Breach of duty is the part of a dental negligence claim most often misunderstood by people outside clinical practice, and occasionally by clinicians asked to give an opinion on a colleague's treatment for the first time. It is not a question of whether the outcome was poor. It is a question of whether the standard of care fell below what a reasonably competent general dental practitioner would have provided in the same circumstances.
The Bolam test
The starting point remains the test from Bolam v Friern Hospital Management Committee: a dentist is not negligent if they acted in accordance with a practice accepted as proper by a responsible body of dental opinion, even if other dentists would have taken a different approach. Dentistry, like medicine, often has more than one acceptable way of managing a presentation. A claimant does not succeed simply by showing that another dentist would have done something differently. They have to show that no responsible body of dental opinion would have supported what was actually done.
The Bolitho qualification
Bolitho v City and Hackney Health Authority added an important qualification: the body of opinion relied upon must itself be capable of withstanding logical analysis. An expert cannot rescue a defendant simply by asserting that some dentists would have acted the same way; the court is entitled to examine whether that asserted practice is actually defensible on the facts. In practice, this means a breach of duty opinion needs to explain why a course of action was, or was not, reasonable, not simply assert that it was common.
Applying this to general dental practice
In assessing breach, I look at the records as they existed at the time, not with the benefit of hindsight. What did the presenting symptoms and clinical findings show at each appointment? What investigations, radiographs or referrals would a reasonably competent GDP have arranged at that point? Was the treatment plan one that a responsible body of practitioners would support, given what was known or reasonably should have been known at the time? Missing a diagnosis is not automatically a breach; failing to investigate findings that should have prompted further assessment usually is.
Common areas where breach issues arise in general dental practice include delayed diagnosis of periodontal disease, inadequate radiographic review before extractions or restorative work, consent that did not cover material risks, and treatment planning that did not account for a patient's full presenting history. Each requires the same structured analysis: what should have happened, what did happen, and whether the gap between the two falls outside the range of acceptable practice.
Breach is not causation
A finding of breach does not automatically mean the claim succeeds. Causation has to be established separately: that the breach, on the balance of probabilities, caused the harm complained of. A dentist might fall short of the expected standard in some respect that made no difference to the eventual outcome, in which case breach is established but causation is not, and the claim fails on that ground. Reports that run breach and causation together, treating a poor outcome as proof of both, are the ones most likely to be successfully challenged at joint statement stage.
Separating these two questions clearly, and being honest about what the evidence actually supports rather than what would make for a more straightforward report, is the difference between an opinion that holds up and one that does not.