Complaints arising from routine dental hygiene visits have got to be the MOST frustrating for dentists.
The care is standard and the intent is appropriate. But then the patient leaves dissatisfied, uncomfortable, or convinced something went wrong! Ugghhh!
The recent case of Su v. Necula is a clear reminder that even ordinary clinical encounters can escalate into multi-year regulatory proceedings. And once again, it shows how good records, thoughtful communication, and professional restraint can carry a dentist safely through that process. Although I must admit that, even with all of this, the dentist’s good name was dragged through the mud and she found herself defending her knowledge, skills, experience and reputation.
In this case, a patient complained that a hygiene appointment was painful, that the cleaning damaged her teeth, and that the dentist failed to respond properly afterward. The RCDSO’s Inquiries, Complaints and Reports Committee investigated and decided to take no further action. End of story right?
No. The patient appealed, and the Health Professions Appeal and Review Board (the “Board”) THANKFULLY confirmed the College’s decision. For dentists, the reasons matter far more than the outcome.
Pain Does Not Equal Misconduct
One of the patient’s core complaints was that the hygiene appointment was “very rough” and caused significant pain. The Board accepted that the patient experienced discomfort but made a critical distinction: discomfort alone does not imply substandard care. The records showed pre-existing periodontal inflammation, plaque, calculus, and bone loss. In that clinical context, some degree of discomfort during scaling is not unexpected.
The lesson here is not that patient pain should be dismissed. Rather, it is that regulators recognize dentistry is not always pain-free, especially when pre-existing disease is present. What matters is whether the care was clinically appropriate and competently delivered. Dentists should still explain expected discomfort in advance and check in during treatment, but they should not assume that pain alone exposes them to discipline.
Pre-Existing Conditions Matter — If You Document Them
The most significant allegation was that the cleaning caused brown spots and tooth damage. The dentist responded by pointing to wear facets, abfractions, fractures, and exposed dentin that were present before treatment. The Board agreed, relying heavily on chart notes, radiographs, and intraoral photographs taken before and after the hygiene appointment. Once calculus was removed, underlying defects became more visible, not newly created.
This is a powerful reminder that what patients notice after treatment is not always what the treatment caused. Regulators understand this distinction, but only if the record supports it. Detailed baseline documentation converts a subjective complaint into an objective analysis. Without it, dentists are left arguing memory against perception, which rarely ends well.
Records Are Legal Documents — and Regulators Treat Them That Way
A key line in the decision is that dental records are legal documents created before any complaint or litigation arises. Because of that timing, they are presumed reliable unless compelling evidence suggests otherwise. The Board repeatedly relied on contemporaneous chart notes rather than later photographs, videos, or insurance paperwork submitted during the appeal.
For dentists, this underscores why rushed, minimal notes are a long-term liability. Clear entries about periodontal status, wear patterns, patient questions, consent discussions, and post-treatment explanations are not bureaucratic chores. They are your most credible witness if your care is later challenged.
Patient Felt Left In the Dark
One of the patient’s core complaints was that they had not been provided with a scientific explanation for the brown spots and other issues with their teeth.
The Board disagreed. The dentist and another dentist had provided reasons: aggressive brushing and grinding. Per the Board: “These dental practitioners applied their science-informed knowledge and dental expertise to the information in the clinic records and considered the expected standards of the profession in assessing the Applicant’s concerns and finding that grinding or aggressive brushing were both possible reasons for tooth discolouration near the gumline, and that the discolouration only became noticeable after hygiene treatment.”
But the problem was that the patient insisted that the brown spots resulted FROM the hygiene treatment and not before it. While dentists can try their best to explain things scientifically, sometimes patients are deaf to reason. Protect yourself accordingly (i.e. document, document, document!).
Communication Helps — But It Is Not a Cure-All
The dentist in this case spent significant time explaining findings, took additional images, repeated scaling at no charge, and warned about possible sensitivity from exposed dentin. None of that prevented the complaint. The Board acknowledged a language barrier and the patient’s dissatisfaction, but still found the dentist’s response reasonable.
This highlights an uncomfortable truth: excellent communication reduces risk, but it does not eliminate it. Some patients remain unconvinced, especially when cosmetic appearance changes after hygiene. Dentists should aim for clarity and patience, while recognizing that regulatory outcomes hinge on reasonableness, not persuasion.
The Board’s Role Is Narrow — and That Matters
The Health Professions Appeal and Review Board emphasized that it does not retry cases or decide whether it would have acted differently. Its role is to assess whether the College’s investigation was adequate and whether the decision was reasonable. That standard is deferential, especially when records are complete and explanations are coherent.
For dentists, this means that early regulatory decisions matter enormously. A thorough College investigation supported by solid documentation is very difficult to overturn on appeal. Conversely, gaps at the investigation stage can echo through the entire process.
Bottom Line
Su v. Necula is not about an aggressive hygienist or a careless dentist. It is about how ordinary dentistry is scrutinized when patient expectations collide with clinical reality. The case reinforces that pain, dissatisfaction, and post-treatment surprises are not misconduct by themselves. What protects dentists is disciplined record-keeping, thoughtful explanations, and adherence to professional standards.
Most importantly, the decision shows that regulators understand dentistry from the inside. They rely on science, experience, and records — not hindsight frustration. Dentists who practice with that in mind are far better positioned when a routine appointment unexpectedly turns into a formal complaint.
