HEARING PARTLY HEARD IN PRIVATE BONNAR, Jayne …

BONNAR, J Professional Conduct Committee – September 2021 Page -1/30-

HEARING PARTLY HEARD IN PRIVATE BONNAR, Jayne

Registration No: 177713 PROFESSIONAL CONDUCT COMMITTEE

SEPTEMBER 2021 Outcome: Adjourned Part Heard

BONNAR, Jayne, a dentist, BDS University of Glasgow 2009, was summoned to appear before the Professional Conduct Committee on 06 September 2021 for an inquiry into the following charge: Charge (as AMENDED on 6,9 and 10 September 2021)

“That, being a registered dentist: 1. Whilst practising as a dentist at Dental Practice A (referred to in Schedule A) (“the

Practice”), you provided dental care and/or treatment at the Practice to the patients identified in Schedule A and referred to below.

2. In relation to Patient 1, you:- (a) between 15 March 2017 and 17 January 2018, failed to discuss with the patient

and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice;

(b) failed to record a radiographic report for the radiograph taken on 15 March 2017; (c) on 10 October 2017, failed to record pre-treatment clinical findings that would

justify the carrying out of the restorations for LL6; (d) WITHDRAWN

3. In relation to Patient 2, you:- (a) On 14 June 2017:

(i) provided composite restorations to UR6 and UR7 which were not clinically indicated;

(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UR6 and UR7;

(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UR6 and UR7;

(iv) failed to make adequate records on the pattern and location of tooth-wear. (b) As a result of matters alleged in paragraph 3 (a)(ii) on the basis that there was a

failure to discuss the option of preventative measures and monitoring, Patient 2 was not in a position to provide valid consent.1

1 Schedule A is a private document that cannot be disclosed


(c) Between 15 March 2017 and 14 June 2017, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

4. In relation to Patient 3, you:- (a) On 19 September 2017:

(i) provided a restoration to UL6 which was not clinically indicated; (ii) failed to discuss with the patient and/or record discussion of the option of

preventative measures and monitoring in respect of UL6; (iii) failed to record pre-treatment clinical findings that would justify the carrying

out of the restorations in respect of UL6. (b) As a result of matters alleged in paragraph 4 (a)(ii) on the basis that there was a

failure to discuss the option of preventative measures and monitoring, Patient 3 was not in a position to provide valid consent.

(c) Between 17 August 2017 and 19 September 2017, failed to record discussion of the patient’s diet and/or the provision of caries preventative advice.

(d) WITHDRAWN 5. In relation to Patient 4, you:-

(a) On 8 June 2017 (i) provided restorations to UL6 and/or UL7 which were not clinically indicated; (ii) failed to discuss with the patient and/or record discussion of the option of

preventative measures and monitoring in respect of UL6 and/or UL7; (iii) failed to record pre-treatment clinical findings that would justify the carrying

out of the restorations in respect of UL6 and UL7. (b) As a result of matters alleged in paragraph 5 (a)(ii) on the basis that there was a


(c) Between 11 May 2017 and 20 July 2017, failed to adequately undertake and/or record investigations in respect of the diagnosis of grinding and/or clenching.

(d) On 20 July 2017: (i) WITHDRAWN; and/or (ii) failed to record clinical findings for the provision of a mouth-guard.

(e) Between 11 May 2017 and 8 June 2017, failed to provide and/or record the provision of caries preventative advice.

6. In relation to Patient 5, you:- (a) On 8 March 2016:

(i) prescribed restorations to LL5 and UR5 which were not clinically indicated; (ii) failed to discuss with the patient and/or record discussion of the option of

preventative measures and monitoring in respect of LL5 and UR5;


(iii) Failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of LL5 and UR5.

(b) As a result of matters alleged in paragraph 6 (a)(ii) on the basis that there was a failure to discuss the option of preventative measures and monitoring, Patient 5 was not in a position to provide valid consent.

7. In relation to Patient 7, you:- (a) On 13 June 2017:

(i) provided a restoration to the UR6 mesial and/or UR6 distal which were not clinically indicated;

(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UR6;

(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UR6 and/or UL6.


(c) Between 17 May 2017 and 13 September 2017, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

8. In relation to Patient 8, you:- (a) On 3 May 2016:

(i) provided a restoration to UL6 which was not clinically indicated; (ii) failed to discuss with the patient and/or record discussion of the option of

preventative measures and monitoring in respect of UL6; (iii) failed to record pre-treatment clinical findings that would justify the carrying


failure to discuss the option of preventative measures and monitoring in respect of UL6, Patient 8 was not in a position to provide valid consent.

(c) On 18 May 2016, (i) WITHDRAWN; and/or (ii) failed to record the diagnosis and presenting symptoms justifying the need

for the prescription of a mouth-guard. (d) Between 13 April 2016 and 13 July 2016, failed to record discussion of the

patient’s diet and/or to record the provision of caries preventative advice. 9. In relation to Patient 9, you:-

(a) On 18 May 2016 provided a restoration to UL4 which was not clinically indicated; (b) On 21 June 2016 provided restorations to UR4 and UR6 which were not clinically

indicated;


(c) In relation to the respective dates set out at paragraphs 9 (a) and (b) above, failed to discuss and/or record discussion of the option of preventative measures and monitoring in respect of UL4, UR4 and UR6;

(d) As a result of matters alleged in paragraph 9 (c) on the basis that there was a failure to discuss the option of preventative measures and monitoring, Patient 9 was not in a position to provide valid consent;

(e) In relation to the respective dates set out at paragraphs 9 (a) and (b) above, failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UL4, UR4 and UR6;

(f) Between 26 April 2016 and 21 June 2016, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

10. In relation to Patient 10, you:- (a) On 17 May 2016 provided restorations to UL6 and UL7 which were not clinically

indicated; (b) On 22 June 2016 provided a restoration to LL6 which was not clinically indicated; (c) In relation to the respective dates set out at paragraphs 10 (a) and (b) above,

failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL6, UL7 and LL6;


(e) In relation to the respective dates set out at paragraphs 10(a) and (b) above, failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UL6, UL7 and LL6;

(f) Between 5 May 2016 and 17 July 2016, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

11. In relation to Patient 11, you:- (a) On 7 June 2016 :

(i) provided restorations to UL5 and UL6 which were not clinically indicated; (ii) failed to discuss with the patient and/or record discussion of the option of

preventative measures and monitoring in respect of UL5 and UL6; (iii) failed to record pre-treatment clinical findings that would justify the carrying



12. WITHDRAWN 13. In relation to Patient 14, you:-


(a) On 20 May 2017, failed to place a mesial restoration on the UL7 when such a restoration was indicated;

(b) WITHDRAWN And that, as a result of the matters set out above, your fitness to practise is impaired by reason of misconduct.” On 06 September 2021 the Chairman made a statement regarding the GDC's application to amend the charge: “Ms Bonnar, This is the Professional Conduct Committee’s inquiry into the facts which form the basis of the allegation against you that your fitness to practise is impaired by reason of your misconduct. You attended the hearing, and you were represented by Miss Vivienne Tanchel of Counsel. Miss Louise Culleton of Counsel presented the General Dental Council’s (GDC) case. The hearing took place remotely via Microsoft Teams video-link and all parties attended remotely except between 9 and 13 September 2021 when the hearing took place at the GDC’s offices at Wimpole Street. Rule 18 Application to Amend the Charge At the outset of the hearing, Miss Culleton made an application under Rule 18 of the General Dental Council (Fitness to Practise) Rules 2006 (‘the Rules”) to amend the charges. She submitted that heads of charge 2(d), 4(d) and 13(b) should be withdrawn as Dr Abhi Pal, the GDC’s expert witness, was no longer critical of your actions after he had discussed this with your expert witness, Dr Thomas Timmons. Miss Culleton also submitted that the reference to the UL5 tooth should be deleted from head of charge 11(a) (iii). Miss Culleton further submitted that heads of charge 2(c), 3(a)(iii), 4(a)(iii), 5(a)(iii), 6(a)(iii), 7(a)(iii), 8(a)(iii), 9(e), 10(e) and 11(a)(iii) should be amended. She submitted that for each of these heads of charge the word “pre-treatment” should be inserted immediately before “clinical findings” and the words “that would justify the carrying out of the restorations” should be inserted immediately after “clinical findings”. Miss Culleton submitted that the amendments were required to add further specification to the heads of charge as the alleged failures related to the pre-treatment clinical findings. She also submitted that no additional allegations are being added to the heads of charge and therefore the amendments could be made without any injustice to you. Miss Tanchel submitted that she had no objections to the proposed amendments. The Committee accepted the advice of the Legal Adviser on the Rule 18 application. With regard to the proposed withdrawal of the heads of charge 2(d), 4(d) and 13(b), the Committee noted that these reflected the opinion of both Dr Pal and Dr Timmons and that it was in the interests of justice for these allegations to be withdrawn. With regard to the proposed amendments to the heads of charge 2(c), 3(a)(iii), 4(a)(iii), 5(a)(iii), 6(a)(iii), 7(a)(iii), 8(a)(iii), 9(e), 10(e) and 11(a)(iii), including the deletion of “UL5” in head of charge 11(a)(iii), the Committee noted that it was in the interests of justice that the GDC clarifies its case as much as possible. The Committee was also satisfied that the proposed amendments could be made without injustice to you and that you did not object to them. The Committee therefore agreed to Miss Culleton’s application to amend the charge”.


On 07 September 2021 the Chairman made a statement regarding the application under Rule 57 to adduce evidence: “Ms Bonnar, GDC Submissions During the course of the GDC’s case, prior to Dr Pal’s oral evidence, Miss Culleton, on behalf of the GDC, applied for the document containing your written submissions to the GDC’s Case Examiners to be admitted into evidence. She submitted that the evidence was relevant and it was fair to admit it. With regard to the issue of relevance, Miss Culleton submitted that this was your first response to the GDC about the matters that have been referred to this hearing. She submitted that it forms part of the picture of the evidence which should properly be before the Committee, and it would be illogical if the Committee did not have this document. Dr Pal has referred extensively to this document in his expert report and it would assist the Committee when considering Dr Pal’s report. It would also be relevant as it would show the development of your response to the allegations. She submitted that the document should have been originally included in the papers for this hearing but owing to an oversight it had been omitted. With regard to fairness, Miss Culleton submitted that there would be no injustice caused to you if the document was admitted into evidence as the document was drafted by your legal team on your instruction. You will be able to answer questions and give evidence on the contents of the document. Miss Culleton also submitted that the document has been redacted properly to ensure that only the matters before the Committee are visible. In summary, Miss Culleton submitted that it makes sense for the Committee to have this document as it is part of the picture of the evidence which should properly be before the Committee. Your Submissions Miss Tanchel opposed the application. She submitted that the GDC had failed to explain why the document was not included as part of the original bundle and why it has been submitted at this late stage. She submitted that Dr Pal’s evidence is plain and clear, and until this is challenged the document has no role to play in this hearing whatsoever. She submitted that the document was received by the GDC in June 2020 when the allegations were different to the ones at this hearing. The document also includes a lot of material that is not relevant to today’s hearing. She submitted that the GDC is perfectly able to put questions to you regarding any previous inconsistent statements at the appropriate time. She also submitted that it is an inaccurate representation of Dr Pal’s report if the GDC state that the Committee cannot understand the report without the document. Miss Tanchel submitted the ultimate test is fairness. She submitted that it was unfair for the Committee to see a document that is 13 months old when the allegations that you face now are different to those when the document was written. If the document is allowed, she submitted that it was unfair for the document to be adduced in its entirety and the proposed redactions by the GDC only support the GDC’s case. She further submitted that the areas of dispute between both experts are narrow and the document has no bearing on this. She concluded by stating that the document was irrelevant to these proceedings. Further, if the GDC wished to point out any inconsistencies in your evidence then the correct approach would be to repeat the application once you had given evidence at this hearing.


The Committee’s decision on the Rule 57 application The Committee took into account the submissions made by both parties and accepted the advice of the Legal Adviser. The Committee had regard to the interests of justice and remained mindful of the principle of fairness. It balanced the interests of the GDC with your interests. The Committee noted its powers under Rules 57(1) and 57(2), which are as follows: (1) A Practice Committee may in the course of the proceedings receive oral,

documentary or other evidence that is admissible in civil proceedings in the appropriate court in that part of the United Kingdom in which the hearing takes place.

(2) A Practice Committee may also, at their discretion, treat other evidence as admissible if, after consultation with the legal adviser, they consider that it would be helpful to the Practice Committee, and in the interests of justice, for that evidence to be heard.

In making its decision, the Committee determined that the document was relevant to these proceedings as it was your first formal response to the GDC regarding the allegations you face at this hearing. The Committee was also of the view that it would be assisted by having sight of the document when considering Dr Pal’s report. The Committee was satisfied that as the document was submitted and written on your behalf by your legal team you would be able to address any questions arising from it. Therefore, the Committee concluded that there would be no unfairness to you if the document was to be admitted. In conclusion, the Committee determined that the document was relevant and that there would be no unfairness to you if this evidence was to be admitted into evidence. The Committee therefore accepted the GDC’s application. That concludes this determination”. On 09 September 2021, Ms Tanchel (Counsel for Ms Bonnar) made a submission under Rule 19(3) on behalf of Ms Bonnar.The Chairman made the following response: “Ms Bonnar, At the conclusion of the GDC’s case, Miss Tanchel made a submission, on your behalf, that pursuant to Rule 19(3) of the Rules, there was no case for you to answer in respect of heads of charges 4(a)(ii), 4(b), 4(c), 5(e), 8(a)(ii), 8(b), 8(d), 12(a) and 12(b). She referred the Committee to the cases of R v Galbraith [1981] 1 WLR 1039, Shippey [1988] Crim.L.R. 767 and Soni v General Medical Council [2015] EWHC 364 (Admin). With regard to head of charge 12, Miss Tanchel submitted that there was simply no evidence for the Committee to find this allegation proved. With regards to heads of charge 4 and 8, she submitted that there was either no evidence or the evidence was too tenuous in nature for the Committee to find the allegations proved. With regard to head of charge 4(a)(ii), Miss Tanchel submitted that Patient 3 stated in oral evidence that she could not remember whether she discussed other options with you as it was “too long ago”. Miss Tanchel submitted that Mr Pal’s main criticism relating to Patient 3 was that you did not give her advice about using fluoride and that she does not recall being given any advice about mouthwash. However, Patient 3 stated that she could not rule out that it was said. Patient 3 also stated in oral evidence that she only remembered some parts of the consultation and did not


remember some aspects of the consultation which were contained in her records. Miss Tanchel therefore submitted that this fundamentally undermines the GDC’s case. Miss Tanchel submitted that your letter to the case examiners was hearsay and that, if the Committee was to consider it, it should also consider your most recent witness statement. With regard to head of charge 4(b), Miss Tanchel submitted that if the Committee accepts that a discussion was had with Patient 3, then it has to accept that Patient 3 provided valid consent. With regard to head of charge 4(c), she submitted that Patient 3 accepted that she had been provided advice about her diet and oral hygiene which included flossing her teeth. With regard to head of charge 5(e), specifically in relation to your alleged failure to discuss and record the discussion of Patient 4’s diet, Miss Tanchel submitted that it is clear from Patient 4’s records that it states that you had discussed the patient’s diet with her during the appointment on 8 June 2017. She submitted that the records were an accurate reflection of your discussion with the patient. With regard to heads of charge 8(a)(ii), 8(b) and 8(d) relating to Patient 8, Miss Tanchel submitted that during cross-examination the patient stated that she could not fully remember the discussions with you during her appointments as it was such a long time ago. Patient 8 also stated that although she could not remember the discussions, that is not to say they did not happen. With regard to heads of charge 12(a) and 12(b) and Patient 12, Miss Tanchel submitted that Dr Pal was specific in his oral evidence that having heard the evidence of Patient 12, he was no longer critical of the treatment provided. Dr Pal stated that the prescription of antibiotics was the right thing to do and once these had not worked then the extraction of the tooth (UL8) was the only viable option. Miss Culleton, on behalf of the GDC, firstly submitted that the GDC concedes that heads of charge 12 (a) and 12(b) should not proceed any further owing to Dr Pal’s evidence that he was no longer critical of your treatment of Patient 12. Miss Culleton opposed the remainder of Miss Tanchel’s application. She submitted that taking all the evidence in the round, there was sufficient evidence to proceed on each of the charges in this case. She submitted that she accepted that the patients during oral evidence stated that they could not remember everything of the appointments. However, she submitted that it could be inferred that the relevant discussions with you did not take place and this is why they did not recall them. With regard to heads of charge 4(a)(ii), 4(b) and 4(c), Miss Culleton submitted that Patient 3 confirmed in oral evidence that you did not discuss the options with her and she had no recall of you mentioning fluoride or mouthwash. Miss Culleton submitted that this could be interpreted as it not having happened if the patient could not recall the conversation. She submitted that Patient 3 also stated that these were her first fillings and if she had been offered the option not to have fillings then she would have chosen not to have them. Miss Culleton also submitted that the Committee should consider your response to the GDC’s case examiners in which you accepted that you did not advise Patient 3 of the option to watch and wait. Miss Culleton concluded that there was sufficient evidence for these heads of charge to proceed beyond this stage. With regard to heads of charge 8(a)(ii), 8(b), 8(d), Miss Culleton submitted that Patient 8 did not recall being told about preventative measures or given advice about diet or oral hygiene. Patient 8 also stated that she had no recollection of options being given as she would have otherwise recollected this.


Miss Culleton submitted that overall, there is sufficient evidence from the patients and it is not so weak, tenuous, vague or inconsistent that the Committee could not rely on it to take it past this stage of the proceedings. She submitted that there was no evidence before the Committee that advice was given about fluoride and mouthwash as the patients do not recall this. Dr Pal has stated in his expert report that this aspect was an essential part of the advice about caries management. With regard to head of charge 5(e), Miss Culleton submitted that fluoride advice was not given to Patient 4 as it is absent on the records and this is part of the allegation in the round. She submitted that Dr Pal had stated that this was a necessary part of the oral health advice that should be given to patients. She submitted therefore that this allegation should proceed. Committee’s Decision The Committee accepted the advice of the Legal Adviser. The Committee had regard to all the evidence thus far adduced. It took account of the submissions made by Miss Tanchel on your behalf and those made by Miss Culleton on behalf of the GDC. The Committee firstly considered heads of charge 12(a) and 12(b). It noted that you had prescribed antibiotics to Patient 12 at the first appointment and as the pain had not subsided by the time of the second appointment, it became necessary for you to extract the tooth. It noted that Dr Pal was no longer critical of your actions and that the GDC did not oppose Miss Tanchel’s application with regard to this head of charge. The Committee determined therefore that there is no case to answer with regard to heads of charge 12(a) and 12(b). The Committee next considered heads of charge 4(a)(ii) and 4(b). It noted that Patient 3 stated in her oral evidence that there was not a discussion about monitoring the UL6. The Committee noted that Patient 3 had stated that this was her first adult filling and she therefore would have chosen to leave the tooth if she had been presented with this option. The Committee also noted that you had denied this allegation in your witness statement to this Committee, but had previously admitted this allegation in your written response to the GDC’s case examiners. The Committee therefore concluded that there was sufficient evidence that if taken at its highest the Committee could find head of charge 4(a)(ii) proved. The Committee found that in light of its findings in relation to head of charge 4(a)(ii) there was also sufficient evidence upon which charge 4(b) could be found proved. Accordingly, the Committee does not accede to the No Case to Answer application made by Miss Tanchel regarding heads of charge 4(a)(ii) and 4(b). With regard to head of charge 4(c), the Committee noted that Patient 3 stated in her oral evidence that she remembered a discussion about sugary foods. She remembered a discussion about brushing twice a day and using interdental brushes and toothpaste. She could not remember whether or not fluoride advice was discussed with her as the appointment was a long time ago. The Committee concluded that there was insufficient evidence and therefore this head of charge could not be found proved. Accordingly, it determined that there is no case to answer in respect of head of charge 4(c) regarding the failure to discuss these matters. The part of this head of charge relating to recording this advice has been admitted and remains live. The Committee next considered head of charge 5(e). The Committee has not heard evidence from this patient. The Committee noted that the records state “discussed diet and OHI” (oral health instruction). The Committee therefore determined that there was no case to answer regarding the part of the charge relating to your alleged failure to discuss with the patient and/or record the patient’s diet. The Committee then considered whether you had failed to provide and/or record the provision of caries preventative advice. The Committee noted that in Dr Pal’s evidence he stated that caries preventative advice should include advice about fluoride. The Committee noted that this


was not mentioned in the patient’s records and therefore this allegation could be found proved. The Committee therefore determined that it does not accede to the No Case to Answer application made by Miss Tanchel regarding this aspect of head of charge 5(e). The Committee next considered heads of charge 8(a)(ii) and 8(b). It noted that Patient 8 had accepted that the appointment took place a long time ago, but she did not believe that the option of managing the tooth conservatively was discussed with her. She stated that no other options were discussed with her. She thought the fillings were necessary work that needed to be done. The Committee therefore determined that there was sufficient evidence that head of charge 8(a)(ii) could be found proved. The Committee found that in light of its findings in relation to head of charge 8(a)(ii) there was also sufficient evidence upon which charge 8(b) could be found proved. Accordingly, the Committee does not accede to the No Case to Answer application made by Miss Tanchel regarding heads of charge 8(a) (ii) and 8(b). With regard to head of charge 8(d), the Committee noted that Patient 8 was vague in her evidence about whether she recalled having a discussion about her diet and being given advice about preventing caries. In particular, the Committee noted that Patient 8 stated in her oral evidence that she would not have remembered anyway even if there was a discussion and advice given. The Committee therefore determined that there was insufficient evidence that this allegation could be found proved. Accordingly, it determined that there is no case to answer in respect of head of charge 8(d) regarding the failure to discuss these matters. The part of this head of charge relating to recording this advice has been admitted and remains live. That concludes this determination”. On 10 September 2021 the Chairman made a statement regarding the Rule 18 application to amend the charge and Rule 53 application for the hearing to be held in private: “Ms Bonnar, Following the announcement of the Committee’s decision on Miss Tanchel’s application for ‘No Case to Answer’, Miss Culleton made an application under Rule 18 of the General Dental Council (Fitness to Practise) Rules 2006 (‘the Rules”) to amend the charge. Miss Culleton submitted that heads of charge 5(d)(i) and 8(c)(i) should be withdrawn as Dr Pal was no longer critical of your actions with regard to your provision of mouth-guards to Patients 4 and 8. Dr Pal confirmed this in his addendum report dated 9 September 2021, which was handed up to the Committee. Miss Tanchel submitted that she had no objections to the proposed amendments. The Committee accepted the advice of the Legal Adviser on the Rule 18 application. The Committee determined that heads of charge 5(d)(i) and 8(c)(i) should be withdrawn as Dr Pal was no longer critical of your actions. The Committee therefore agreed to Miss Culleton’s application to amend the charge. Rule 53 Application for Hearing to be held in Private The Committee then considered Miss Tanchel’s application, pursuant to Rule 53 of the Rules, for the hearing to be held partly in private. Miss Tanchel made this application before you gave oral evidence to this Committee as you would be referring to matters in your personal life, including aspects of your health. Miss Culleton had no objection to this application. The Committee heard and accepted the advice of the Legal Adviser.


The starting point for the Committee is for all hearings to be held in public as it is in the interests of justice to do so. However, a hearing may be heard in private where it concerns matters that are inextricably linked to the health or private and family life of the Registrant or any other person concerned, under Rule 53(2) (a) of the Rules. The Committee agreed that as you would be referring to matters in your personal life and your health during your oral evidence then it would be in the interests of justice that the hearing should be heard in private when these matters were being discussed. The Committee therefore acceded to the application”. On 17 September 2021 the Chairman announced the finding of facts: “Ms Bonnar, Admissions At the start of the hearing, you made admissions to heads of charge 1, 2(b), 2(c), 3(a)(i), 3(a)(iii), 3(a)(iv), 4(a)(i), 4(a)(iii), 5(a)(i), 5(a)(iii), 5(d)(ii), 6(a)(i), 6(a)(iii), 7(a)(i), 7(a)(iii), 8(a)(i), 8(a)(iii), 8(c)(ii), 9(a), 9(b), 9(e), 10(a), 10(b), 10(e), 11(a)(iii) and 13(a). You also made admissions with regard to heads of charge 2(a), 3(a)(ii), 3(c), 4(a)(ii), 4(c), 5(a)(ii), 5(c), 5(e), 6(a)(ii),7(a)(ii), 7(c), 8(a)(ii), 8(d), 9(c), 9(f), 10(c), 10(f) and 11(a)(ii). However, your admissions were only in relation to the alleged failures to record the information mentioned in those heads of charge. Background The allegations you face at this hearing relate to concerns raised about your dental care and treatment of 13 patients between March 2016 and January 2018, while you were working as a dentist at a practice in Edinburgh. The allegations against you mainly relate to treatment planning, including the diagnosis and management of caries, patient communication and consent, and failures in record-keeping. Evidence Received By way of factual evidence from the GDC, the Committee was provided with dental records for the relevant patients. It received signed witness statements from Patients 3, 8 and 12, and heard oral evidence from them. It also received a signed witness statement from Ms Emma O’Keefe, a Consultant in Dental Public Health for NHS Fife and South-East of Scotland, and heard oral evidence from her. Furthermore, the Committee received an expert report dated 25 November 2020 and an addendum report dated 9 September 2021 from Dr Abhi Pal. It also heard oral evidence from him. As part of your defence case, the Committee received your witness statements dated 30 March 2021 and 22 August 2021. It also heard oral evidence from you. Furthermore, the Committee received an expert report dated 23 March 2021 from Dr Thomas Timmons and heard oral evidence from him. The Committee also received a joint expert report, dated 22 August 2021, from Dr Pal and Dr Timmons. The Committee’s Findings of Fact The Committee has considered all the evidence presented to it, both oral and documentary. It took account of the submissions made by Miss Culleton on behalf of the GDC and by Miss Tanchel on your behalf. The Committee heard and accepted the advice of the Legal Adviser. In accordance


with that advice, it has considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the alleged matters are found proved on the balance of probabilities. Before making its decision on the heads of charge, the Committee decided it would be useful to set out its conclusions on certain matters which would have a bearing on its decision. Reliability of Dental Records The Committee was of the view that the dental records could be relied upon as they are a contemporaneous account of the dental care and treatments you provided to the patients. As a broad principle, where the dental records were in conflict with the recollection of witnesses some years after the events, the Committee considered that the dental records were more likely to be reliable. The Committee also considered that when the records did not contain any aspect of your treatment and care of these patients, then it was not conclusive proof that it did not occur. The Committee noted that both Dr Pal and Dr Timmons acknowledged that an absence of information in the dental records did not automatically mean that something did not take place. MDDUS Letter to the GDC dated 30 June 2020 (‘The Rule 4 letter’) The Committee determined that it could place significant weight on this letter in its decision making. The Committee noted that this was a formal letter in response to the allegations against you, which was written on your behalf and on your instructions. It noted that the letter stated, “we confirm that Dr Bonnar has seen and approved this letter”. The Committee took into consideration your evidence that some of the apparent admissions you made in the letter were a mistake and should be disregarded. However, the Committee also noted the considerable amount of work that was undertaken to draft the letter and the meticulous way you have prepared your case in response to the investigations by NHS Lothian and the GDC. In light of your meticulous approach throughout, the Committee did not consider it plausible you would have made accidental admissions in this letter. In addition, the Committee noted that the broad thrust of the letter was that, at the time of writing it, your practice had changed and that you thus accepted that a preventative, non-operative approach should have been provided to these patients. The Committee considers that the admissions made in the letter are entirely consistent with this. The Committee was satisfied, therefore, that this represented what you believed to be a true account of your actions in response to these allegations and that the admissions contained in the letter should not be disregarded as errors. Personal Matters The Committee took into consideration the personal matters that you referred to during your oral evidence. However, the Committee concluded that they have no relevance to its decisions on the heads of charge in the fact-finding stage. Your Usual Practice – Treatment Options The Committee noted that during your oral evidence you stated that you did not recollect the appointments for some of the patients, and you relied on your usual practice in giving evidence with respect to these. You stated that you had “a script” that you followed when discussing options with patients. The Committee, therefore, determined that it would be appropriate after hearing the evidence in this case to make a decision as to what it considered to be your usual practice when


explaining treatment options to patients at the time of the allegations. The Committee was of the view that this would assist them when making its decision regarding the allegations concerning the appointments which you do not recollect and where you rely on your usual practice. After hearing all the evidence in this case, the Committee was satisfied that your usual practice would have been to carry out a restoration on a tooth if you believed it needed to be done. The Committee also decided that you would have advised patients that if a tooth was not restored then it would be likely to deteriorate. In reaching this conclusion, it relied on the following:

• Your oral evidence, in which you explained that you would always offer the patient the choice of doing nothing, but that this might mean they needed a larger restoration in the future.

• The evidence of patients 3 and 8, who were clear that they were not offered a non-interventionist approach as a viable treatment option.

• The admissions you made within the Rule 4 Letter. The Committee considered that a non-interventionist approach to managing carious lesions is different to ‘doing nothing and risking deterioration’. It was of the view that you did not at the time recognise that the cavities that you had diagnosed could be managed conservatively. You therefore did not offer this option to your patients. Therefore, the Committee determined that your usual practice was not to offer conservative treatment but was instead to warn patients of the risk of deterioration if no treatment was undertaken. Expert Opinion – Treatment Options Both experts agreed that you had a duty to offer a non-interventionist approach to these patients. The Committee accepted their opinion. Your Usual Practice – Caries Preventative Advice The Committee also considered that it would assist its decision making if it could determine what it considered to be your usual practice when you issued caries preventative advice to these patients. You stated that you had “a script” that you followed when giving this advice to patients. The Committee noted that you stated in oral evidence that you gave general advice on diet, over the counter fluoride toothpaste, and oral hygiene instruction to all your patients. The Committee found that your evidence on this was consistent and reliable. It was also consistent with the clinical records, which record extensive discussions on the patients’ brushing habits. It was also consistent with the recollections of Patients 3 and 8, who recall at least in part these discussions. You admitted that you did not offer any of the patients in this case high fluoride toothpaste, varnish or mouthwash. After hearing all the evidence in this case, the Committee determined that your usual practice would have been to advise patients on their diet, and to provide oral hygiene instruction, which included the use of over the counter toothpaste with a standard amount of fluoride. However, the Committee concluded that you did not provide advice on high fluoride to these patients. Expert Opinion – Caries Preventative Advice The Committee noted that Dr Pal stated in his evidence that caries preventative advice for all these patients should include advice on high fluoride varnish, mouthwash or using high fluoride toothpaste, in addition to advice on diet and oral hygiene instruction. The Committee considered Dr Pal’s evidence to be reliable and consistent on this matter and concluded it could place weight on his evidence. The Committee noted that Dr Timmons was muddled in his oral evidence on this


matter and considered his evidence to be inconsistent and unclear although he eventually agreed that high fluoride advice should have been given as part of the caries preventative advice to most of these patients. For this reason, where the experts were in disagreement on this matter, the Committee preferred the evidence of Dr Pal. The Committee therefore concluded that you had a duty to provide this advice with respect to these patients. The Committee’s findings in relation to each head of charge are as follows:

1. Whilst practising as a dentist at Dental Practice A (referred to in Schedule A) (“the Practice”), you provided dental care and/or treatment at the Practice to the patients identified in Schedule A and referred to below. Admitted and Found Proved

2. In relation to Patient 1, you:-

(a) between 15 March 2017 and 17 January 2018, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice;

Admitted (in respect of failure to record only) Found Not Proved (failed to discuss patient’s diet and recording provision of caries preventative advice) Found Proved (failed to record discussion of patient’s diet and to provide caries preventative advice in relation to high fluoride only) The Committee has not heard evidence from this patient and you had no recollection of your appointments with them. The Committee firstly considered whether you failed to discuss the patient’s diet and record the discussion of this. The Committee had regard to your oral evidence and the patient’s records. It noted that you stated in evidence that your usual practice would have been to issue advice to patients on their diet and the Committee has determined (see above) that it accepts your evidence on this. The Committee determined therefore that it was more likely than not that you did discuss the Patient’s diet and accordingly, found this aspect of the head of charge not proved. With regard to recording the advice on diet, the Committee noted and accepted your admission to this head of charge. Accordingly, it found this aspect of the head of charge proved. The Committee next considered the provision of caries preventative advice. The Committee noted from the records that you provided extensive oral hygiene instruction to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee had regard to the evidence of Dr Pal and Dr Timmons, who both stated that you had a duty to include this as part of your advice on caries prevention for this patient. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you recorded the advice on oral hygiene that you did provide. You


did not provide advice on high fluoride products. The Committee was satisfied, therefore, that you did not have a duty to record advice that you did not give. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.

(b) failed to record a radiographic report for the radiograph taken on 15 March 2017;

Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(c) on 10 October 2017, failed to record pre-treatment clinical findings that would justify the carrying out of the restorations for LL6;


(d) WITHDRAWN.


(a) On 14 June 2017:

(i) provided composite restorations to UR6 and UR7 which were not clinically indicated;


(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UR6 and UR7;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) The Committee noted that it heard no evidence from Patient 2. You have no recollection of this appointment and stated in evidence that you rely on your usual practice. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, it found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UR6 and UR7;


(iv) failed to make adequate records on the pattern and location of tooth-wear.



Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UR6 and UR7. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(c) Between 15 March 2017 and 14 June 2017, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

Admitted (in respect of failure to record only) Found Not Proved (failed to discuss patient’s diet and recording provision of caries preventative advice) Found Proved (failed to record discussion of patient’s diet and to provide caries preventative advice in relation to high fluoride only) The Committee firstly considered whether you failed to discuss the patient’s diet and record discussion of this. The Committee had regard to your oral evidence and the patient’s records. It noted that you stated in evidence that your usual practice would have been to issue advice to patients on their diet and the Committee has determined (see above) that it accepts your evidence on this. The Committee determined therefore that it was more likely than not that you did discuss the Patient’s diet and accordingly, found this aspect of the head of charge not proved. With regard to recording the advice on diet, the Committee noted and accepted your admission to this head of charge. Accordingly, it found this aspect of the head of charge proved. The Committee next considered the provision of caries preventative advice. The Committee noted from the records that you provided extensive oral hygiene instruction to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee had regard to the evidence of Dr Pal and Dr Timmons, who both stated that you had a duty to


include this as part of your advice on caries prevention for this patient. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you recorded the advice on oral hygiene that you did provide. You did not provide advice on high fluoride products. The Committee was satisfied, therefore, that you did not have a duty to record advice that you did not give. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


(a) On 19 September 2017:

(i) provided a restoration to UL6 which was not clinically indicated; Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) When considering this head of charge, the Committee had particular regard to the oral evidence of Patient 3. The Committee noted that Patient 3 stated that she was not provided with this option and, if she had been, she would have chosen not to have a filling as this was her first adult filling. The Committee considered Patient 3’s evidence to be reliable and compelling. The Committee noted that you stated in your oral evidence that you had no memory of Patient 3 or of this appointment. The Committee further noted that in your Rule 4 letter to the GDC’s Case Examiners you stated that you did not advise Patient 3 of the ‘watch and wait’ option. The Committee, therefore, determined that it was more likely than not that you did not discuss the the option of preventative measures and monitoring in respect of UL6. Accordingly, it found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.

(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UL6.

Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly,


found it proved. (b) As a result of matters alleged in paragraph 4 (a)(ii) on the basis that there

was a failure to discuss the option of preventative measures and monitoring, Patient 3 was not in a position to provide valid consent.

Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(c) Between 17 August 2017 and 19 September 2017, failed to record discussion of the patient’s diet and/or the provision of caries preventative advice.

Admitted Found Proved (failure to record discussions of diet) Found Not Proved (failure to record caries preventative advice in relation to high fluoride only) The Committee accepted your admission that you failed to record discussion of the patient’s diet, and, accordingly, found this aspect of the head of charge proved. The Committee noted you have recorded extensive discussions of oral hygiene advice, which the experts agree is part of caries prevention advice. In light of its earlier findings on the ‘no case to answer’ application, the Committee has not made any finding that other advice should have been offered. Accordingly, the Committee has found no failure with regard to recording such caries prevention advice. Therefore, notwithstanding your admission, this is found not proved.

(d) WITHDRAWN


(a) On 8 June 2017

(i) provided restorations to UL6 and/or UL7 which were not clinically indicated;


(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL6 and/or UL7;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record)


The Committee noted that it heard no evidence from Patient 4. The Committee considered your evidence with regard to this appointment and noted that you stated that you would have followed your usual practice. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, it found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.

(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UL6 and UL7.



Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL6 and UL7. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(c) Between 11 May 2017 and 20 July 2017, failed to adequately undertake and/or record investigations in respect of the diagnosis of grinding and/or clenching.

Admitted (in respect of failure to record only) Found Not Proved (failure to undertake investigations) Found Proved (failure to record) When considering this head of charge, the Committee had particular regard to your oral evidence. You informed the Committee about your usual practice in respect of the diagnosis of grinding and clenching, outlining a comprehensive examination. This included checking the joints and its movements, its associated muscles, tooth wear and signs on the soft tissues related to grinding, as well as asking the patient about relevant symptoms. You stated that you did this for every patient. The Committee found that your evidence was detailed and uncontradicted. In addition, you have recorded in the notes that you checked the patient’s TMJ (Temporomandibular Joint), which supports your account. The Committee accepted your evidence on this and considered that these were adequate investigations in respect of this diagnosis. Accordingly, it found this aspect of the head of charge not proved. With regard to the failure to record your investigations, your entry with respect to


checking the TMJ is silent on the details of the investigations you undertook. You admitted and the experts agreed that this was an inadequate record. The Committee accepted your admission and accordingly found this aspect of the head of charge proved.

(d) On 20 July 2017:

(i) WITHDRAWN

(ii) failed to record clinical findings for the provision of a mouth-guard. Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(e) Between 11 May 2017 and 8 June 2017, failed to provide and/or record the provision of caries preventative advice.

Admitted (in respect of failure to record only) Found Not Proved (failure to record caries preventative advice) Found Proved (failure to provide caries preventative advice in relation to high fluoride only) The Committee noted from the records that you provided extensive oral hygiene instruction and diet advice to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee had regard to the evidence of Dr Pal and Dr Timmons, who both stated that you had a duty to include this as part of your advice on caries prevention for this patient. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you did not provide this advice. The Committee was satisfied, therefore, that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved


(a) On 8 March 2016:

(i) prescribed restorations to LL5 and UR5 which were not clinically indicated;


(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of LL5 and UR5;

Admitted (in respect of failure to record only)


Found Proved (failed to discuss) Found Not Proved (failed to record) You stated in evidence that you did not recall this appointment and so you rely on your usual practice. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, it found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.

(iii) Failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of LL5 and UR5.



Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of LL5 and UR5. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.


(a) On 13 June 2017:

(i) provided a restoration to the UR6 mesial and/or UR6 distal which were not clinically indicated;


(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UR6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) The Committee considered your evidence with regard to this appointment and noted that you stated that although you do recollect the patient, you do not recall the appointment and, therefore, you rely on your usual practice.


The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Furthermore, the Committee noted the following comments in the Rule 4 letter: “Dr Bonnar accepts that based on the radiographic appearance alone she would now not intervene operatively on this tooth” and “It is accepted that the patient should have been offered a conservative approach in relation to UR6 in place of a restorative approach”. Accordingly, the Committee found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.

(iii) failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UR6 and/or UL6.



Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UR6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(c) Between 17 May 2017 and 13 September 2017, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

Admitted (in respect of failure to record only) Found Not Proved (failed to discuss patient’s diet and recording provision of caries preventative advice) Found Proved (failed to record discussion of patient’s diet and to provide caries preventative advice in relation to high fluoride only) The Committee firstly considered whether you failed to discuss the patient’s diet and record the discussion of this. The Committee had regard to your oral evidence and the patient’s records. It noted that you stated in evidence that your usual practice would have been to issue advice to patients on their diet and the Committee has determined (see above) that it accepts your evidence on this. The Committee determined therefore that it was more likely than not that you did discuss the Patient’s diet and accordingly, found this aspect of the head of charge not proved. With regard to recording the advice on diet, the Committee noted and accepted


your admission to this head of charge. Accordingly, it found this aspect of the head of charge proved. The Committee next considered the provision of caries preventative advice. The Committee noted from the records that you provided extensive oral hygiene instruction to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee had regard to the evidence of Dr Pal and Dr Timmons, who both stated that you had a duty to include this as part of your advice on caries prevention for this patient. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you recorded the advice on oral hygiene that you did provide. You did not provide advice on high fluoride products. The Committee was satisfied, therefore, that you did not have a duty to record advice that you did not give. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


(a) On 3 May 2016:

(i) provided a restoration to UL6 which was not clinically indicated; Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) When considering this head of charge, the Committee had particular regard to the oral evidence of Patient 8. The Committee noted that Patient 8 was clear in her evidence that no alternatives to fillings were discussed with her. She stated that she remembered the appointment as the pain was significant and she had not had fillings before. The Committee considered Patient 8’s evidence to be clear and consistent, both orally and in her written witness statement. The Committee also considered your written and oral evidence regarding this appointment. The Committee noted that in your witness statement you gave a detailed recollection of this appointment. However, you did not repeat this in your oral evidence nor did you give this account to the case examiners when discussing this patient. The Committee considered your evidence on this head of charge to be inconsistent and considers that your memory on this matter has become unreliable due to the time which has elapsed since what was, to you, a routine appointment. The Committee also determined that this was not a routine appointment to patient 8 because she experienced pain and because it was her first filling. It therefore considered that her recollection is likely to be more reliable


on this matter than your own. The Committee, therefore, determined that it was more likely than not that you did not discuss the the option of preventative measures and monitoring in respect of UL6. Accordingly, it found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.



(b) As a result of matters alleged in paragraph 8 (a)(ii) on the basis that there was a failure to discuss the option of preventative measures and monitoring in respect of UL6, Patient 8 was not in a position to provide valid consent.

Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(c) On 18 May 2016,

(i) WITHDRAWN

(ii) failed to record the diagnosis and presenting symptoms justifying the need for the prescription of a mouth-guard.


(d) Between 13 April 2016 and 13 July 2016, failed to record discussion of the patient’s diet and/or to record the provision of caries preventative advice.

Admitted Found Proved (failure to record discussion of diet) Found Not Proved (failure to record provision of caries preventative advice) The Committee accepted your admission that you failed to record discussion of the patient’s diet, and, accordingly, found this aspect of the head of charge proved. The Committee noted you have recorded extensive discussions of oral hygiene advice, which the experts agree is part of caries prevention advice. In light of its earlier findings on the ‘no case to answer’ application, the Committee has not


made any finding that other advice should have been offered. Accordingly, the Committee has found no failure with regard to recording such caries prevention advice. Therefore, notwithstanding your admission, this is found not proved.


(a) On 18 May 2016 provided a restoration to UL4 which was not clinically indicated;


(b) On 21 June 2016 provided restorations to UR4 and UR6 which were not clinically indicated;


(c) In relation to the respective dates set out at paragraphs 9 (a) and (b) above, failed to discuss and/or record discussion of the option of preventative measures and monitoring in respect of UL4, UR4 and UR6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) The Committee noted that in your witness statement you stated that you followed your usual practice regarding this appointment and there was no reference as to whether you recollected this appointment. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, the Committee found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL4, UR4 and UR6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(e) In relation to the respective dates set out at paragraphs 9 (a) and (b) above, failed to record pre-treatment clinical findings that would justify the


carrying out of the restorations in respect of UL4, UR4 and UR6; Admitted and Found Proved The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(f) Between 26 April 2016 and 21 June 2016, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

Admitted (in respect of failure to record only) Found Not Proved (failed to discuss patient’s diet and recording provision of caries preventative advice) Found Proved (failed to record discussion of patient’s diet and to provide caries preventative advice in relation to high fluoride only) The Committee has not heard evidence from this patient and you had no recollection of your appointments with them. The Committee firstly considered whether you failed to discuss the patient’s diet and record the discussion of this. The Committee had regard to your oral evidence and the patient’s records. It noted that you stated in evidence that your usual practice would have been to issue advice to patients on their diet and the Committee has determined (see above) that it accepts your evidence on this. The Committee determined therefore that it was more likely than not that you did discuss the Patient’s diet and accordingly, found this aspect of the head of charge not proved. With regard to recording the advice on diet, the Committee noted and accepted your admission to this head of charge. Accordingly, it found this aspect of the head of charge proved. The Committee next considered the provision of caries preventative advice. The Committee noted from the records that you provided extensive oral hygiene instruction to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee noted Dr Timmons’ oral evidence that he considered this patient to be at low risk of caries, but Dr Pal did not agree. The Committee also noted the following from Dr Pal’s expert report: “Given the presence of caries, it was appropriate to discuss the patient’s diet and provide caries preventative advice. Such advice would be dietary advice, OHI and fluoride in the form of mouthwash or varnish”. The Committee considered Dr Pal’s evidence to be more reliable and consistent and therefore placed more weight on this than on Dr Timmons’ evidence. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you recorded the advice on oral hygiene that you did provide. You did not provide advice on high fluoride products. The Committee was satisfied, therefore, that you did not have a duty to record advice that you did not give. Accordingly, notwithstanding your admission, the Committee has found this aspect


of the head of charge not proved.


(a) On 17 May 2016 provided restorations to UL6 and UL7 which were not clinically indicated;


(b) On 22 June 2016 provided a restoration to LL6 which was not clinically indicated;


(c) In relation to the respective dates set out at paragraphs 10 (a) and (b) above, failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL6, UL7 and LL6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss) Found Not Proved (failed to record) You have not stated in either your oral or written evidence that you remember these appointments. The Committee therefore considered your usual practice. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, the Committee found this aspect of the head of charge proved. With regard to the alleged failure to record this discussion, the Committee was satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL6, UL7 and LL6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

(e) In relation to the respective dates set out at paragraphs 10(a) and (b) above, failed to record pre-treatment clinical findings that would justify the carrying out of the restorations in respect of UL6, UL7 and LL6;

Admitted and Found Proved


The Committee accepted your admission to this head of charge and, accordingly, found it proved.

(f) Between 5 May 2016 and 17 July 2016, failed to discuss with the patient and/or record discussion of the patient’s diet and to provide and/or record the provision of caries preventative advice.

Admitted (in respect of failure to record only) Found Not Proved (failed to discuss patient’s diet and recording provision of caries preventative advice) Found Proved (failed to record discussion of patient’s diet and to provide caries preventative advice in relation to high fluoride only) The Committee has not heard evidence from this patient and you had no recollection of your appointments with them. The Committee firstly considered whether you failed to discuss the patient’s diet and record the discussion of this. The Committee had regard to your oral evidence and the patient’s records. It noted that you stated in evidence that your usual practice would have been to issue advice to patients on their diet and the Committee has determined (see above) that it accepts your evidence on this. The Committee determined therefore that it was more likely than not that you did discuss the Patient’s diet and accordingly, found this aspect of the head of charge not proved. With regard to recording the advice on diet, the Committee noted and accepted your admission to this head of charge. Accordingly, it found this aspect of the head of charge proved. The Committee next considered the provision of caries preventative advice. The Committee noted from the records that you provided extensive oral hygiene instruction to this patient. However, you have not recorded providing advice on high fluoride and you accept that you did not provide it. The Committee had regard to the evidence of Dr Pal and Dr Timmons, who both stated that you had a duty to include this as part of your advice on caries prevention for this patient. The Committee found this head of charge proved with respect to that element of caries prevention advice alone. With regard to the recording of the caries preventative advice, the Committee has determined that you recorded the advice on oral hygiene that you did provide. You did not provide advice on high fluoride products. The Committee was satisfied, therefore, that you did not have a duty to record advice that you did not give. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.


(a) On 7 June 2016:

(i) provided restorations to UL5 and UL6 which were not clinically indicated;

Admitted (UL6) and Not Admitted (UL5)


Found Proved (UL6) Not Proved (UL5) With regard to UL6, the Committee accepted your admission to this head of charge and the agreed evidence of Dr Pal and Dr Timmons that the restoration was not clinically indicated. Accordingly, the Committee found the head of charge proved in respect of UL6. With regard to UL5, the Committee noted that the records document that there was a cavity. The Committee also had regard to your oral evidence, in which you stated that the cavity was not amenable to monitoring owing to its position with respect to the adjacent tooth. You, therefore, considered that it was reasonable to treat it. The Committee also noted the evidence of Dr Pal, in which he stated that the lesion could not have progressed into dentine because it did not appear on the radiograph, and therefore that it was amenable to conservative management. Dr Timmons disagreed with this opinion and stated that although a large cavity would have been visible on the radiograph, an early one may not have been. He was of the opinion that it was reasonable to restore the tooth. The Committee accepted Dr Timmons’ evidence on this. The Committee was of the view that both a conservative approach and a filling were reasonable options that a responsible body of dentists would have provided. Accordingly found this head of charge not proved in respect of UL5.

(ii) failed to discuss with the patient and/or record discussion of the option of preventative measures and monitoring in respect of UL5 and UL6;

Admitted (in respect of failure to record only) Found Proved (failed to discuss for UL5 and UL6) Found Not Proved (failed to record for UL5 and UL6) The Committee noted that you have no recollection of this appointment. You are relying on the patient’s notes and your usual practice. The Committee has already determined that your usual practice would not have involved discussion of the option for preventative measures and monitoring. Accordingly, the Committee found this head of charge proved in respect of UL6. With regard to UL5, the Committee noted the specific circumstances in which you noticed that there was a cavity in the tooth. The Committee also noted that Dr Pal’s evidence was that a preventative approach should have been undertaken, whereas, Dr Timmons disagreed and stated that it was reasonable to restore the tooth. The Committee has already decided that both options were reasonable and so both should have been offered to the patient. The Committee determined, however, that for the reasons already given, you did not offer this patient the conservative approach with respect to this tooth. Accordingly, the Committee found this head of charge proved in respect of UL5. With regard to the alleged failure to record these discussion, the Committee was


satisfied that you did not have a duty to record it in the patient’s records as it had not taken place. Accordingly, notwithstanding your admission, the Committee has found this aspect of the head of charge not proved.




Not Admitted and Found Proved The Committee has determined that you failed to discuss the option of preventative measures and monitoring in respect of UL5 and UL6. The Committee determined, therefore, that the patient would not have been able to give valid consent. Accordingly, the Committee found this head of charge proved.

12. WITHDRAWN


(a) On 20 May 2017, failed to place a mesial restoration on the UL7 when such a restoration was indicated;


(b) WITHDRAWN.

We move to Stage Two". The hearing adjourned part heard on 17 September 2021 and will resume on 6 December 2021.

HEARING PARTLY HEARD IN PRIVATE BONNAR, Jayne …

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