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Qualifications the lawyer should look for when choosing a dental expert by Roger Goulden, Forensic Dentist and Practising Dental Surgeon (Previously published in New Law Journal and in the
Expert Witness Supplement of Solicitors Journal).
Recent years have seen a vast increase in professional negligence cases and in personal injury litigation involving medical and, more specifically, dental matters. Since the majority of cases require the services of a dental adviser there has been a corresponding increase in the number of dental practitioners holding themselves out as 'experts'. Most legal practitioners will not be aware that recent
years have witnessed a proliferation of medical and dental postgraduate
activities and qualifications. It thus seems that, just as lawyers need
an expert to guide them through the technicalities of a subject such as
dentistry when preparing a case for trial, many will appreciate similar
guidance through the maze of qualifications and courses to assist them
in selecting an expert who is as able as his resume suggests. It therefore
seemed appropriate to offer this guide, so that the legal practitioner
will obtain a dental expert suitable for his needs who will also be able
to convince opponents and the court of his expertise in this field.
Medical and dental qualifications at all levels are confusing in the UK since there are two groups of bodies authorised by the General Medical and General Dental Councils to confer degrees and diplomas. These are (1) the Universities which have dental faculties, and (2) the Royal Colleges of Surgeons of England, Edinburgh, Glasgow and Ireland. The Universities award degrees, whereas the Royal Colleges award licences and diplomas. Thus, the basic qualification awarded on graduation is either the BDS (Bachelor of Dental Surgery) degree or the LDS (Licentiate in Dental Surgery) licence from one of the Royal Colleges. Many dental practitioners will have both qualifications,
since both examinations may have been taken as undergraduates, but note
that these qualifications are of equal standing and thus provide no indication
of a higher degree of training or expertise than in the case of those individuals
who hold only one. The level of expertise, whether holding one or both
qualifications, might, therefore, be no more than that of a lawyer at the
time of admission.
The Universities award higher degrees to dentists who have undergone recognised (and usually rigorous) postgraduate courses of study or research, followed by examination or the submission of a thesis. These will be masters degrees (MSc, MDS or MPhil) or doctorates (PhD or, very rarely, DSc). Whilst these are positive indicators of an individual's intellect it should be noted that the MDS (Master of Dental Surgery), and the MPhil or PhD (Master or Doctor of Philosophy) degree will in all probability be awarded on the strength of a research project, ultimately written up as a thesis, and could well have no clinical element whatsoever, and will thus provide little indication of the standards of clinical knowledge or practical expertise of the holder. The Royal Colleges award diplomas to dentists who have undertaken recognised and approved postgraduate courses of study, followed by formal examinations which usually have both written and practical elements. These awards will be either diplomas, such as the DDPH (Diploma in Dental Public Health), memberships, such as the MCCD (Membership in Clinical Community Dentistry) or fellowships, such as the FDS (Fellowship in Dental Surgery). The standards of all the above qualifications are constantly monitored and are invariably of a high standard. In some cases they have been thought to be too daunting, for example the MGDS (Membership in General Dental Surgery), which was planned as the highest qualification for the general dental practitioner. Because of its rigorous standard it was felt by the authorities that a less aggressive diploma would be more appropriate to the junior members of the profession, so the DGDP (Diploma in General Dental Practice) has recently been developed to set such practitioners on the path of continuing education. However, be advised that several hundred of these were awarded without examination, on a 'grandfathering' basis, so possession of this diploma does not necessarily mean that the holder has been tested by his peers in open examination. Practitioners will also be encountered who have undergone
postgraduate education in the USA, usually leading to the award of masters
degrees, MSc (Master of Science) or MS (Master of Surgery).
These qualifications invariably indicate a high standard of postgraduate
training.
There is an increasing number of dental practitioners who have sought to increase their breadth of knowledge by undertaking courses of study and examination in subjects related and peripheral to dentistry. There are now dentists who have obtained formal legal qualifications, and in some cases practise as lawyers, either exclusively or in addition to dentistry. There are also an increasing number who have undertaken further training, such as the MA (Master of Arts) course at the Centre of Medical Law and Ethics at King's College London and the LLM (Master of Laws) course in the legal aspects of medical practice at the University of Wales, who, whilst not purporting to be legally qualified, will be in a favourable position to assist those who instruct them from their knowledge of the processes of the law gained during these courses. There is also an increasing number of dentists who
have taken courses and examinations in forensic dentistry, leading to the
award of the Diploma in Forensic Odontology (DipFOd). These practitioners
will also be well placed to assist their instructing lawyers as they have
been trained to prepare and handle evidence for use by the courts.
Some dentists will have ambitions to practise in North America and will have taken the basic qualification, the DDS (Doctor of Dental Surgery), to allow this. Be advised that whilst this might be a doctorate it is in fact only equivalent to the British BDS or LDS, discussed above, and does not indicate that the holder has received any postgraduate training. Many dentists have commitments with the administrative and political bodies of the profession. Valuable as these are to the dental community it should be recognised that membership, for example, of an LDC (Local Dental Committee) says nothing about that individual's clinical expertise and/or training. Quite apart from the qualifications mentioned thus far, which all have an element of examination or assessment, there is a myriad of organisations to which dental practitioners can belong, such as the British Dental Association and General Dental Practitioners Association, membership of which merely requires the payment of a fee. Similarly, beware those who belong to bodies such
as the Royal Society of Medicine, where membership is called a `Fellowship',
and permits use of the letters FRSM (Fellow of the Royal Society
of Medicine). There is the implication here that these letters constitute
a qualification, conveying a level of expertise or training which other
practitioners might not have; whereas in fact the principal requirement
for membership or 'Fellowship' of the Society is merely the payment of
the annual subscription.
Dentists are known to be enthusiastic about their subject, and to fuel this enthusiasm there has been a proliferation of postgraduate courses. Many are run under the auspices of the recognised teaching establishments and will therefore be monitored and of an approved standard, but others will be run by private individuals or organisations. There is no doubt that many privately run courses are of the highest possible standards, but since none are subject to any official control this can never be guaranteed. Any practitioner could carry out techniques in his own practice which are unproven and unacceptable, and then present courses thereon to his fellow practitioners. Be cautious where the basis of a practitioner's expertise
is the participation in or running of private courses, however official
or important the self-styled title may sound.
There are essentially two types of professional journal. There is the true scientific publication, where all papers are submitted to a rigorous system of refereeing, and the 'popular press' style journal, where papers are not refereed and are printed for commercial reasons, or where the editors think they will be of interest to their readers. In the latter case there is nothing to guarantee that papers extolling unproven and unscientific theories and treatments are not published. Caution should, therefore, be exercised when any
expert's resume includes reference to publications made in any non-refereed
journal if it is suggested that such publication is indicative of a standard
of excellence or a high level of training.
It can thus be seen that a lengthy and ostensibly
impressive CV can be created with little difficulty by a dental practitioner
who in reality has undertaken no formal or acceptable postgraduate training
since the day of qualification. Hopefully this guide will assist the lawyer
in the most important process of selecting an appropriate dental expert
who not only has the training, background and knowledge to provide the
essential technical guidance, but will also have the standing within his
profession to meet such challenges as may be levelled by opponents in court.
The courtroom is not the place to learn that your expert has embellished
his qualifications or been 'economical with the truth' when you enlisted
his services.
****************** Roger Goulden is a general dental practitioner of thirty years standing who is in independent practice in the West End of London. He holds the qualifying degree of BDS (Bachelor of Dental Surgery) of London University and the diplomas of MGDS (Membership in General Dental Surgery) of the Royal College of Surgeons of England, the DRD (Diploma in Restorative Dentistry) of the Royal College of Surgeons of Edinburgh and the DipFOd (Diploma in Forensic Odontology) from the London Hospital Medical College. He also holds the LLM postgraduate degree of Master of Laws (Legal aspects of medical practice) from the University of Wales. He has held part time undergraduate teaching posts at London University since 1978 and has been an examiner for the MGDS diploma of the Royal College of Surgeons. ****************** |