While recent years have seen the rise of the 'dental industry', I firmly believe dentistry is a traditional profession at heart. By this, I mean we are an autonomous group of practitioners governed by a group of peers according to our guidelines, principles and ethical standards. Key to this is that these standards are not set in stone. They are not rules, per se, but advice on how to practise and conduct ourselves, which is context-dependent. We should be encouraged to use our informed judgement to know in which situations they apply and when we can and should move away from them.
When it comes to regulatory matters, whether regarding clinical issues or personal conduct, it is often left to an expert's opinion to judge if these guidelines have been breached. Unfortunately, experts are only human, and two recent GDC cases have demonstrated that expert opinions can be flawed.1,2 In one case, the expert appears to have overestimated their understanding of factors outside of their area of expertise, whereas, in the other, the court overruled multiple experts who were in agreement.
It's worth remembering that expert testimony, whether in the form of a written report or a spoken statement, should be unbiased based on the evidence given. Experts do not give evidence in favour of the GDC or indemnity companies. They provide independent opinions on what should be expected of us and whether the person in question has exceeded or fallen short of those standards.
There are multiple issues with the current concept of the expert witness. Firstly, we must acknowledge that an increased depth of knowledge can lead to a narrower breadth. Those specialising in one subject may comprehend less than average about another, even if they are related. Furthermore, those with an increased level of ability in a specific subject are likelier to overestimate the typical level of understanding or skill of that subject. This could, for example, lead specialist witnesses to judge their generalist peers to a higher than reasonable level of clinical care. Indeed, it is only fair that our peers judge us, and for general dentists, that means by the opinion and expected standards of another general dentist.
Additional complications arise if there is a lack of consensus regarding a treatment modality or a paucity of evidence surrounding a clinical subject. We know that the evidence base for many dental interventions is lacking, and there are many cases where experts disagree over acceptable treatments for a condition.
Moreover, there is little, if any, profession-specific expert witness training for dentists. What teaching there is, is generally tailored to the world of medicine, and while there are clear parallels, the professions differ significantly enough to warrant specific education. A register of expert witnesses can then be kept, including details of areas of specialism and enhanced knowledge, which would help prevent witnesses from stepping out of their niche and improving the quality of evidence to the court - helping both patients and dentists avoid miscarriages of justice.
Dental Professionals Hearing Service. Charnley, LJW. 2023. Available at https://www.gdpuk.com/media/pdf/no_case_to_answer.pdf (accessed September 2023).
General Dental Council v Williams. EWCA Civ 481. 2023.
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Sellars, S. The whole tooth. Br Dent J 235, 365 (2023). https://doi.org/10.1038/s41415-023-6340-5