The Valuation of Dental Negligence Claims Revisited
An update from Andrew Pickering on dental negligence valuations

Introduction
A little over 10 years ago I wrote a series of three articles on the valuation of claims for dental negligence.
A decade later it seemed a reasonable time to re-visit the issues which I discussed in those articles and to provide some updated guidance on what remains a significant area of personal injury litigation.
What Do People Claim About?
In the three articles I looked in particular at “negligent extraction of teeth”, “negligent failure to detect or treat periodontal disease” and “extreme cases” (which looked in particular at nerve damage claims and claims in relation to inappropriate and prolonged courses of treatment)
Research suggests that these remain amongst the most common causes of dental claims.
A review of the websites of a number of firms of Solicitors who practice in this area suggests that their “top 5 claim types” tend to include nerve damage, gum disease/periodontal problems, failings in restorative dentistry (crowns, veneers and bridges), failings in respect of root canal treatment and failed implant treatment. One website also listed failure in diagnosing dental cancer.
I have for the purpose of this article ignored claims in respect of cosmetic treatment, both dental and non-dental but provided through dental practices.
Figures, albeit dating back to 2017 and so prior to Covid which may have altered the profile of claim types, released by the DDU noted that during that year just five aspects of dental care resulted in 80% of claims notified by general dental practitioners to the DDU. Extractions accounted for around a quarter (24%) of all claims, followed by root canal treatments with a fifth of cases (20%) and caries and fillings with 17% of claims. In fourth and fifth place respectively were claims for periodontal disease (10%) and for implant treatment (9%)[1].
This article will therefore focus primarily on claims where negligence has resulted in loss of a tooth/teeth, a scenario which embraces many of those “top 5” claim types.
Valuing Loss of Teeth
This loss may arise from a simple “extraction of the wrong tooth”, through failed root canal treatment cases to periodontal cases where multiple teeth may have been or will be lost.
As I did in the original series of articles, I will look at the valuation process by breaking it down into the individual heads of loss which would often be associated with claims of this type.
Pain Suffering and Loss of Amenity
As with any personal injury claim, the starting point must be the JC Guidelines[2]. This still includes damage to teeth within Chapter 10 Facial Injuries under Section A Skeletal Injuries. The brackets are defined by the positioning of the tooth (is it a front tooth or a back tooth) and the number of teeth lost.
Where the tooth has been lost the award will tend to be at the top of the relevant bracket (with awards in relation to “serious damage” coming in at the bottom). That would suggest that the starting point for loss of an adult front tooth is likely to be around or above £4,000 (the figure in my original article was below £2,500).
The Guidelines brackets address cases where more than one tooth has been lost and have a section in respect of significant, chronic, tooth pain (such as from an untreated abscess) extending over a number of years together with significant
general deterioration in the overall condition of teeth which will be relevant in long term periodontal claims (the figure is up to £46,540).
An important element in the valuation to bear in mind is the rider in the introduction to the effect that awards may be greater where the damage results in or is caused by protracted dentistry.
Reports of comparable cases can be found at Kemp Vol III D.7 and by using the Lawtel Personal Injury Quantum Reports Advanced Search engine (search under “clinical negligence” and “teeth”). Some caution needs to be exercised when relying upon these cases as the overwhelming majority of them are out of court settlements.
There may, and this needs to be considered in all cases, particularly those involving younger claimants, be some element of psychological damage arising from the loss of a front teeth or of multiple teeth. If this is pronounced a specific report may be required to deal with this.
Treatment Costs
Even where the loss is of a single tooth this can be the most financially significant element of a claim, all the more so where the loss is of multiple teeth.
Those advising in such cases are likely to be reliant upon expert evidence for input as to what restorative treatment is appropriate (although the potential claimant may have discussed a treatment plan with another dentist which may assist with their views on costings).
Treatment plans may include an initial removable prosthesis (denture), particularly where the claimant is a child and further treatment must await the end of growth in the jaw.
This is likely to be followed by a more permanent restoration. Many experts will favour implant supported crowns if that is appropriate to the individual patient (it may not be because of ongoing poor oral hygiene, underdeveloped or unsuitable bone structure or the like).
Costings should be obtained from the expert providing the advice on the treatment plan required. However, consideration of a number of recent such reports suggests that potential figures may be along the lines set out below :-
- a) removable prosthetics
Temporary denture £500
Cobalt Chrome denture £750
- b) Implant related costs[3]
Bone graft (where necessary) £1,000
Implant (per implant) £1,500
Crown (per crown) £1,000 to £1,200
Experience appears to suggest that implants have a long life span, so it is unusual for a report to contend that the implants themselves will need to be replaced, but the crowns are likely to need replacement. Different experts will advance a range of intervals, but the “middle ground” is somewhere around 15 years between replacements. The most appropriate, although not the only, calculation method for the future costs of such replacement is to take the life expectancy figure (Ogden Table 1 or 3 at 0% rate of return) and then use Table A5 “Multipliers for Fixed Periods and at Intervals” of PNBA Facts & Figures[4].
Treatment plans involving multiple bridges are too case specific for this article to be able to provide any useful general guidance.
A further potential significant element may be “maintenance costs”, such as regular monitoring of the patient’s periodontal condition or upkeep of implants. Whilst such costs may be only a matter of a few hundred pounds or even less per year, when a full life multiplier is applied to them the resulting amount can be considerable. Those advising defendants in such cases will want to consider whether it can reasonably be argued (it often can) that such costs would have been incurred in any event.
Other Consequential Losses
These claims are personal injury claims. The consequential losses which flow from them are no different to any other such claim.
Earnings loss claims, save perhaps for a few days off work whilst being treated, are unlikely (unless there is a very significant psychological injury).
Care claims are equally unlikely in the generality of such cases.
However, whilst the failure to detect the signs of potential oral cancer claims are less common (not making the DDU’s top five), those cases will often generate not only significant care and loss of earnings claims but also, as many oral cancers are aggressive, lead to death and trigger claims for dependency under the Fatal Accidents Act 1976.
Andrew Pickering
Atlantic Chambers
October 2024
[1] Note – depending upon the patient a number of other costs such as CT scans, surgical guides, consultation with oral surgeons or prosthodontists and sedation may arise
[2] The Introductory Notes to these tables explain how to use them
[3] BDJ In Pract 32, 6 (2019)
[4] the current edition is the 17th