reasonable if you considered that you lacked the necessary skills.

The Committee considers that it was reasonable for you not to have attempted to extract LR8 at the first appointment on 16 January 2017, or indeed at the three subsequent appointments, on the basis that it was appropriate for you to instead refer the patient to another practitioner for extraction. You accept that you should have referred the patient for extraction, and the Committee below finds that you should have done so. It therefore finds that this alternative head of charge at head of charge 2 (a) (i) falls away and is not proved.

2. (a) (ii) not arranging for root canal treatment (RCT); or

Not proved

The Committee finds the facts alleged at head of charge 2 (a) (ii) not proved. As set out at head of charge 2 (a) (i) above, the Committee considers that it would have been appropriate for you to refer the patient to another practitioner for extraction. You accept that you should have referred the patient for extraction, and the Committee below finds that you should have done so. It therefore finds that this alternative head of charge at head of charge 2 (a) (ii) falls away and is not proved.

2. (a) (iii) not referring Patient A for extraction; and/or

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (a) (iii) proved on


the basis of your admission.

2. (a) (iv) not placing a sedative dressing until the provision of a RCT or extraction.

Admitted and proved in respect of 16 January 2017; proved in respect of 23 January 2017 and 23 March 2017; and not proved in respect of 20 April 2017

The Committee finds the facts alleged at head of charge 2 (a) (iv) proved in respect of 16 January 2017 on the basis of your admission. The Committee also finds the facts alleged in respect of 23 January 2017 and 23 March 2017 proved. The Committee finds the facts alleged not proved concerning 20 April 2017.

The Committee finds, and you accept, that you should have placed a sedative dressing at the patient’s LR8 at the first appointment on 16 January 2017. At the next appointment on 23 January 2017, you advised the patient that a filling was needed. It does not appear that you filled the tooth on that date. The Committee accepts the expert evidence of Ms Thomson that you should have applied a sedative dressing at that appointment. The patient next saw you on 23 March 2017, at which you noted that decay was worsening at LR8. You filled the tooth at that appointment. The Committee accepts the expert evidence of Ms Thomson that that was the wrong choice of treatment, and that instead a sedative dressing should have been applied pending extraction. The Committee finds that you were not under a duty to apply a sedative dressing at the final appointment on 20 April 2017, as the patient was not reported to be in pain at that appointment, and it was therefore not necessary for you to remove the filling which had been placed at the previous appointment for the purposes of applying such a dressing.

2. (b) On 23 January 2017, you carried out the restoration treatment on LL5 by:

2. (b) (i) attempting to re-cement an amalgam filling; and/or

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (b) (i) proved on the basis of your admission.

2. (b) (ii) filling the tooth with glass ionomer which was not appropriate material in the circumstances.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (b) (ii) proved on the basis of your admission.

2. (c) On 23 March 2017, you carried out the restoration treatment on LR8 by filling the tooth with a composite filling, when alternative treatment would have been appropriate, specifically:

2. (c) (i) extracting the tooth; or

Not proved

The Committee finds the facts alleged at head of charge 2 (c) (i) not proved.


As set out above, Patient A saw you on 23 March 2017, at which appointment you placed a composite filling at LR8.

As set out at head of charge 2 (a) (i) above, the Committee considers that it would have been appropriate for you to refer the patient to another practitioner for extraction. You accept that you should have referred the patient for extraction, and the Committee below finds that you should have done so. It therefore finds that this alternative head of charge at head of charge 2 (c) (i) falls away and is not proved.

2. (c) (ii) arranging for RCT; or

Not proved

The Committee finds the facts alleged at head of charge 2 (c) (ii) not proved.

As set out at head of charge 2 (a) (i) above, the Committee considers that it would have been appropriate for you to refer the patient to another practitioner for extraction. You accept that you should have referred the patient for extraction and placed a sedative dressing, and the Committee below finds that you should have done so. It therefore finds that this alternative head of charge at head of charge 2 (c) (ii) falls away, and is not proved.

2. (c) (iii) referring Patient A for extraction; and/or

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (c) (iii) proved on the basis of your admission.

2. (c) (iv) placing a sedative dressing until the provision of a RCT or extraction.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (c) (iv) proved on the basis of your admission.

2. (d) On 11 October 2017, 8 January 2018 and 25 March 2019, you carried out the restoration treatment on LR6 which was not suitable treatment in the circumstances.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (d) proved on the basis of your admission.

2. (e) On 24 January 2018, 19 April 2018 and 28 November 2018, you failed to identify that LR8 was unsuitable for restoration and filled the tooth with a glass ionomer, when alternative treatment would have been appropriate, specifically:

2. (e) (i) extracting the tooth; or

Not proved

The Committee finds the facts alleged at head of charge 2 (e) (i) not proved.

You accept that, rather than attempting to restore the patient’s LR8 with a glass ionomer filling, you should have referred the patient for extraction. The Committee below finds that you should indeed have referred the patient for


extraction. It therefore finds that this alternative head of charge at head of charge 2 (e) (i) falls away and is not proved.

2. (e) (ii) arranging for RCT; or

Not proved

The Committee finds the facts alleged at head of charge 2 (e) (ii) not proved.

You accept that, rather than attempting to restore the patient’s LR8 with a glass ionomer filling, you should have referred the patient for extraction. The Committee below finds that you should indeed have referred the patient for extraction. It therefore finds that this alternative head of charge at head of charge 2 (e) (ii) falls away and is not proved.

2. (e) (iii) referring Patient A for extraction.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (e) (iii) proved on the basis of your admission.

2. (f) On the four occasions contained in Schedule D, between 22 March 2018 and 5 February 2019 you failed to treat Patient A’s pain in LR8 by:

2. (f) (i) not extracting the tooth; or

Not proved

The Committee finds the facts alleged at head of charge 2 (f) (i) not proved.

You accept that you should have referred the patient for extraction on the dates set out at Schedule D. The Committee below finds that you should indeed have referred the patient for extraction. It therefore finds that this alternative head of charge at head of charge 2 (f) (i) falls away and is not proved.

2. (f) (ii) arranging for RCT; or

Not proved

The Committee finds the facts alleged at head of charge 2 (f) (ii) not proved.

You accept that you should have referred the patient for extraction on the dates set out at Schedule D. The Committee below finds that you should indeed have referred the patient for extraction. It therefore finds that this alternative head of charge at head of charge 2 (f) (ii) falls away and is not proved.

2. (f) (iii) not referring Patient A for extraction.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (f) (iii) proved on the basis of your admission.

2. (g) On 8 January 2019 and 5 February 2019, you carried out the restoration treatment on LL5 and LL6 by filling the teeth with a glass ionomer which was not appropriate material in the circumstances.

Admitted and proved


The Committee finds the facts alleged at head of charge 2 (g) proved on the basis of your admission.

2. (h) On 5 February 2019, 20 February 2019 and 15 March 2019, you failed to treat Patient A’s pain in LR7 by:

2. (h) (i) not extracting the tooth; or

Not proved

The Committee finds the facts alleged at head of charge 2 (h) (i) not proved.

At the first of these three appointments on 5 February 2019, you noted sensitivity and swelling at LR7. As set out in respect of head of charge 1 (o), the Committee notes that you took a radiograph of the patient’s lower right quadrant and, having noted periradicular radiolucency at the LR7 and adjacent LR8, you identified that fillings were required. The patient reattended on 20 February 2019 in connection with a complaint of pain and swelling at around LL5. That appointment had originally been made for the purposes of treating the LR7. In your written evidence to the Committee, you stated that the issue concerning the patient’s LL5 was ‘more pressing than the LR7’. At this appointment on 20 February 2019 the patient’s notes state, ‘LR7 was to be deal (sic) with, however the patient has been fine from this since last appt […] patient accepted this’. Since the patient was not apparently in pain from LR7 at this appointment, the Committee considers that there was no pain to treat in this tooth on this occasion.

At the appointment on 15 March 2019, you noted swelling on the right side, but diagnosed recurrent pulpitis rather than an acute apical infection. Indeed, you specifically recorded that the patient did not have an infection. The Committee therefore finds that you did not diagnose an acute apical infection. The Committee prefers this evidence to your subsequent written witness statement in which you state that you were aware of the infection, as it considers that your contemporaneous written record is likely to be more reliable. On 15 March 2019 the patient reattended complaining of a swelling on the lower right side. You prescribed mouthwash, which Ms Thomson states would not have treated the patient’s pain, with a view to the patient returning for RCT on 25 March 2019. You stated in your written evidence that you should have started RCT on 15 March 2019. Ms Thomson states that you should have attempted RCT, or extracted the tooth, or referred the tooth for extraction.

The Committee accepts the expert evidence of Ms Thomson that, if not extracting the tooth or referring for extraction, you should have arranged for RCT. It therefore finds that this alternative head of charge at head of charge 2 (h) (i) falls away and is not proved.

2. (h) (ii) not arranging for root canal treatment; or

Proved in respect of 5 February 2019; not proved in respect of 20 February 2019 and 15 March 2019

The Committee finds the facts alleged at head of charge 2 (h) (ii) proved in respect of 5 February 2019 only.

The Committee accepts the expert evidence of Ms Thomson that, if not


extracting the tooth or referring for extraction, you should have arranged for RCT. The Committee considers that you did not arrange for RCT at the first appointment on 5 February 2019. The Committee considers that, as no pain was apparent at the next appointment on 20 February 2019, there was no culpable failure to treat pain by providing or arranging for RCT at that appointment. You accept that you should have commenced RCT on 15 March 2019, although the evidence is that you arranged for the patient to return for such treatment ten days later on 25 March 2019. This amounts to arranging for RCT on 15 March 2019.

The Committee considers that you did therefore fail to arrange for RCT on 5 February 2019, but that there was no such failure at the final two appointments on 20 February 2019 and 15 March 2019.

2. (h) (iii) not referring Patient A for extraction; and/or

Not proved

As set out at head of charge 2 (h) (i), you accept that you should have commenced RCT on 15 March 2019. The Committee accepts the expert evidence of Ms Thomson that, if not extracting the tooth or referring for extraction, you should have arranged for RCT. It therefore finds that this alternative head of charge at head of charge 2 (h) (iii) falls away, and is not proved.

2. (h) (iv) not placing a sedative dressing until the provision of a root canal treatment or extraction.

Admitted and proved regarding 5 February 2019 and 15 March 2019; not proved regarding 20 February 2019

The Committee finds the facts alleged at head of charge 2 (h) (iv) proved in respect of 5 February 2019 and 15 March 2019 on the basis of your admission.

The Committee finds the facts alleged at this head of charge not proved in respect of 20 February 2019. As set out at head of charge 2 (h) (ii) above, as no pain was apparent at that appointment, you were not under a duty to place a sedative dressing.

2. (i) On 5 February 2019 and 15 March 2019, you advised that Patient A use a salt water mouthwash to treat pain in LR7 and LR8 which was inappropriate and/or ineffective.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (i) proved on the basis of your admission.

2. (j) On 20 February 2019, with regard to the RCT on LL5, you:

2. (j) (i) failed to discuss or record the risks and benefits of RCT with Patient A; and/or

Admitted and proved in respect of failing to record; not proved in respect of failing to discuss

The Committee finds the facts alleged at head of charge 2 (j) (i) not proved in


respect of a discussion and proved in respect of recording.

Your evidence to the Committee is that you did explain the risks and benefits of RCT with Patient A on 20 February 2019. You accept that you did not record those risks and benefits. The Committee again accepts as credible and plausible your account, and the Committee has not been provided with evidence to demonstrate that you did not have this discussion. The Committee is not content to infer from the absence of a record of such a conversation that that conversation did not take place.

The Committee finds the facts alleged at head of charge 2 (j) (i) proved in respect of failing to record the risks and benefits on the basis of your admission.

2. (j) (ii) failed to discuss or record the likely success of RCT with Patient A; and/or

Admitted and proved in respect of failing to discuss; not proved in respect of failing to record

The Committee finds the facts alleged at head of charge 2 (j) (ii) proved in respect of failing to discuss on the basis of your admission.

Having found that you failed to discuss the likely success of RCT, it follows that you could not record that which you did not do.

2. (j) (iii) failed to take a radiograph before starting the RCT; and/or

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (j) (iii) proved discuss on the basis of your admission.

2. (j) (iv) left LL5 “open to drain”.

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (j) (iv) proved discuss on the basis of your admission.

2. (k) On/or before 25 March 2019, with regard to the RCT on LR7, you:

2. (k) (i) failed to discuss or record the risks and benefits of RCT with Patient A; and/or


The Committee finds the facts alleged at head of charge 2 (k) (i) not proved in respect of a discussion, and proved in respect of recording.

Your evidence to the Committee is that you did explain the risks and benefits of RCT at LR7 with Patient A on or before 25 March 2019. You accept that you did not record those risks and benefits. The Committee again accepts your account as credible and plausible, and the Committee has not been provided with evidence to demonstrate that you did not have this discussion. The Committee is again not content to infer from the absence of a record of such a conversation that that conversation did not take place.

The Committee finds the facts alleged at head of charge 2 (k) (i) proved in


respect of failing to record the risks and benefits on the basis of your admission.

2. (k) (ii) Failed to discuss or record the likely success of RCT with Patient A.


The Committee finds the facts alleged at head of charge 2 (k) (ii) not proved in respect of a discussion and proved in respect of recording.

Your evidence to the Committee is that you did explain the likely success of RCT at LR7 with Patient A on or before 25 March 2019. You accept that you did not record the likely success. The Committee again accepts your account as credible and plausible, and the Committee has not been provided with evidence to demonstrate that you did not have this discussion. The Committee is again not content to infer from the absence of a record of such a conversation that that conversation did not take place.

The Committee finds the facts alleged at head of charge 2 (k) (ii) proved in respect of failing to record the likely success on the basis of your admission.

2. (l) With regard to RCT on LL5 and/or LR7, you failed to obtain informed consent in that you did not discuss the risks and benefits and/or the likely success of RCT with Patient A.

Admitted in respect of failing to discuss the likely success of RCT at LL5 only; proved in respect of likely success of LL5; not proved in respect of risks and benefits and likely success of LR7; not proved in respect of risks and benefits of LL5

The Committee finds the facts alleged at head of charge 2 (l) not proved in respect of LR7 in light of its findings at heads of charge 2 (k) (i) and 2 (k) (ii) above.

The Committee finds the facts alleged at head of charge 2 (l) in respect of the likely success of RCT at LL5 proved in light of its findings at head of charge 2 (j) (ii) above and on the basis of your admission.

The Committee finds the facts alleged at head of charge 2 (l) in respect of the risks and benefits of treatment at LL5 not proved in light of its findings at head of charge 2 (j) (i) above.

2. (m) On 25 April 2019, you undertook RCT on LR7 which was not adequate, in that you:

2. (m) (i) Failed to fill the distal canal adequately leaving voids; and/or

Admitted and proved

The Committee finds the facts alleged at head of charge 2 (m) (i) proved on the basis of your admission.

2. (m) (ii) Did not remove gross caries in the mesial of the crown.

Proved


The Committee finds the facts alleged at head of charge 2 (m) (ii) proved.

Your evidence to the Committee is that the shading apparent on a radiograph is in fact a liner that you used, rather than caries as alleged. The Committee notes that Ms Thomson accepted that she is not an expert in dental materials and could not preclude the possibility that the area was, as you maintain, a liner used as a composite filling.

However, on 20 May 2019, which was less than a month later, an appointment with another dentist took place. At that appointment gross caries in the mesial of the crown of this tooth was recorded as being present. Ms Thomson’s view was that it was highly unlikely that such gross caries could have arisen in the intervening period between that appointment and the appointment on 25 April 2019.

The Committee accepts and prefers the expert evidence of Ms Thomson on this point and determines that gross caries was indeed present on 25 April 2019. The Committee also accepts the expert evidence of Ms Thomson that you were under a duty to remove the gross caries.

The Committee therefore finds the facts alleged at head of charge 2 (m) (ii) proved.

3. On 18 September 2017 and 28 November 2018, you failed to carry out or record sufficient treatment planning with regard to either the filling or extraction of:

3. (i) LR6;

Admitted and proved in respect of failing to carry out

The Committee finds the facts alleged at head of charge 3 (i) proved in respect of failing to carry out sufficient treatment planning on the basis of your admission.

Having found that you failed to carry out sufficient treatment planning, it follows that you could not record that which you did not do.

3. (ii) LL5;


The Committee finds the facts alleged at head of charge 3 (ii) proved in respect of failing to carry out sufficient treatment planning on the basis of your admission.


3. (iii) LL6;


The Committee finds the facts alleged at head of charge 3 (iii) proved in respect of failing to carry out sufficient treatment planning on the basis of your admission.

Having found that you failed to carry out sufficient treatment planning, it follows


that you could not record that which you did not do.

3. (iv) LR8.


The Committee finds the facts alleged at head of charge 3 (iv) proved in respect of failing to carry out sufficient treatment planning on the basis of your admission.


We move to stage two”.

On 30 April 2021 the hearing adjourned part heard. It resumed on 14 December 2021.

On 15 December 2021 the Chairman announced the determination as follows:

“Mr Prior Moreira,

Having announced its findings of fact, the Committee has considered the submissions made by Mr Thomas on behalf of the General Dental Council (GDC) and those made by Mr McDonagh on your behalf as well as the stage two documents before it. The Committee has accepted the advice of the Legal Adviser.

Mr Thomas submitted that the shortcomings identified in this case are clinical in nature and wide ranging albeit that they relate to one patient. In his submission they amounted to a serious falling short of what would be proper in the circumstances. He drew the Committee’s attention to Standards 1.4, 6.3 and 7 (in its entirety) of the GDC’s “Standards for the Dental Team” (September 2013) which in his submission you breached. In short, the GDC’s position is that the facts found proved amount to misconduct that is serious.

Mr Thomas then moved on to the issue of current impairment and addressed the Committee on the factors that it must consider, including your level of insight and any remediation. He acknowledged that you have undertaken Continuing Professional Development (CPD) in areas relevant to your failings but said that as you had not been practising you have not been able to undertake any meaningful remediation. He submitted that you have shown insight to some degree in recognising that dentistry is no longer the path for you. He reminded the Committee of the need to declare and uphold proper standards and maintain public confidence in the profession. He referred the Committee to the case of Cohen v General Medical Council [2008] EWHC 581 (Admin) and CHRE v NMC and Paula Grant [2011] EWHC 927 (Admin). Mr Thomas submitted that your fitness to practise is currently impaired by reason of your misconduct.

Mr Thomas submitted that in this particular case conditions could potentially have been an appropriate sanction. However, as you have decided not to return to dentistry this would not be practicable. Mr Thomas acknowledged that there were no deep seated attitudinal concerns and that the appropriate sanction in this case would be a period of suspension.

Mr McDonagh referred the Committee to the principles it must have regard to when considering matters of misconduct and impairment. He acknowledged that whilst the questions of misconduct and impairment are ultimately matters for the Committee, you


recognise that your clinical shortcomings are so serious that the Committee will need to find your current fitness to practise impaired and impose a sanction on your registration.

Mr McDonagh submitted that had you wished to stay in dentistry then conditions would have been sought. However, you have taken a decision to move forward in a different direction whilst using your skills learnt as a dentist in other scientific areas. He submitted that a short period of suspension would satisfy the public interest in marking your misconduct and would enable you to make a second application for voluntary removal from the register allowing you to leave the profession on the best possible terms and still respecting it.

The Committee determined that it would approach this part of the hearing in three stages. First, it would consider whether the facts found proved amounted to misconduct. If the Committee found misconduct, then it would go on to consider whether your fitness to practise is currently impaired. These are matters of judgement for the Committee. If current impairment were to be found, the Committee would then consider the appropriate sanction.

Decision on whether the facts found proved amount to misconduct:

When determining whether the facts found proved amount to misconduct the Committee had regard to the terms of the relevant professional standards in force at the time of the events. The Committee, in reaching its decision, had regard to the public interest and reminded itself that misconduct was a matter for its judgement.

The Committee has concluded that your conduct was in breach of the following Standards for the Dental Team (2013):

1.4 You must take a holistic and preventative approach to patient care which is appropriate to the individual patient.

6.3 Delegate and refer appropriately and effectively.

7.1 Provide good quality care based on current evidence and authoritative guidance.

7.2 Work within your knowledge, skills, professional competence and abilities.

The facts found proved constituted breaches of these standards. The Committee appreciated that breaches of the standards do not automatically result in a finding of misconduct. However, it was of the view that the failings in this case are serious and the Committee concluded that your conduct was a significant departure from the standards expected of a registered dental professional.

In considering the gravity of your departure from the GDC’s Standards, the Committee took into account the opinion of the GDC expert witness in this case, Ms Thompson. Ms Thompson’s evidence was many of your failures fell far below the relevant standards.

The factual findings in this case included a range of clinical failings with respect to a single patient between January 2017 and May 2019. Patient A had attended appointments with you on multiple occasions and you failed to carry out adequate assessments and made serious errors in your treatment. The Committee took into account that Patient A’s dental treatment was complex and presented with difficult clinical concerns that highlighted weaknesses in your practice but noted that your inadequate standard of care impacted significantly upon Patient A and ultimately resulted in harm.

The Committee considered that your failings concern basic and fundamental aspects of dentistry which directly relate to the overarching issue of patient safety, at the core of


dentistry. The Committee was satisfied that the clinical failings were wide-spread, repeated, serious and in view of all the facts found proved amounted to misconduct.

Current Impairment

The Committee then went on to consider whether your fitness to practise is currently impaired by reason of your misconduct. In doing so, the Committee has again exercised its independent judgement.

The Committee took into account that your misconduct is capable of being remedied by way of further learning and professional development. In considering whether your identified failings have in fact been remedied, the Committee comprehensively reviewed all the information before it, including that contained in the 78 page stage 2 bundle provided on your behalf. The bundle included evidence of your CPD and a reflective statement, all of which have been taken into account.

In relation to your CPD the Committee noted completion of courses carried out between 2019 and 2021. Although you have reflected on what you have learnt and shown some understanding of the concerns in this case, you have not been in practice since 2019 and therefore there is no evidence to demonstrate that you have changed your practice or that your professional failings have been effectively remediated.

The Committee notes that you have not renewed your GDC registration since January 2020 and that you have indicated that you no longer wish to practice in dentistry. The Committee took into account your oral evidence during stage one and reflective statement in which you recognise the impact of the standard of care you provided. You have made extensive admissions at the start of these proceedings and engaged fully with the regulatory process. It further noted your regret and your apology to Patient A. It is apparent to the Committee that you have used the time wisely whilst these regulatory proceedings took place by recognising your failures and dedicating yourself to embarking upon a new career path. The Committee considered that you have demonstrated significant insight into your failings.

However, the Committee considers that the evidence of remediation provided is not sufficient to satisfy it that you have addressed all of the concerns identified in this hearing and that you have not practised dentistry since 2019. It concluded that there is a continued risk to the safety of patients were a finding of impairment not to be made.

The Committee also considers that a finding of impairment is necessary in the wider public interest to maintain public confidence and uphold proper standards of conduct and behaviour. In view of the gravity of your misconduct the Committee considered that public confidence in the dental profession and in the GDC as regulator would be undermined if a finding of impairment was not made in the circumstances of this case.

Accordingly, the Committee finds that your fitness to practise is impaired by reason of your misconduct.

Sanction

The Committee next considered what action, if any, to take in relation to your registration. The Committee reminded itself that the purpose of a sanction is not to be punitive although it may have that effect. The Committee took into account the GDC’s “Guidance for the Practice Committees, including Indicative Sanctions Guidance (ISG) (October 2016 revised December 2020). The Committee bore in mind the principle of proportionality.


The Committee considered the mitigating and aggravating factors in this case. It took into account your engagement with the GDC proceedings and that you made extensive admissions to the charges against you. The Committee considered that you have shown insight into your misconduct and have taken steps to remediate and better understand where you fell short albeit you have not been practising and have decided to pursue an alternative career path. Conversely, although your shortcomings involved only one patient and you have apologised, your failings were repeated over multiple appointments and did cause harm.

The Committee bore these factors in mind and considered the available sanctions in ascending order starting with the least restrictive.

The Committee was of the view that to conclude this case with no further action or with a reprimand would be inappropriate because neither would manage the risk your clinical shortcomings pose to the public. In addition, neither course of action would be sufficient to protect the wider public interest.

The Committee next considered whether it could formulate conditions which would be workable, measurable, enforceable and which would address the risks that have been identified. It considered that conditions could adequately address the risks identified in this case had you continued in the dental profession. The Committee has heard from Mr McDonagh on your behalf that if you were still in practice it might have been possible to have considered conditions. The Committee noted that you commenced a master’s programme in Oral Sciences at Glasgow University in October 2021 and that you intend to apply for voluntary removal once these proceedings have concluded. It notes that you had also previously applied for voluntary removal but that application did not progress in light of the ongoing fitness to practise proceedings. You wish to leave the GDC on good terms and be an asset to the public serving them in the healthcare environment, albeit in a different role.

Your career has moved on in a different direction and the Committee notes that you accept that a short period of suspension is appropriate in these circumstances.

The Committee considered erasure but concluded that your misconduct is not fundamentally incompatible with continued registration. The Committee has already indicated that you have insight and your misconduct is remediable albeit you are not currently able to demonstrate full and effective remediation. In these circumstances the Committee considered that erasure would not be proportionate or appropriate in this case.

Accordingly, the Committee has concluded that suspension for a period of 6 months is the proportionate and appropriate sanction to impose. The Committee determined that this period of suspension is necessary to protect the public, to declare and uphold proper standards of conduct and behaviour and to maintain trust and confidence in the profession and in the regulatory process.

The Committee has determined that the order should be reviewed prior to the end of the period of suspension. Without seeking in any way to limit the discretion of a future reviewing Committee, this Committee considers that a future Committee might benefit from a report into the progress of your application for voluntary removal.

The Committee understands that an interim order is in place and now invites submissions as to whether your registration should be suspended immediately.

_________________________________________________________________________


Immediate order

The Committee has considered whether to make an order for the immediate suspension on your registration. The Committee heard the submissions made on behalf of the GDC by Mr Thomas, and those made on your behalf by Mr McDonagh. It has accepted the advice of the Legal Adviser.

Mr Thomas, on behalf of the GDC, made an application in relation to an immediate order to protect the public and maintain public confidence in the profession.

Mr McDonagh submitted that you have no intention to appeal or practice dentistry. He submitted that an immediate order is not necessary because there is protection already in place from the current interim order of suspension which even if revoked, will remain in place until the substantive order commences.

The Committee has had regard to its earlier findings that there remains a risk of repetition, as well as its considerations of issues of public confidence. The Committee therefore concluded that your registration should be suspended during the intervening period prior to the substantive order coming into effect. It took the view that this period was more appropriately covered by an immediate order of suspension given that these proceedings have now been concluded and interim orders are more appropriately in place to provide protection whilst concerns are under investigation.

The Committee has therefore determined that it is necessary for the protection of the public and is otherwise in the public interest that your registration be suspended forthwith.

The Committee hereby revokes any order for interim suspension that relates solely to these matters on your registration and imposes an immediate order of suspension.

The effect of this direction is that your registration will be suspended immediately. Unless you exercise your right of appeal, the substantive order of suspension will come into effect 28 days from the date on which notice of this decision is deemed to have been served on you. Should you exercise your right of appeal, this immediate order for suspension will remain in place until the resolution of any appeal.”


Schedule A

1. 16 January 2017

2. 23 January 2017

3. 23 March 2017

4. 5 February 2019

Schedule B

1. 23 January 2017

2. 23 March 2017

3. 20 April 2017

4. 24 January 2018

5. 22 March 2018

6. 19 April 2018

7. 23 April 2018

8. 28 November 2018

9. 6 December 2018

10. 8 January 2019,

11. 5 February 2019

Schedule C

1. 16 January 2017

2. 23 January 2017

3. 23 March 2017

4. 20 April 2017

Schedule D

1. 22 March 2018

2. 23 April 2018

3. 6 December 2018

4. 5 February 2019

hearing heard in public prior moreira, hugo manuel

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