The Dental Association of Malta (DAM) has said that it is "very concerned about the outcome of the case instituted by Nathalie Bartolo against Jeffrey Pullicino Orlando and Alex Azzopardi."

This is in reference to a case where the court ordered Pullicino Orlando to pay €16,000 in compensation to a former patient.

"The presiding judge would appear to have decided to base his conclusions on his own 'moral certainty', ignoring the report drawn up by the court-appointed expert and the testimony of four expert witnesses brought forward. The judgement focused on a root treatment which was performed by Pullicino Orlando on Bartolo, which ended up being too short and had to be rectified. Rectification was carried out by Alex Azzopardi a few weeks later. Notwithstanding, the patient still complained of persistent, debilitating pain in her lower jaw and further interventions were carried out in repeated efforts by different practitioners to seek to resolve the problem."

"From the court proceedings it also transpired that the patient was also seen by other Dental Surgeons in the past, for various other treatments including a root canal treatment in the same area on another tooth, which had also failed and the tooth in question needed to be removed. The Dental Association of Malta is concerned that key expert witnesses' opinions were disregarded. The expert, Prof. J. Portelli concluded that the chronic pain which the patient is suffering from cannot be a result of a root canal treatment. He also refers to the testimony of Dr. Marilyn Casha, pain specialist, and concluded that the pain was oro-facial in nature attributed to maxillary and mandibular nerves on the right side of the face - Chronic Facial Pain Syndrome," the DAM said.

"This completely goes against the conclusions arrived at by the Judge in his judgement. The reason why Judge Depasquale decided not to give weight to Prof. Portelli's report was because the patient was not directly examined by the court expert. Although this is factually correct, it is our opinion that this does not mean that all that was written in the report - including a detailed analysis of all the extensive medical history of the patient, and reasons why the source of pain is not of dental origin - can be simply thrown out and disregarded. If the court truly cannot give weight to an expert's report, the least that could be done is to appoint another expert to analyze the case and make sure that the right scientific dental facts have been presented and explained."

"The DAM would like to make it clear to the public that a root canal treatment on a tooth is usually the last resort before extracting a tooth because - for some reason or another - its vitality has been lost. Moreover, like anything else in medicine and dentistry, results can never be guaranteed. In fact all this is supported by extensive studies by the scientific community."

"Another point from the judgment which from a scientific point of view is incorrect, is that a short root canal treatment is a result of negligence. There are many justifiable reasons why a root canal cannot be completely accessed or filled. Various studies have been carried out over the years and the consensus is that a successful root canal treatment may or may not be a short one."

"In conclusion, the DAM notes with regret that the judge decided to ignore the advice given to him by several experts in their field including a former dean of the Faculty of Dental Surgery of the University of Malta, a pain specialist and three other specialists whom the patient had gone to after the alleged negligence was committed. It is expected that all medical and dental professionals act in the best interest of their patients and in accordance with all ethical and moral obligations. That said, the risk of being made liable for complications which can arise from any treatment when the experts agree that there was no negligence is indeed a slippery slope which could have serious ramifications for medical professionals, insurers and the Maltese population in general alike."