Before-and-After Photographs, a Minor and a Review Discount

Consent must match the use. The parent consented to photography for clinic records. Records use and marketing use are different purposes, and marketing requires a separate, specific, informed and voluntary consent explaining where the images will appear, for how long, who can see them, and that consent can be withdrawn. 'Never objected' is not consent; silence is not agreement, and the dentist had a duty to ask.

The patient is a minor. A 16-year-old cannot consent on her own to marketing use. A parent or guardian must consent on her behalf, and the young person's own agreement should also be sought, because publishing an identifiable image of a child is not something to be done on a parent's signature alone.

Identifiability. Full-face before-and-after images with a distinctive birthmark are identifiable even without a name. Identifiable clinical images are personal data, and health-related data is sensitive, so the data protection obligations are stricter: lawful basis, minimisation, security, and the right to erasure on withdrawal.

The public reply. Names, teeth treated and dates confirm that the person writing the review is a patient of the clinic. That is a disclosure of health information to the public, and it is a more serious breach than the original advertising, because it was done deliberately in response to criticism. Reputation is protected by correcting factual inaccuracies generically, or replying privately, never by confirming who your patients are or what was wrong with them.

Remedy. Remove the posts and the reply, document the removal, obtain proper marketing consents going forward, and apologise to both patients.

The claims. 'Guaranteed results' and 'painless' are absolute claims that cannot be substantiated. Composite bonding can chip, stain or need replacement, and sensitivity is a recognised outcome - indeed a patient has described it publicly. Guarantees in dentistry are misleading because outcome depends on the patient's biology, habits and follow-up. 'The best cosmetic dentist in Nairobi' is a comparative claim of superiority that cannot be verified and is exactly the kind of self-laudation that advertising rules restrict.

The discount for a five-star review. This is the most damaging element. It purchases positive reviews, which means the review base is no longer independent evidence, and it pressures patients to publish only favourable comments. Patients who had a poor outcome are effectively silenced. It also encourages disclosure of clinical information by patients in a public forum in exchange for money, which the dentist then cannot control.

What advertising should look like. Factual information: services offered, qualifications, hours, fees. No claims of superiority, no guarantees, no misleading before-and-after images, no inducements tied to testimonials, and no use of patient testimonials that cannot be verified or that imply typical results.

Aggravating features. The conduct continued after a negative review, was directed at attracting minors' families, and was justified rather than corrected when challenged. That pattern is likely to be treated as more serious than an isolated lapse.

Defensible. Treating a minor with parental consent, provided clinical records support the treatment plan, the assessment and the follow-up. Being on social media at all is not prohibited. Correcting a factually false review is legitimate in principle.

Not defensible. Marketing use of identifiable images on a records-only consent; publishing a patient's name, treatment and dates in reply to a review; guaranteed and 'best in Nairobi' claims; and paying for five-star reviews. These are not documentation disputes; they are admitted on the face of the posts.

How to respond.

• Do not delete or edit records, and do not ask staff to alter their accounts.
• Preserve everything: the posts, the messages, the consent form, the clinical notes. Take the material down but keep a copy.
• Respond to the Council within its timeline, in writing, with a factual chronology. Concede what is conceded clearly and explain the rest with evidence.
• Apologise to the patients for the disclosure and the use of the images, and confirm the takedown. An expression of regret for the disclosure is appropriate; it should not be muddled with admissions about the clinical care.
• Notify the professional indemnity insurer now, not after a decision.
• Do not contact the complainants directly about the complaint; route communication through the Council.

Likely outcome and mitigation. A finding of professional misconduct is realistic. Mitigation rests on prompt remediation, an audit of all marketing consents, a written social media policy, and demonstrated understanding - not on arguing that nobody objected.