Bruises That Do Not Match the Story, and a Manager Who Says Not to Make Trouble
A seven-year-old boy is brought in by his mother after "a fall from his bicycle". He has a torn upper labial frenum, a grey discoloured upper central incisor, and three bruises on the upper arm in a clustered pattern, one yellow-brown and two purple. There is a healed scar on the forearm shaped like a small oval. The mother answers every question before the boy can, and each time he looks at her before saying anything. She asks the dentist not to write anything about the bruises in the record because "it will look bad at school". When the treating dentist raises a report, the clinic manager, Dr. S, tells her the family are long-standing VIP customers and that a report would be bad for business and possibly defamatory. The dentist files a report with the police and the local child protection service that afternoon. Two weeks later the mother lodges a complaint against her with the disciplinary panel alleging breach of confidentiality.
1. Was the dentist obliged to report, and does confidentiality or the mother's request change that?
Read the worked answer
The trigger for a report is reasonable suspicion, not proof, and not certainty that a crime occurred. Clustered bruises in a pattern, injuries of different ages, a frenum tear in a child who is not yet mobile enough to fall that way, and a history that does not explain the findings together meet that threshold. The dentist does not need to determine who caused the injury; that is the investigator's task, and attempting it is where clinicians go wrong and contaminate the evidence.
Confidentiality does not block the report. The duty of confidentiality is not absolute; it yields where legislation imposes a reporting duty and where disclosure is required for the protection of a person at risk. Child protection legislation obliges any person who becomes aware of violence against a child to report it to the police or the child protection service. A parent's request not to record or not to report cannot override a statutory duty, and acceding to it would make the clinician complicit in concealment.
What the dentist should not do. Do not confront the mother with an accusation, do not investigate, do not promise the child secrecy, and do not let the manager's commercial argument delay the report by even a day. Note the manager's instruction in writing; it is no defence and it is relevant later.
Good-faith reporting under a statutory duty is the protection, and the complaint about confidentiality is answerable on exactly that basis.
2. What must the clinical record contain, and how should the dentist handle the request not to record and the question of photographs?
Read the worked answer
The record must be complete and contemporaneous. A record with the injuries omitted is a false record, and once it is written that way it cannot be repaired except by a dated addendum, which itself invites the question of why it was missing. The mother's request should be declined and the refusal itself noted.
Content. The history in the mother's own words, quoted. The child's behaviour and who answered which question. Each injury described by site, size, colour and shape, with a body chart or a simple diagram. The dental findings: mobility, vitality, colour change, the frenum tear. The child's own words, if any, recorded verbatim. Every action taken afterwards, with the time, the person contacted, and the reference number if one is given.
Photographs. Useful but not compulsory. Normally the guardian's consent is needed; where the guardian may be the source of harm, consent is not the mechanism and consent should not be sought as a bargaining chip. If consent is refused, do not force the issue: a careful written description by a clinician is strong evidence. Where the clinic has access to a hospital-based child protection team, ask them for local guidance on imaging.
Do not alter the tooth-chart to fit the story, and do not record a conclusion such as "abuse by the mother". Record findings and the reason for concern; the conclusion belongs to the authorities.
3. Walk through what happens to the mother's complaint to the disciplinary panel: its scope, the dentist's rights, and how the record answers it.
Read the worked answer
Scope. The disciplinary body decides whether professional discipline was breached: competence, conduct, ethics and compliance with professional obligations. It does not award compensation and does not decide criminal guilt; those are separate civil and criminal tracks, and the same facts can travel down all three without the outcomes contradicting each other.
Process. The complaint is registered and screened for whether it falls within the panel's remit. The dentist is informed of the substance and given the chance to respond in writing, and usually to appear and be heard, with the option of being accompanied. Evidence is examined, a decision is reached, and the outcomes range from no violation, through a written warning or an obligation to complete further education, to restriction or suspension of practice for a period, recommended onward to the licensing authority.
The dentist's rights. To know the complaint, to be heard, to be accompanied, to submit evidence, to a reasoned decision. Silence is not a strategy; a written response filed on time with documents attached is.
How the record answers it. The complaint asserts a breach of confidentiality. The response is that the disclosure was made under a statutory reporting duty, that only necessary information was given, that it was given to the proper authority and to no one else, and that the reasoning and the timing are documented. A complete, contemporaneous record converts the complaint from an allegation into a closed question. The dentist should also retain a copy of the report, the manager's instruction, and her own notes on the day.