HEARING HEARD IN PUBLIC HENNING, Abraham Johannes

HENNING, A J Professional Conduct Committee – May 2021 Page -1/24-

HEARING HEARD IN PUBLIC

HENNING, Abraham Johannes Registration No: 75539

PROFESSIONAL CONDUCT COMMITTEE MAY 2021

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

Henning, Abraham Johannes, a dentist, BChD University of Pretoria 1981 MChD University of Pretoria 1990, was summoned to appear before the Professional Conduct Committee on 17 May 2021 for an inquiry into the following charge:

Charge “That being registered as a dentist: 1. You failed to provide an adequate standard of care to Patient A, in that you:

a. Did not carry out sufficient diagnostic assessments prior to commencing treatment on 16 January 2015, in that you: i. Did not carry out a general dental assessment, adequately or at all;

b. Provided a poor standard of orthodontic treatment from 16 January 2015 to 3 July 2017 in that you: i. Did not place the brackets in the centre of the labial clinical crown on the

lower incisors and/or the LL1 and/or the LL2 and/or the UL3; ii. Did not always ensure the bracket clips were closed on all teeth; iii. Created a gap between the LL5 and the LL6;

iv. Caused a traumatic occlusion of the front teeth; v. Caused bimaxillary proclination; vi. Caused the root apex of the UL4 to bulge through the buccal plate; vii. Caused alveolar bone loss; viii. Caused a poor buccal occlusion which was worse than at the outset of

treatment; ix. Took a longer period of time to treat Patient A than was necessary for her presenting condition;

c. Did not adequately respond to Patient A’s concerns about her treatment raised: i. In or around May 2016; ii. On 27 June 2016; iii. In or around September 2016;


iv. On 3 October 2016; v. On 17 October 2016; vi. On 6 March 2017; vii. On 3 July 2017;

d. Did not manage Patient A’s pain effectively during an appointment on 11 January 2017.

2. You failed to maintain adequate professional boundaries between yourself and Patient A on 11 January 2017 in that you attempted to hug her.

3. You failed to treat Patient A with dignity and respect on 3 April 2017 in that you: a. Said you had a “dislike of American smiles” and that you “liked English smiles

with character and some tooth movement rather than perfect teeth” or words to that effect;

b. Said “you can’t have that [i.e. a smile like the nurses’] because you are not that age and it would not look right” or words to that effect;

c. Said “you are not going to look anything like the Damon leaflets” or words to that effect.

4. You failed to maintain an adequate standard of record keeping in respect of Patient A’s appointments in that you: a. Did not record, adequately or at all, a general dental examination on 10 February

2014; b. Did not record, adequately or at all, a general dental examination on 16 January

2015; c. On 3 October 2016, did not record, adequately or at all, Patient A’s concern that

she had swallowed a piece of wire; d. Throughout the course of treatment, did not record, adequately or at all,

discussions with Patient A. AND, by reason of the facts stated, your fitness to practise as a dentist is impaired by reason of your misconduct.”

On 25 May 2021 the Chairman made the following statement regarding the finding of facts:

“Mr Henning, This is a Professional Conduct Committee hearing of your case. The hearing commenced on 17 May 2021, with the first four days, 17 to 20 May 2021, having taken place at the hearings venue of General Dental Council (GDC) in London. This was to allow the main witness in this case, Patient A, and you, to give evidence before the Committee physically, in person. During that time, the two expert witnesses in this case joined the proceedings remotely via video-link. From 21 May 2021 onwards, the hearing has been conducted via Microsoft Teams video-link with everyone participating remotely. This is in line with the current practice of the GDC.


You are represented at this hearing by Mr James Buchanan, Counsel. The Case Presenter for the GDC is Mr Christopher Saad, Counsel. Background and summary of the charge The charge against you arises out of your treatment of one patient, Patient A, to whom you provided orthodontic treatment between January 2015 and July 2017, whilst you were practising at Simply Orthodontics in Orpington (‘the Practice’). You have since retired. Patient A had sought treatment with you to straighten her bottom teeth, in addition to widening and straightening the definition on her top arch. The treatment that you provided included the placing of brackets on Patient A’s teeth using the Damon technique. In December 2017, Patient A made a complaint to the GDC regarding the standard of clinical treatment you provided to her. It is her evidence that the aesthetic appearance and function of her teeth have been affected by the orthodontic treatment you provided. Patient A also complained about the way in which she said you dealt with her more generally. As part of its investigation into Patient A’s complaint, the GDC instructed an expert, Professor Derrick Willmot, Consultant Orthodontist. Professor Willmot was critical of several clinical aspects of your treatment of Patient A, and these criticisms form the basis of a number of the allegations in the charge. In summary, the charge alleges that you failed to provide an adequate standard of care to Patient A, and that you provided her with a poor standard of orthodontic treatment over the period in question. It is further alleged that you did not adequately respond to concerns Patient A raised with you on a number of occasions about her treatment. There is also an allegation that you failed to manage Patient A’s pain effectively during an appointment on 11 January 2017. In addition, it is alleged that you failed to maintain adequate professional boundaries between yourself and Patient A on 11 January 2017 in that you attempted to hug her, and that you failed to treat her with dignity and respect on 3 April 2017 on account of alleged comments that you made to her. There are also alleged failings in record keeping. Admissions The Committee was provided with a written schedule of your admissions, in which you admitted the following heads of charge: 1(a)(i),1(c)(v), 4(a), 4(b), 4(c) and 4(d). You admitted that you failed to provide an adequate standard of care to Patient A in that you did not carry out sufficient diagnostic assessments prior to commencing treatment on 16 January 2015, in that you did not carry out general dental assessment, adequately or at all. You also admitted that you did not adequately respond to Patient A’s concerns about her treatment raised on 17 October 2016, when she is said to have told you that a band that you placed on her UR6 was loose and moving round the tooth. You further admitted that you failed to maintain an adequate standard of record keeping in respect of Patient A’s appointments on 10 February 2014, 16 January 2015, 3 October 2016 and, that throughout the course of treatment, you did not record, adequately or at all, discussions with the patient. You made further admissions in respect of heads of charge: 1(b)(i), 1(b)(ii), 1(b)(iii), 1(b)(iv), 1(b)(v), 1(b)(vi), 1b(vii). These allegations relate to alleged individual failings in Patient A’s treatment which, the GDC contended, amount to providing the patient with a poor standard of orthodontic treatment from 16 January 2015 to 3 July 2017. Whilst you admitted, as fact, the individual clinical matters set out at heads of charge 1(b)(i) to 1(b(vii), you denied that they reflected a poor standard of orthodontic treatment.


Subsequently, during the course of the hearing, you made a full admission to head of charge 1(b)(viii), which you had initially denied. You admitted that you caused a poor buccal occlusion which was worse than at the outset of treatment, and that this particular failing amounted to a poor standard of orthodontic treatment.

All the remaining allegations contained within the charge were denied. The Committee noted your admissions, but deferred any findings on the alleged facts until all the evidence had been adduced. Evidence The Committee received from the GDC documentary evidence which comprised Patient A’s witness statement, dated 25 October 2019, along with associated exhibits. The exhibits provided by Patient A included a copy of a diary that she kept from September 2016. In evidence, Patient A explained that she had undertaken a rewrite of the diary to exclude profanities and confirmed that she had made substantial additions to the document on the basis of her recollection as she conducted the re-draft. This affected the weight the Committee could give to the diary, as it was not a fully contemporaneous account. The GDC also provided a records bundle, which contained Patient A’s dental records including records relating to her treatment with you, as well as records from her previous and subsequent treating dentists. The evidence received by the Committee in relation to your case consisted of your witness statement, dated 12 April 2021, along with associated exhibits, as well as a number of witness statements from members of staff who worked at the Practice during the material time. The Committee received the main and supplementary witness statements, dated 1 November 2019 and 30 March 2021, of Witness 1, an Orthodontic Therapist; the main and supplementary witness statements, dated 24 October 2019 and 23 March 2021, of Witness 2, Clinical Practice Manager, who worked previously as a Dental Nurse at the Practice; the witness statement, dated 18 March 2021, of Witness 3, the current Practice Manager, who worked previously at the Practice as a Receptionist and Administrator; the witness statement, dated 11 April 2021, of Witness 4, Orthodontic Therapist; and the witness statement, dated 25 March 2021, of Witness 5, Dental Nurse. The Committee was also provided with a copy of a ‘Record of a Telephone Call’ dated 28 October 2019, which set out the content of a telephone call made by Patient A to an in-house lawyer at the GDC. In addition, the Committee received expert evidence from both parties. It was provided with an expert report, dated 29 November 2019, prepared by Professor Willmot, Consultant Orthodontist, who was called by the GDC, and an expert report, dated 10 April 2021, prepared by Mr Gerry Bellman, Specialist Orthodontist, who was called on your behalf. The experts also prepared a joint report, which was signed and dated by Mr Bellman on 6 May 2021 and Professor Willmot on 7 May 2021. The Committee heard oral evidence from Patient A, from Professor Willmot, from you, from Mr Bellman, and from Witnesses 1, 2, 4 and 5. The Committee’s findings of fact The Committee considered all the evidence presented to it. It took account of the closing submissions made by Mr Saad on behalf of the GDC, and those made by Mr Buchanan on behalf of Mr Henning. The Committee accepted the advice of the Legal Adviser. It 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 facts are proved on the balance of probabilities. The Committee’s findings are as follows:

1. You failed to provide an adequate standard of care to Patient A, in that you:

1.(a) Did not carry out sufficient diagnostic assessments prior to commencing treatment on 16 January 2015, in that you:

1.(a)(i) Did not carry out a general dental assessment, adequately or at all;

Admitted and found proved. It was your evidence that you did not carry out a general dental assessment, as you were not aware that you were required to do so.

1.(b) Provided a poor standard of orthodontic treatment from 16 January 2015 to 3 July 2017 in that you:

1.(b)(i) Did not place the brackets in the centre of the labial clinical crown on the lower incisors and/or the LL1 and/or the LL2 and/or the UL3;

Found proved. You admitted as fact that you did not place the brackets in the centre of the labial clinical crown on the lower incisors and/or the LL1 and/or the LL2 and/or the UL3. However, you denied that this reflected a poor standard of orthodontic treatment, as alleged in the stem of this allegation at 1(b). Having noted your admission, and having had regard to the expert evidence of Professor Willmot and Mr Bellman, the Committee itself was satisfied that you did not place the brackets in the centre of the labial clinical crown on the lower incisors of the LL1 and/or the LL2 and/or the UL3. In considering whether, this misplacement of the brackets amounted to poor orthodontic treatment, the Committee took into account the evidence of both experts. In giving his opinion that the brackets were placed too low and below the mid-point, Professor Willmot referred the Committee to two photographs of Patient A, one taken pre-treatment on 16 January 2015 and one taken post-treatment on 6 September 2017, showing the brackets on the patient’s teeth. Professor Willmot’s evidence was that the misplaced brackets would cause the patient’s teeth to extrude, and that this would lead to height discrepancies in the teeth. It was his opinion that you should have repositioned the brackets early in the treatment. He noted, however, that they had not been repositioned after two and a half years of treatment. Mr Bellman agreed that there were some issues with the placement of the brackets. He stated in his report, in reference to a photograph of Patient A’s brackets, taken on 23 June 2017, that there appeared to be “some small bracket height discrepancies between LL1 and LL2, leading to height discrepancy at the incisal edge of these 2 teeth. Also, the bracket on the UL3 appears too occlusal”. However, it was Mr Bellman’s opinion that the misplacement of the brackets could be compensated by the placing of bends in the arch wires, which is what you did. He stated that it would have been ideal for the brackets to have been replaced earlier in Patient A’s treatment, but


considered that you were not afforded that opportunity, as the patient left your care before treatment could be completed. The Committee preferred the evidence of Professor Willmot on this issue. It took into account the considerable treatment history of Patient A, which included previous surgery on her jaw, as well as previous orthodontic treatment. In these circumstances, the Committee considered that it was fundamental, to avoid the potential problems referred to by Professor Willmot, for you to have repositioned the misplaced brackets early in the patient’s treatment, notwithstanding any initial compensatory measures you had taken. Given that you did not reposition the brackets at an early stage, the Committee was satisfied that this amounted to providing a poor standard of orthodontic care to Patient A.

1.(b)(ii) Did not always ensure the bracket clips were closed on all teeth;

Found not proved. You admitted as fact that you did not always ensure the bracket clips were closed on all teeth. However, you denied that this reflected a poor standard of orthodontic treatment, as alleged in the stem of this allegation at 1(b). The Committee noted your admission. It also had regard to the photographic evidence which showed that some of the bracket clips were open. It further had regard to the evidence of Patient A, who stated in her witness statement regarding the brackets that “Often the gates wouldn’t close…”. The Committee was satisfied on your admission, and the evidence, that you did not always ensure the bracket clips were closed on all teeth. The Committee went on to consider whether this amounted to a poor standard of orthodontic care. It noted Professor Willmot’s evidence that a failure to close bracket clips allows individual teeth to drift and does not allow the bracket to express its correct value, “leading to malalignment and occlusal disharmony”. The Committee noted, however, that Professor Willmot conceded that it could be difficult to close bracket clips and that while he was critical of you not doing so, he was not overly critical. Mr Bellman’s also highlighted that “clips on ceramic Damon brackets are often difficult to close”. He stated that he himself had had experience of this, and he stated that he was sure that any practitioner who uses the system would have also had this problem. Therefore, Mr Bellman was not critical of you having left some bracket clips open. He acknowledged that this was not ideal, but not necessarily serious and that the problem could be mitigated with a module. Indeed, it was your evidence that as an alternative to exerting too much pressure in trying to close the Damon brackets, which in turn would cause the patient pain, you would place a module to retain the wire in the best position. Having considered all the evidence, the Committee’s view was that always closing bracket clips was the gold standard. Given the identified and well-known difficulties associated with the Damon system, the Committee considered the alternative measure that you took by placing a module, was adequate in all the circumstances. It was not satisfied that this represented a poor standard of orthodontic care. Accordingly, taking into account the stem of this allegation,


this head of charge is not proved.

1.(b)(iii) Created a gap between the LL5 and the LL6;

Found not proved. You admitted as fact that you created a gap between Patient A’s LL5 and the LL6. However, you denied that this reflected a poor standard of orthodontic treatment, as alleged in the stem of this allegation at 1(b). The Committee noted your admission, and it had regard to the photographic evidence referred to by Professor Willmot, The Committee noted from the pre-treatment photograph of Patient A, dated 16 January 2015, that there was no gap between the LL5 and LL6. However, a gap is present on the post-treatment photograph of 6 September 2017. The Committee also received clear evidence from Patient A regarding the gap. The Committee was satisfied on your admission and on the evidence that you caused the gap between the patient’s LL5 and LL6. However, in considering whether your causing of the gap amounted to poor orthodontic treatment, the Committee took into account the expert evidence it received. It noted that Professor Willmot conceded under cross-examination, that the treatment that you were providing to Patient A, which involved the proclination of her anterior teeth, would have naturally caused a gap. Professor Willmot also acknowledged, that there was evidence of your intention to close the gap, in that all the mechanics for removing the gap were in place. Mr Bellman, who was of the view that it was highly likely that the gap in question would have been closed, highlighted that Patient A stopped attending for treatment with you in July 2017 before the treatment had been completed. In reaching its decision, the Committee took into account that you undertook Patient A’s treatment in stages. The treatment, as the Committee understood it, did not involve the extraction of any of the patient’s teeth, but rather the movement of her teeth for the creation of space. The Committee noted and accepted the evidence that creating a gap between the LL5 and LL6 was a natural consequence. It therefore considered that you had good reason to cause the gap, and it also took into account the evidence indicating that, had Patient A continued with the treatment, it was more likely than not that the gap would have been closed. The Committee further took into account that, in an email to you, dated 1 August 2017, in which Patient A listed a number of issues relating to her treatment that she was unhappy with, she did not list the gap between LL5 and LL6 as being one of her concerns. In all the circumstances, the Committee was not satisfied that you provided a poor standard of orthodontic care in this instance. Accordingly, taking into account the stem of this allegation, this head of charge is not proved.

1.(b)(iv) Caused a traumatic occlusion of the front teeth; Found proved.

1.(b)(v) Caused bimaxillary proclination; Found proved. The Committee considered heads of charge 1(b)(iv) and 1(b)(v) separately and


made the same finding in relation to each allegation. You admitted as facts that you caused a traumatic occlusion of the front teeth and that you caused bimaxillary proclination. However, you denied that either of these matters reflected a poor standard of orthodontic treatment, as alleged in the stem at 1(b). The Committee noted your admissions. It also had regard to the photographic evidence drawn to its attention by Professor Willmot. The pre-treatment photograph of Patient A taken on 16 January 2015, showed a good buccal occlusion with no gaps. However, a further post-treatment photograph taken of the patient on 6 September 2017, without the brackets on her teeth, showed evidence of traumatic occlusion in that the patient’s top front teeth were meeting prematurely with her lower front teeth. There was also evidence of bimaxillary proclination. Professor Willmot described teeth moving forwards out of the labial bone and there having been gum recession with loss of interdental papillae. Further, in her evidence, Patient A spoke about her teeth banging together and the general problems that she experienced day to day. The Committee was satisfied on your admission and on the evidence that you caused a traumatic occlusion of the front teeth and bimaxillary proclination. In considering whether these issues amounted to a poor standard of orthodontic treatment, the Committee took into account Professor Willmot’s evidence that a traumatic occlusion can cause a number of problems, including tooth root resorption, pulp death and enamel damage. He further stated that bimaxillary proclination would lead to a change in the patient’s profile and her smile, “and more probably than not the result will be unstable in the medium to long term”. Professor Willmot highlighted that the issues of Patient A’s traumatic occlusion and bimaxillary proclination were present after 31 months of treatment. It was his opinion that they should have been rectified sooner. The Committee took into account the evidence of Mr Bellman that the issues should have been corrected, if Patient A had continued treatment, as well as your evidence that it was actually your intention to correct them. However, the Committee accepted the evidence of Professor Willmot that these were issues of concern and should have been rectified much earlier. In reaching its decision, the Committee took into account the associated problems referred to by Professor Willmot. It also had regard to Patient A’s evidence of how uncomfortable she was. The Committee was not satisfied that the patient should have endured a traumatic occlusion and bimaxillary proclination as part of her orthodontic treatment. It therefore found that both matters amounted individually to providing a poor standard of orthodontic care.

1.(b)(vi) Caused the root apex of the UL4 to bulge through the buccal plate;

Found proved. You admitted as fact that you caused the root apex of the UL4 to bulge through the buccal plate. However, you denied that this reflected a poor standard of orthodontic treatment, as alleged in the stem of this allegation at 1(b). The Committee noted your admission, as well as the photographic evidence drawn to its attention by Professor Willmot. It was satisfied on your admission


and on the evidence that you caused the root apex of the UL4 to bulge through the buccal plate. In considering whether this amounted to a poor standard of orthodontic treatment, the Committee considered the opinion of the experts in relation to this matter. It was Professor Willmot’s opinion that it was more likely than not that the bulge was due to the misplaced bracket on the patient’s UL4. He explained that the misaligned bracket would apply a torquing force which would cause the root apex of the tooth to be forced outwards. Mr Bellman agreed that the apex of the UL4 did protrude through the buccal cortex, but in his opinion, it was a rare and unfortunate event that you could not have predicted. Mr Bellman stated that he could not be sure that it was an issue with your workmanship that had caused the bulge. The Committee noted that you stated in your witness statement that you had only seen this problem three times in your 33 years of orthodontic practice. However, the Committee was satisfied on the balance of probabilities, that the origin of the problem was your misplacement of the bracket on the UL4. It accepted the opinion of Professor Willmot in this regard, and also took into account the letter, dated 20 June 2017, which was sent to Patient A following an appointment she attended at King’s College Hospital to complain about the bulge. The clinician from the hospital stated in the letter that “I have explained to the patient that this is due to her current active orthodontic treatment…” The Committee considered that the problem of the bulging root apex could have been avoided with proper placement of the bracket on the patient’s UL4. It noted Professor Willmot’s evidence regarding the potential for loss of vitality in that tooth or loss of the tooth itself, and concluded that causing the root apex of the UL4 to bulge through the buccal plate was a poor standard of orthodontic care.

1.(b)(vii) Caused alveolar bone loss;

Found not proved. You admitted as fact that you caused alveolar bone loss. However, you denied that this reflected a poor standard of orthodontic treatment, as alleged in the stem of this allegation at 1(b). The Committee noted your admission. It also took into account the agreed opinion of the experts that bone loss is a risk associated with of orthodontic treatment. It saw a periapical radiograph of Patient A taken on 1 October 2019, which indicated that there was a degree of bone loss. The Committee was therefore satisfied on your admission and the evidence that some alveolar bone loss was caused during your treatment of Patient A. The Committee noted the opinion of Professor Willmot that it was more likely than not that the orthodontic treatment you provided exacerbated the bone loss in Patient A by virtue of periodontal breakdown in the presence of the orthodontic appliance for 31 months and the lower incisor proclination that occurred. However, the Committee took into account that it did not receive any comparative periapical radiographs of Patient A to indicate what the alveolar bone levels were prior to her commencing orthodontic treatment with you. It had regard to her considerable treatment history, which included jaw surgery and


previous orthodontic treatment which, in the Committee’s view, could have also affected the patient’s bone levels. Therefore, in all the circumstances, the Committee accepted the opinion of Mr Bellman that it was not possible to state how much of the alveolar bone loss seen on the post-treatment periapical radiograph was caused by the treatment you provided. Accordingly, the Committee was not satisfied that the GDC had discharged its burden in proving that the bone loss caused by the treatment you provided was caused by a poor standard of orthodontic treatment.

1.(b)(viii) Caused a poor buccal occlusion which was worse than at the outset of treatment;

Admitted and found proved. 1.(b)(ix) Took a longer period of time to treat Patient A than was necessary for her

presenting condition;

Found proved. You stated in your witness statement that you had informed Patient A at the outset, that treatment may take up to three years. The Committee noted that Patient A made reference to this time estimate in an email to you dated 21 June 2017. The Committee had regard to the evidence of Professor Willmot. His opinion, as set out in his report, was that the original proposed treatment plan for Patient A could have been achieved by a reasonable practitioner in 12 to 18 months. However, he accepted in cross-examination that your attempts to address the issues raised by the patient during the course of the treatment, had extended the period of time. Nonetheless, Professor Willmot highlighted that even after 31 months, when Patient A ceased treatment with you, there was still a degree of remedial work to be undertaken and, in his view, this work would have taken longer than six months to complete and therefore would have exceeded three years. It was Mr Bellman’s opinion that the length of Patient A’s treatment, which was approximately two and a half years, was not excessive. In giving this opinion, Mr Bellman stated that he took into account “the complexity of the malocclusion, the age of the patient and patient co-operation”. He noted that on reading the records, Patient A’s expectations in relation to her treatment were “very high”. The Committee acknowledged the evidence indicating that Patient A was a prescriptive patient with high expectations of outcome. It noted from her evidence that she was very articulate in stating what she had wanted and had undertaken a considerable amount of research in relation to her orthodontic treatment. It saw her prescriptive requests in the clinical records, in particular noting your disagreements in September 2016 and December 2016 regarding utility bars. The Committee also noted that during her oral evidence, Patient A made several references to the successful treatment of her son and a neighbour, both of whom had been treated by you. Nonetheless, the Committee was of the view that, as the treating orthodontist, you had a responsibility to retain professional accountability and judgement,


and it considered that you did not do so in your treatment of Patient A. The Committee noted the letter dated 19 July 2017, which it considered indicated that you arranged your appointments with Patient A around issues that she raised, as opposed to clinical need and need for treatment. The Committee considered this to be a major factor in the duration of the treatment. Taking all of the evidence into account, including the remedial work that was required for Patient A’s treatment to be completed, the Committee found this head of charge proved. The Committee was satisfied that you took a longer period of time to treat Patient A than was necessary for her presenting condition, and that this amounted to a poor standard of orthodontic treatment.

1.(c) Did not adequately respond to Patient A’s concerns about her treatment raised:

1.(c)(i) In or around May 2016;

Found not proved. The Committee took into account Patient A’s evidence, including her account given in her witness statement regarding this allegation. In doing so, the Committee found that it was not clear that she did raise a concern about her treatment with you in or around May 2016. In her witness statement, Patient A made reference to a number of concerns she had “At around this point” and mentioned that you said, “things like…”, but she does not identify any specific treatment concerns. Whilst the Committee considered that Patient A describes an underlying concern about your tone towards her, it found her account lacked particularity and specificity, both in relation to timeframe and the nature of her concern in respect of her treatment. Accordingly, the Committee was not satisfied that the GDC discharged its burden of proof in relation to this head of charge.

1.(c)(ii) On 27 June 2016;

Found proved. This head of charge relates to Patient A’s request that you consider moving some of the brackets on her upper teeth so that they would correctly align. Patient A stated that she made this request after having seen another orthodontist for a second opinion. Her evidence was that without any measurement, you declined to move the brackets stating, “they are fine where they are”. Patient A stated in her oral evidence that you said this verbatim. You stated that you could not recall saying this to Patient A, but that if you did, you would have explained to her why you considered it appropriate for the brackets to remain where they were. The Committee found that Patient A’s evidence on this issue was clear and compelling. It considered that it was more likely than not that she did raise this concern with you and that you responded as she said, without any explanation. In the Committee’s view, your response was not adequate. Patient A was sufficiently concerned to have sought a second opinion, which was her right, and this should have been respected. The patient should have left this appointment with a full understanding as to why your professional opinion differed from the other orthodontist she had seen. The Committee was satisfied from Patient A’s evidence that this was not the case. In reaching its decision,


the Committee also took into account the absence of any reference to such a discussion in the clinical records.

1.(c)(iii) In or around September 2016;

Found not proved. This head of charge relates to an allegation that you said in response to a concern raised by Patient A “ok if that’s what you want that’s what you get”.

The Committee took into account that this was said to have occurred at a time after Patient A had been to see a further orthodontist, and that orthodontist had advised her to continue with the treatment being provided by you. The Committee noted the indication from Patient A’s witness statement that this was not the answer she had been expecting, and that she was disappointed. Whilst the Committee accepted that Patient A was clearly unhappy at this stage with the treatment you were providing, it was not satisfied that there was sufficient evidence that she did raise treatment concerns with you in or around September 2016. Patient A stated in her witness statement that your alleged response to her, “ok if that’s what you want that’s what you get” occurred “When I questioned something…”. However, she does not state what specifically. Further, she goes on to state that “I had my warning. So, I kept quiet and pressed on…”. The Committee was in no doubt from her evidence that her concerns were escalating internally, but it was not satisfied that there was enough evidence to prove that she raised a treatment concern around this time, to which you did not adequately respond.

1.(c)(iv) On 3 October 2016;

Found proved. This head of charge relates to Patient A’s concern that she had swallowed part of the wire that had been used to secure the brackets on her teeth. It was this concern that initiated her return to see you on this date, following her visit to a hospital Accident and Emergency department. The Committee noted Patient A’s evidence as contained within her witness statement that, at the appointment, she elaborated on her concerns, which included her complaints that she thought “the assessment was poor which led to no securing of the wire, which is why it slid through the brackets, dug into my cheek and eventually broke. I would not have swallowed it if it had been tightened/ secured”. Patient A stated that you listened without comment or apology and then walked out of the room. The Committee took into account your denial that this happened. It was your evidence in your witness statement that you recalled being alerted by Witness 4 of Patient A’s concern about swallowing the wire, and that you informed the patient that the wire was soluble in stomach acid and unlikely to be harmful. You stated that to the best of your recollection, Patient A was “content and reassured”. Whilst the Committee had regard to your evidence, and the evidence of the witnesses who worked with you at the Practice that walking out on a patient


would not have been in your nature, it preferred the evidence of Patient A on this matter. It considered that it would have been very clear to you at that appointment that Patient A was unhappy with a number of issues, and it was satisfied that it was more likely than not, that you did walk out when she confronted you. The Committee also took into account that, despite your evidence of Patient A being reassured, there is little or no reference to any conversation in the clinical records; just an indication that no wire was broken. In all the circumstances, the Committee found this head of charge proved.

1.(c)(v) On 17 October 2016;

Admitted and found proved. You admitted that you did not respond adequately to the concern raised by Patient A at this appointment that a band that you placed on her UR6 was loose and moving round the tooth.

1.(c)(vi) On 6 March 2017;

Found not proved. This head of charge relates to an allegation that you asked Patient A for her “shopping list” in response to a concern she raised. In her witness statement, Patient A referred to you as having been “sarcastic, rude, placatory and condescending”. The Committee noted, however, that in answer to questions under cross-examination, Patient A conceded that you had said “shopping list” in a cordial and jovial manner. It was your evidence that you did use the phrase “shopping list” with patients and that it was likely that you did so with Patient A. You stated that you would have done so in a joking, jovial manner, to put patients at ease, so that they could be entirely open about their requirements and concerns. In light of the conflict in Patient A’s oral and written evidence, and having taken into account your evidence and that of the witnesses who have worked with you regarding your friendly manner, the Committee accepted that when you used “shopping list” in conversation with Patient A, you did so in jovial terms. Whilst the Committee acknowledged that this was not the most professional of terms, it took into account that by this time you were fully aware of Patient A’s unhappiness and it considered it plausible that you were trying to put her at ease. It did not consider that you were being rude or attempting to avoid responding to her concerns. Therefore, this head of charge is found not proved.

1.(c)(vii) On 3 July 2017;

Found proved. The Committee was satisfied from the evidence of Patient A that she did raise concerns with you at this appointment regarding the orientation of two of her front teeth, which she considered were slanting. It was Patient A’s evidence that you responded by saying “that’s how they were to start with dear”. Patient A stated that she recalled being “furious” and saying “so after 2 and a half years and four thousand pounds they are no better, they are actually worse”. You stated in your evidence that you did not recall the precise details of the


conversation that you had with Patient A on this date, but you referred to a follow-up letter that you sent to her, dated 19 July 2017 which, you stated, set out a summary of your discussions with Patient A at the appointment on 3 July 2017. The Committee had regard to that letter of 19 July 2017, which it found did set out in details responses to Patient A’s concerns, including her concerns about the occlusal slant. However, the Committee considered the wording of this head of charge as its stands, which is whether you responded adequately to the patient’s concerns on the date in question, namely 3 July 2017. In addition to Patient A’s account, the Committee had regard to the clinical records. It noted that there was no evidence within them to indicate that there had been any discussion regarding the concerns raised by the patient on that day. In all the circumstances, the Committee was satisfied on the balance of probabilities, that you did not respond adequately to the patient’s concerns at the time she raised them.

1.(d) Did not manage Patient A’s pain effectively during an appointment on 11 January 2017.

Found proved. It was the evidence of Patient A that she “yelped” in pain when you pushed titanium wire into the bracket of her lower incisors during treatment. In your oral evidence, you initially stated that you did not recall the patient being in pain, but later accepted that she had “yelped” in pain as she described, as you mentioned this in your witness statement. It was the opinion of Professor Willmot that you did not manage Patient A’s pain effectively during the procedure you undertook. He stated that he would have expected a reasonable practitioner to explain the likely sequelae and if necessary, prescribe and appropriate analgesic. The Committee also noted Mr Bellman’s evidence that when placing wires on the lower incisors, it was not uncommon to cause transitory pain to a patient. He was therefore not critical in this regard. The Committee preferred the evidence of Professor Willmot. It considered that there was a continuum of care that you should have provided to the patient, which should have included setting an expectation about pain, as well an apology, advice and aftercare, including recommended painkillers if the pain persisted. The Committee noted from Patient A’s witness statement, the graphic description of the pain that she said she experienced. She stated that “There was absolutely no apology” and that all you said was “I hate to have to do that to you”. Whilst the Committee noted your evidence that you did apologise for the pain caused, it took into account that there is no reference to the incident in the clinical records. In all the circumstances, the Committee was satisfied on the balance of probabilities that you did not manage the patient’s pain effectively at this appointment.

2. You failed to maintain adequate professional boundaries between yourself and Patient A on 11 January 2017 in that you attempted to hug her.


Found not proved. Patient A demonstrated in evidence how you had extended your arm towards her at the appointment in question. In the Committee’s view, this action did not indicate an attempt to hug her. The Committee heard from a number of the witnesses that had worked with you at the Practice, that you are a caring practitioner, and that you would comfort a patient in distress. They also stated that you may on occasion have comforted members, including by placing a hand on a shoulder. However, they were clear in stating that you would never hug a patient. It was also your evidence that you have never attempted to hug a patient and you highlighted that you were always accompanied by a dental nurse or occupational therapist at appointments. Taking all of the evidence into account, the Committee considered that the action described by Patient A was more of a spontaneous on your part, given your caring nature, and was not an attempt to hug her. It did not, therefore, cross professional boundaries. This head of charge is not proved.

3. You failed to treat Patient A with dignity and respect on 3 April 2017 in that you:

3.(a) Said you had a “dislike of American smiles” and that you “liked English smiles with character and some tooth movement rather than perfect teeth” or words to that effect;

Found not proved. 3.(b) Said “you can’t have that [i.e. a smile like the nurses’] because you are not that

age and it would not look right” or words to that effect;

Found not proved. 3.(c) Said “you are not going to look anything like the Damon leaflets” or words to

that effect.

Found not proved. The Committee considered heads of charge 3(a) to 3(c) separately and made the same finding in respect of each allegation. The Committee was not satisfied that the GDC had presented sufficient evidence to prove that you failed to treat Patient A with dignity and respect on 3 April 2017. In reaching its decision, it considered the context in which you were said to have made the comments to Patient A, or words to that effect. This included the evidence regarding Patient A’s prescriptive approach to her treatment and her high expectations, which included her comparisons with the treatment received by others. In the circumstances, the Committee considered that there was legitimacy in you trying to find comparators to engage Patient A with the likely outcome of her treatment, given your view that her age and bone density were relevant factors. The Committee was therefore of the view that the language that you used, even if it was as alleged, was selected to try to manage Patient A’s expectations and was not a failure on your part to treat her with dignity and respect. Accordingly, those three allegations have been found not proved.

4. You failed to maintain an adequate standard of record keeping in respect of


Patient A’s appointments in that you:

4.(a) Did not record, adequately or at all, a general dental examination on 10 February 2014;

Admitted and found proved. 4.(b) Did not record, adequately or at all, a general dental examination on 16 January

2015;

Admitted and found proved. 4.(c) On 3 October 2016, did not record, adequately or at all, Patient A’s concern that

she had swallowed a piece of wire;

Admitted and found proved. 4.(d) Throughout the course of treatment, did not record, adequately or at all,

discussions with Patient A. Admitted and found proved. In finding heads of charge 4(a) to 4(d) proved on your admissions and on the evidence, the Committee was also satisfied that the stem at head of charge 4 is proved. It was satisfied that you had a duty in accordance with the GDC Standards for the Dental Team (Effective from September 2013) to maintain an adequate standard of record keeping in respect of Patient A’s appointment. By not doing so, as you have admitted, you failed in that duty.

We move to Stage Two”.

On 27 May 2021 the Chairman announced the determination as follows: “Mr Henning, This is a Professional Conduct Committee hearing of your case. This stage of the hearing has been conducted entirely remotely via Microsoft Teams in line with the current practice of the General Dental Council (GDC). You are represented at this hearing by Mr James Buchanan, Counsel. The Case Presenter for the GDC is Mr Christopher Saad, Counsel. The Committee’s task at this second stage of the hearing has been to consider whether the facts found proved against you amount to misconduct and, if so, whether your fitness to practise is currently impaired by reason of that misconduct. The Committee noted that if it found current impairment, it would need to go on to consider the issue of sanction. The Committee considered all the evidence presented to it, both at the fact-finding stage and at this stage. The evidence received by the Committee at this stage comprised your remediation bundle, as well as a further report, dated 26 May 2021, from the GDC’s expert witness, Professor Derrick Willmot, which is based on his review of your remediation bundle. The Committee took account of the submissions made by Mr Saad and by Mr Buchanan in relation to misconduct, impairment and sanction. It accepted the advice of the Legal Adviser. The Committee reminded itself that misconduct and current impairment were matters for its


own independent judgement. There is no burden or standard of proof at this stage of the proceedings. Summary of the facts found proved The facts found proved by the Committee relate to your treatment of one patient, Patient A, to whom you provided orthodontic treatment between January 2015 and July 2017, whilst you were practising at Simply Orthodontics in Orpington (‘the Practice’). You have since retired. Patient A had sought treatment with you to straighten her bottom teeth, in addition to widening and straightening the definition on her top arch. The treatment that you provided included the placing of brackets on Patient A’s teeth using the Damon technique. The Committee’s findings, which include a number of matters that you admitted, some in their entirety and some as factual admissions, demonstrate that there was a range of shortcomings in your care and treatment of Patient A. In particular that,

• You failed to provide the patient with an adequate standard of care in that you did not carry out a general dental assessment prior to commencing treatment.

• You provided the patient with a poor standard of orthodontic care over the period in question in that you:

did not place the brackets in the centre of the labial clinical crown on the LL1, LL2 and UL3;

caused a traumatic occlusion of the front teeth;

caused bimaxillary proclination;

caused the root apex of the UL4 to bulge through the buccal plate;

caused a poor buccal occlusion which was worse than at the outset of treatment; and

took a longer period of time to treat Patient A than was necessary for her presenting condition.

• On four separate occasions, you did not adequately respond to the concerns raised by Patient A about her treatment.

• During an appointment on 11 January 2017, you did not effectively manage Patient A’s pain.

• You failed to maintain an adequate standard of record keeping in respect of a number of Patient A’s appointments and also, throughout the course of treatment, you did not record, adequately or at all, discussions with the patient.

Summary of the submissions made by the parties It was Mr Saad’s submission that the facts found proved in this case amount to misconduct. In this regard, he asked the Committee to take into account the opinion of Professor Willmot that a number of the clinical failings identified, individually, in and of themselves, fell far below what was expected of a reasonable practitioner. Mr Saad also invited the Committee to have regard to the GDC ‘Standards for the Dental Team (Effective from September 2013)’ (‘GDC Standards), in particular, Standards 2.1, 4.1, 7.1 and 7.3.


Mr Saad also submitted that your fitness to practise was currently impaired, both on the grounds of public protection and the wider public interest. Whilst he acknowledged Professor Willmot’s positive report regarding your remediation, Mr Saad stated that your remediation bundle needed to be read alongside the evidence seen and heard at this hearing. Mr Saad highlighted that a number of the allegations denied by you were subsequently found proved by the Committee. He submitted that this may indicate a lack of insight in your part. Mr Saad also drew the Committee’s attention to the case of Clarke v General Optical Council [2018] EWCA Civ 1463 which, he said, sets out how the Committee should view the issue of your retirement when considering impairment. With reference to Clarke, Mr Saad submitted that your retirement did not change the fundamental question of whether your fitness to practise is impaired currently. He submitted that the Committee must take into account all that it would do normally in reaching its decision. In relation to sanction, Mr Saad referred the Committee to what he considered to be the relevant paragraphs in the ‘Guidance for the Practice Committees, including Indicative Sanctions Guidance (Effective from October 2016; last revised December 2020)’ (‘the Guidance’). He asked the Committee to take into account a number of aggravating factors which he considered existed in this case which, he said, included your lack of insight. Mr Saad submitted that taking into account that the charge against you related to a number of topics of some seriousness, the most appropriate and proportionate sanction was one of suspension, for a period of six months, with a review. Mr Buchanan submitted that your treatment of Patient A was not typical of the way in which you had treated patients, clinical or otherwise, in your career of over three decades. He further submitted that this was not a case of the seriousness and gravity asserted by the GDC. Mr Buchanan stated, however, that there were areas of agreement between the parties, and it was accepted on your behalf that misconduct was made out. In relation to impairment, Mr Buchanan reiterated that the issues raised in this case, were not representative of your conduct generally. He asked the Committee to take into account the evidence before it from patients and your colleagues which, he said, attested to the esteem in which you were held, both professionally and personally. Mr Buchanan also asked the Committee to take into account the evidence of what you have done since the matters in this case came to light, notwithstanding the fact of your retirement. Mr Buchanan stated that you “stood your ground” with regard to the treatment elements of this case, knowing that your position was supported by an eminent expert, Mr Gerry Bellman, called on your behalf. Mr Buchanan stated that this did not mean that you rejected the findings made against you. Further, the fact that you adopted that stance did not prevent you from undertaking remedial activity. Mr Buchanan asked the Committee to take into account the positive comments made by Professor Willmot regarding your remediation, and questioned what more you could have provided. Mr Buchanan submitted that you had provided the “gold standard or better” of remediation and that this should satisfy the Committee of your insight. It was Mr Buchanan’s submission that the Committee could be confident that your fitness to practise is not currently impaired. Mr Buchanan accepted that an assessment of your fitness to practise would be based on how you are today and irrespective of your retirement. Mr Buchanan addressed the issue of sanction, submitting that, in the event that the Committee disagreed with his submission of no impairment, it could properly and proportionately impose a reprimand in this case. Mr Buchanan submitted that there was no evidence to suggest that you pose any danger to the public. He stated that your failings in


this case were not deliberate, and that you have given an appropriate apology to Patient A. He further stated that you have shown insight and taken clear rehabilitative steps. The Committee’s decision on misconduct In considering whether the facts found proved against you amount to misconduct, the Committee noted that a finding of misconduct, in the regulatory context, represents a serious falling short of the professional standards expected of a registered dental professional. The Committee had regard to the following GDC Standards which it considered to be engaged in this case: 2.1 Communicate effectively with patients – listen to them, give them time to consider information and take their individual views and communication needs into account. 4.1 Make and keep contemporaneous, complete and accurate patient records. 7.1 Provide good quality care based on current evidence and authoritative guidance. 7.3 Update and develop your professional knowledge and skills throughout your working life. The Committee considered the facts found proved against you both individually and cumulatively. In its view, your failure to carry out a general dental assessment prior to commencing orthodontic treatment on Patient A represented a serious breach of the standards expected of a competent dental practitioner. You told the Committee that you were unaware that you had to carry out such an assessment. The Committee considered that you should have been aware. This was a failing in a basic and fundamental aspect of dentistry about which both experts in this case, Professor Willmot and Mr Bellman, were critical. In the absence of a general dental assessment, you had no information about Patient A’s oral hygiene or periodontal status before embarking on her treatment. The Committee considered this to be unacceptable. In relation to the standard of treatment you provided to Patient A, the Committee was of the view that the individual failings found proved were not necessarily, in and of themselves, failings that fell far below the standard expected. Whilst the Committee noted the opinion of Professor Willmot that a number of the treatment issues did fall far below what was expected, it also took into account that Mr Bellman was not critical in a number of instances. The Committee was therefore satisfied that there was a reasonable body of opinion that supported your clinical position. However, the Committee considered the cumulative effect of the clinical failings on Patient A, which included actual and potential harm, as well as the fact that after 31 months of treatment, there was still a considerable amount of remedial work outstanding. The evidence before the Committee indicates that Patient A’s dental condition was worse off than when she started treatment with you. It therefore concluded that, when viewed together, the clinical failings found proved in this case, did reflect a pattern and course of treatment that fell far short of what was proper in the circumstances. The Committee also considered that your not adequately responding to Patient A’s concerns on the four occasions highlighted, was conduct that amounted to a serious departure from the standards. This was a patient who was sufficiently concerned about her treatment with you that on two occasions she sought other professional opinions. The evidence demonstrates that you did not take her concerns as seriously as you should have which, the Committee found, included walking out of the room on one of the occasions she raised


issues with you. Your failure to respond to the patient’s concerns persisted over a period of time and the Committee was satisfied that this was conduct that other dental professionals would find deplorable. The Committee next considered the shortcomings in your record keeping. The deficiencies in your record keeping persisted throughout the entire period of Patient A’s treatment. The Committee noted again that record keeping is a basic and fundamental aspect of general dental practice. Your evidence was that you were not aware at the time of the requirement to record certain information, including your discussions with the patient about her treatment. The Committee considered that you should have been aware, and it was satisfied that the identified failings in your record keeping fell far below what was expected. In all the circumstances, the Committee determined that the facts found proved in this case amount to misconduct. It noted that it was conceded on your behalf that misconduct is made out. The Committee’s decision on impairment The Committee next considered whether your fitness to practise is currently impaired by reason of your misconduct. It had regard to the over-arching objective of the GDC, which is: the protection, promotion and maintenance of the health, safety and well-being of the public; the promotion and maintenance of public confidence in the dental profession; and the promotion and maintenance of proper professional standards and conduct for the members of the dental profession. Your misconduct included multiple non-clinical and clinical failings. This included clinical failings of a basic and fundamental nature, which you said had been as a result of your lack of knowledge. Further, there was the resultant harm caused to Patient A. Notwithstanding the serious and wide-ranging nature of your misconduct, the Committee considered that the identified shortcomings were all matters capable of being remedied. The Committee noted that you have taken steps to address the concerns raised in this case. It considered that this demonstrated a degree of insight into your failings. The Committee did not consider that your denial of some of the allegations represented a lack of insight, particularly given the evidence that some aspects of your practice were supported by a reasonable body of opinion. However, the Committee found that there was a late realisation on your part of a number of the problems in your treatment of Patient A. The Committee noted from the remediation bundle provided that you have since undertaken extensive Continuing Professional Development and that you have reflected on your practice. The Committee had regard to Professor Willmot’s report, dated 26 May 2021, in which he stated that you have “undertaken an excellent and well documented period of remediation…” The Committee considered this commendable, particularly taking into account that you undertook this learning irrespective of being retired from clinical practice. However, the Committee did regard the fact that you have been out of clinical practice for almost three years to be a matter of concern when assessing the extent of your remediation. The Committee took into account that the issues in this case relate to matters of clinical assessment, clinical technique, record keeping and patient communication. In its view, these are all concerns that can only be assessed as being remedied, if there is evidence to indicate that they have been embedded into one’s clinical practice. The Committee has received little or no independent assurance, such as peer reviews and verified audits in the


areas of concern, to demonstrate that the remediation you have undertaken has made any difference to your day to day clinical practice. Therefore, whilst the Committee appreciated your significant efforts towards remediation, and noted the comments of Professor Willmot in this regard, it considered that in the absence of any up to date evidence regarding the standard of your practice, there is a risk of repetition. The Committee acknowledged the fact of your retirement and the impact of this on your ability to provide such evidence. However, it had regard to the case of Clarke and took into account that it must assess your current fitness to practise, irrespective of your retirement. The Committee noted that you remain on the Dentists Register, and as such, have the potential to return to clinical practice. Accordingly, the Committee determined that a finding of impairment is necessary for the protection of the public. The Committee next considered the wider public interest. It took into account that wide-ranging and serious findings have been made in this case, and there is little or no evidence of embedded learning. The Committee was of the view that public confidence in the dental profession would be seriously undermined if a finding of impairment were not made in these circumstances. It also considered that such a finding is required to promote and maintain proper professional standards. The Committee determined that your fitness to practise is currently impaired by reason of your misconduct. The Committee’s decision on sanction The Committee considered what sanction, if any, to impose on your registration. It noted that the purpose of a sanction is not to be punitive, although it may have that effect, but to protect patients and the wider public interest. In reaching its decision, the Committee had regard to the Guidance. It applied the principle of proportionality, balancing the public interest with your own interests. In deciding on the appropriate sanction, the Committee first considered the issue of mitigating and aggravating factors. It identified the following aggravating features in this case:

• that there was actual harm caused to Patient A;

• that your misconduct was sustained or repeated over a period of time;

• that you have demonstrated limited insight by your late realisation of the problems you caused Patient A;

• your failure to respond adequately to Patient A’s concerns, despite her repeated attempts to raise them with you; and

• that you failed to take the opportunity to deal earlier with the issues Patient A raised, including after she had sought other professional opinions.

In mitigation, the Committee considered the following factors:

• the admissions you made at the outset of the hearing;

• the body of evidence before the Committee which suggests that your treatment of Patient A was not indicative of your usual practice; this evidence included a considerable number of patient feedback forms spanning a period of time;

• the evidence of the significant efforts you have made towards remediation;


• evidence of your previous good character;

• some evidence of insight and remorse and evidence of an apology; and

• that you made no financial gain; the Committee noted that you provided Patient A with a full refund.

Taking all these factors into account, the Committee considered the available sanctions, starting with the least restrictive. The Committee noted that it was open to it to conclude this case without taking any action in relation to your registration. However, it concluded that taking no action would not be appropriate or proportionate, given the gravity of its findings and ongoing risk to the public. The Committee also considered that such a course would not satisfy the wider public interest. The Committee considered whether to issue you with a reprimand. However, in its view, the misconduct found in this case is not at the lower end of the spectrum, which is when a reprimand might be considered appropriate. Further, the Committee has identified a risk of repetition and a reprimand would not impose requirements on your practice. In all the circumstances, the Committee concluded that a reprimand would be insufficient to protect the public, the wider public interest, and that it would not be appropriate. The Committee next considered whether to impose conditions on your registration. In doing so, it took into account that any conditions imposed would need to be workable, measurable and enforceable. It noted the wide-ranging nature of the concerns raised in this case, and considered that addressing these concerns would require the putting in place of a structure and support network to enable you to engage with the remediation process and evaluate your progress. Given that you have retired from clinical practice, the Committee could not see how it could formulate a set of conditions that would protect the public and address the wider public interest considerations. It therefore decided that conditional registration in the circumstances of this case would not be practical or workable. The Committee went on to consider whether to suspend your registration for a specified period. It had regard to the Guidance at paragraph 6.28, which sets out the factors to be considered when deciding whether the sanction of suspension would be appropriate. The Committee noted that a number of those factors are present in this case, including that there is a risk of repetition. The Committee also considered that patients’ interests and public confidence in the dental profession would be insufficiently protected by a lesser sanction. The Committee had regard to the fact that this case involved one patient, albeit your misconduct persisted over a period of time, and that you have demonstrated some insight into the matters that have been brought before the GDC. This has included your considerable efforts towards remediation, which have been viewed positively by the Council’s expert witness. The Committee also took into account the evidence which suggests that the matters it found proved were not reflective of your usual practice. Taking all the evidence into account, the Committee decided that a period of suspension would be appropriate and proportionate to protect the public and uphold the wider public interest. The Committee noted that the sanction of erasure was open to it. However, it had received no evidence to suggest that you have deep-seated personal or professional attitudinal problems which might make erasure appropriate. Further, in its view, this is not a case where the misconduct found represents behaviour that is fundamentally incompatible with continued registration. The Committee therefore decided that the sanction of erasure would be disproportionate.


In all the circumstances, the Committee has determined to suspend your registration for a period of six months. It considered that a six-month period marks the seriousness of the misconduct found. It also considered that this period would afford you the opportunity to address the concerns raised by the Committee, whilst ensuring that members of the public are adequately protected. The Committee also determined to direct a review. Therefore, a Committee will review your case at a hearing to be held shortly before the end of the period of suspension. That Committee will consider what action to take in relation to your registration. You will be informed of the date and time of that hearing, with which you will be expected to engage. The Committee was satisfied that the sanction that it has decided to impose, a six-month suspension with a review, is the most appropriate and proportionate sanction now, to address its concerns about public protection and the wider public interest. The Committee had regard to the unusual circumstances in this case, including the fact that you have retired from dentistry. It also had regard to the outcome in the case of Clarke and the Statutory Declaration of Retirement from Dentistry, signed by you on 7 November 2018. This Committee considered that the reviewing Committee would be assisted by the GDC and your representatives entering into discussions as to the practicalities of how this case might proceed. Unless you exercise your right of appeal, you will be suspended from the Dentists Register, 28 days from the date when notice of this Committee’s direction is deemed to have been served upon you. The Committee now invites submissions from Mr Saad and from Mr Buchanan, as to whether an immediate order of suspension should be imposed on your registration to cover the appeal period, pending its substantive determination taking effect.

Mr Henning, In reaching its decision on whether to impose an immediate order of suspension on your registration, the Committee took account of the submissions made by both parties. Mr Saad submitted that such an order should be imposed. It was Mr Buchanan’s submission that it cannot be necessary for an immediate order to be imposed in respect of a registrant who has retired and not practised dentistry since August 2018. The Committee had regard to paragraphs 6.35 to 6.38 of the Guidance, which deal with immediate orders. It accepted the advice of the Legal Adviser. The Committee determined that the imposition of an immediate order of suspension on your registration is necessary for the protection of the public and is otherwise in the public interest. The Committee has identified an ongoing risk to the public in the absence of sufficient evidence to demonstrate that you have embedded your remediation into your practice. It therefore considered that it would be inappropriate to allow you to potentially resume practise, if you so wished, during the appeal period, or longer in the event of an appeal. An immediate order of suspension is therefore necessary for the protection of the public. The Committee also considered that public confidence in the dental profession would be undermined if an immediate order of suspension were not imposed in all the circumstances


of this case. Accordingly, an order is required in the wider public interest to maintain public confidence and to uphold proper professional standards. The effect of the foregoing determination and this order is that your registration will be suspended from the date on which notice is deemed to have been served upon you. Unless you exercise your right of appeal, the substantive direction for suspension, as already announced, will take effect 28 days from the date of deemed service for a period of six months.

That concludes this determination”.

Documents

HEARING HEARD IN PUBLIC HENNING, Abraham Johannes