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					                                   GENERAL DENTAL COUNCIL
                            PROFESSIONAL CONDUCT COMMITTEE
                                        July 2008 – July 2010
                                        Bray, Stephen James
                                       Registration No: 52686


Charge
Stephen James Bray, registered as of 9 Appt.22 B, 151, Tremont Street, BOSTON MA, 02111,
United States of America1; BDS, Lond. 1978, DDS Toronto 1981, MFDS RCPS Glasg. 2005,
MFDS RCS Edin. 2005, was summoned to appear before the Professional Conduct Committee on
28 July 2008 for inquiry into the following charge:
        “That, being a registered dentist:
        1.   At all material times you worked at the dental practice at 16 Story Lane, Broadstone
             BH18 8EQ.
        2.   On various dates between 2003 and 2004 you provided care and treatment to the
             patients listed in Schedule 1.
             Patient A
        3.   In or around August 2003, Patient A complained of a crack in the veneer of at least one
             of her teeth and requested an examination of her further veneers.
        4.   You determined that Patient A required a bite splint and full mouth reconstruction.
        5.   During the course of your appointments with Patient A you failed to:
             (a) adequately chart Patient A‟s teeth, in that there was no baseline charting of Patient
                 A‟s dentition;
             (b) record a report of the OPG radiograph taken on 29th August 2003;
             (c) take bitewing radiographs.
        6.   The radiograph taken on 29th August 2003 demonstrated periapical radiolucencies at
             LL6 and LR5.
        7.   You failed to provide the treatment required by the findings referred to at paragraph 6
             above.
        8.   You failed to carry out sufficient investigations to identify whether caries was present at:
             (a) UL7
             (b) UL4
             (c) UL3
             (d) UR7
             (e) LL7.


1
    Formerly registered at 9 Cropmton Drive, POOLE, Dorset BH14 PW

BRAY, SJ                Professional Conduct Committee July 2008 – July 2010                   Page 1
    9.     You failed to carry out treatment to remove the caries that was present at:
           (a) UL7
           (b) UL4
           (c) UL3
           (d) UR7.
    10.    Despite persistent deep pocketing being present following treatment by a hygienist at
           the practice, you failed to refer Patient A to a periodontist.
    11.    You failed to:
           (a) advise Patient A of the effect of smoking as a causative factor in the progression of
               periodontal disease;
           (b) provide Patient A with smoking cessation advice.
    12.    In or around November 2003 you provided Patient A with an acrylic bite splint.
    13.    In relation to the treatment described at paragraphs 4 and 12 above you failed to
           discuss with the patient:
           (a) the alternatives;
           (b) the risks.
    14.    As a consequence of the matters described at paragraph 13 above you failed to obtain
           Patient A‟s informed consent to treatment.
           Patient B
    15.    In around September 2003, Patient B presented to you in respect of the cosmetic
           appearance of his teeth.
    16.    You determined that Patient B should have a full mouth restoration.
    17.    You failed to make any periodontal charting following completion of the programme of
           treatment by the hygienist at the practice on 20th February 2004.
    18.    Prior to embarking upon the treatment described at paragraph 16 above, you did not:
           (a) take bitewing radiographs to enable you to determine whether there was caries in
               the molar and pre-molar teeth;
           (b) take periapical radiographs to enable you to eliminate the possibility of pathology in
               the roots of the teeth prior to the provision of crowns and/or bridges.
    19.    In around February 2004 you provided an acrylic bite splint.
    20.    You failed to keep adequate records of the treatment provided to Patient B.
    21.    During the course of providing treatment to Patient B:
           (a) your preparations of the upper teeth were unnecessarily invasive in that an
               excessive amount of sound tooth substance was removed;
           (b) your provisional restorations of the upper teeth were inadequate.
    22.    Your treatment referred to at paragraphs 21 (a) and (b) above caused:
           (a) an increased risk of pulpitis;


BRAY, SJ              Professional Conduct Committee July 2008 – July 2010                  Page 2
           (b) an increased risk of the need for root canal treatment;
           (c) the patient to require more root canal treatments than would otherwise have been
               necessary.
    23.    In relation to the treatment described at paragraphs 16 and 19 above you failed to
           discuss with the patient:
           (a) the alternatives;
           (b) the risks.
    24.    As a consequence of the matters described at paragraph 23 above you failed to obtain
           Patient B‟s informed consent to treatment.
           Patient C
    25.    In or around December 2003, you discussed the provision of veneers for Patient C.
    26.    In the course of your treatment you used an out of date cementing material.
    27.    You failed to provide Patient C with any, or any adequate, information as to:
           (a) the risks associated with such treatment;
           (b) alternative forms of treatment.
    28.    As a consequence of the matters described at paragraph 27 above you failed to obtain
           the patient‟s informed consent to treatment.
           Scanning and nutritional supplements
    29.    In or about August 2004, you caused, or you permitted your son Richard to cause,
           letters to be sent to patients of the practice to promote the use of a „scanner‟ to
           measure antioxidant levels.
    30.    In the initial letter sent to patients in your name it was stated:
           „The implications to gum disease prevention and indeed general health, wellness and
           longevity are enormous. Normally dentists aren‟t supposed to get “excited” but the
           advent of this biomedical measurer brings enormous benefits to you. We look forward
           to discussing this with you at your next “gum maintenance” appointment‟.
    31.    In or about August 2004, you caused, or you permitted your son Richard to cause,
           telephone calls to be made to patients to promote the use of a „scanner‟ to measure
           antioxidant levels.
    32.    In the course of your promotion you or your son Richard sought to sell nutritional
           supplements to patients.
    33.    Your conduct described at paragraph 32 above was inappropriate.
    34.    Your promotion of the venture as described in paragraphs 29 and 31 above to patients
           without periodontal disease was inappropriate.
    35.    The claims made in the letter referred to at paragraph 30 above that:
           (a) „The implications to gum disease prevention…are enormous‟; and
           (b) „this biomedical measurer brings enormous benefits to you‟ in the context of gum
               disease prevention;



BRAY, SJ            Professional Conduct Committee July 2008 – July 2010                   Page 3
           were misleading as that at the time the claims were made the link between antioxidants
           and gum disease was considered possible but not proven.




BRAY, SJ           Professional Conduct Committee July 2008 – July 2010                 Page 4
            Electromyography
    36.     In the course of your examination of patients, including Patient A, Patient B, Patient C
            and Patient D, you used an electronic muscle measuring device (“the Device”).
    37.     In relation to Patient A, Patient B, Patient C and Patient D, you failed to provide any or
            any appropriate explanation of:
            (a) alternatives to the use of the Device;
            (b) the cost of the alternatives to the use of the Device;
            (c) the fact that the use of the Device was unconventional in UK dentistry.
    38.     As a consequence of the matters described at paragraph 36 above you failed to obtain
            the informed consent of Patient A, Patient B, Patient C and Patient D.
    And that in relation to the facts alleged, you have been guilty of serious professional
    misconduct”.


    Findings of fact
    “Mr Bray,
    I have to announce that the facts alleged in the following Heads of Charge have not been
    proved to the satisfaction of the Committee:
    5(a), 11(a) and 11(b), 27(a) and 27(b), 28 In relation to Patients A, C and D
    37(a) and (c),In relation to Patient B
    37(c)
    In relation to these facts you have been found not guilty of serious professional misconduct.
    In relation to the following Heads of Charge, which you have admitted, the facts have been
    proved to the satisfaction of the Committee:
    1, 2, 3, 4, 5(b) and 5(c), 6, 7, 8(a), (b), (c), (d) and (e), 9(a), (b), (c) and (d), 10, 12, 13(a) and
    (b), 14, 15, 16, 17, 18(a) and (b), 19, 20, 21(a) and (b), 22(a), (b) and (c), 23(a) and (b), 24,
    25, 26, 29 (as amended to remove the words “or you permitted your son Richard to cause”)
    30, 31 (as amended to remove the words “or you permitted your son Richard to cause”),
    32, 33, 35(a) and (b), 36, 37(b)
    The facts have been proved to the satisfaction of the Committee in relation to the following
    Heads of Charge:
    34, 37(a) – in relation to Patient B, 38 – in relation to patients A, B, C and D
    At this stage the Committee has decided that such facts as have been proved would not be
    insufficient to support a finding of Serious Professional Misconduct and the case continues.
    We move to Stage Two.”

    Determination
    Mr Bray,



BRAY, SJ             Professional Conduct Committee July 2008 – July 2010                        Page 5
    The Committee has heard that during 2003 and 2004 you provided dental treatment to
    patients A, B, C and D at 16 Story Lane, Broadstone, where you operated a dental practice
    with your colleague, Mr Visser. It was at this practice that you chose to move progressively
    into the provision of neuro-muscular dentistry, whilst Mr Visser continued to provide general
    dental services.
    In reaching its determination the Committee has paid very careful regard to the large number
    of allegations and facts you have admitted. It has also considered those allegations found
    proved against you in your treatment of the four patients, your approach to scanning,
    nutritional supplements and to the appropriate use of electromyography.
    It was clear to the Committee that your provision of treatment was philosophy-driven, rather
    than patient-centred, with an emphasis on the bite and occlusion.        While this field of
    treatment may have a place in dental practice, you allowed your “excitement” over certain
    diagnostic and treatment methods to cloud your professional judgment on more than one
    occasion. The Committee finds that your patients were, on the whole, unaware of the lack
    of substantive evidence for the treatments and methods you operated. The Committee was
    very concerned that in some of these cases you carried out invasive treatment based on
    strongly held personal philosophy, even when this was not in the best interests of your
    patients.
    During the relevant period the ethical guidance in force was contained in Maintaining
    Standards. The Committee has found that you breached the ethical guidance as follows:

           Improper statements or certificates and misleading announcements
           (Paragraph 2.3) and misleading claims (Paragraph 4.6)
           The Committee noted that in respect of making misleading statements, you were
           warned in a letter from the General Dental Council dated 18th May 2004 about
           misleading statements you made regarding the “HealOzone” method of treating caries.
           This method of treatment has since been discounted by the National Healthcare
           Institute for Clinical Excellence (NHICE).
           The Committee has noted that misleading statements and correspondence regarding
           the anti-oxidant hand-scanner were sent to patients within 6 months of that warning.
           This displayed a lack of insight into your own shortcomings and very little regard to the
           warning issued by your regulatory body.
           Furthermore, the contents of your booklet entitled Unravelling the Mystery, given to
           patients and which you seem still to be using, including the references to your own
           treatment experience and your qualifications, are misleading.
           Acting in the best interests of the patients (Paragraph 3.1)
           On your own admission, patient B‟s initial presenting complaint, as recorded in your
           notes, did not justify the subsequent occlusal investigation and prescription of full-
           mouth reconstruction. This was not in the best interests of patient B.

           Providing a high standard of care (Paragraph 3.2)
           With regard to patient A, the Committee accepted the evidence that you failed to
           diagnose and treat caries. The Committee note that you hold an MFDS qualification.
           You should therefore be aware of the importance of adequate diagnosis including the
           appropriate use of radiographs and subsequent treatment of dental caries. Despite

BRAY, SJ            Professional Conduct Committee July 2008 – July 2010                  Page 6
           the request of patient A that you treat her dental caries you failed to do so. This was a
           basic and dangerous failing which amounted to a period of supervised neglect.
           Explaining treatment and costs (Paragraph 3.6)
           On your own admission, and the Committee found proved, you failed to provide
           adequate treatment plans or discuss alternative treatment options and costs.
           Consent (Paragraph 3.7)

           For all four patients you failed to gain informed consent. Gaining
           informed consent is particularly important when the treatment is not
           mainstream dentistry and is particularly expensive.

           Contemporaneous records (Paragraph 4.3)
           You admitted, and it was found proved, that you failed to keep adequate
           contemporaneous records. For example, you failed to report on any radiographs that
           you took, as required in the Ionising Radiation (Medical Exposure) Regulations
           [IR(ME)R] 2000.
    The Committee noted that, whilst you admitted Head of Charge 10 in that you failed to refer
    patient A to a periodontist, the level of treatment she had received by the hygienist, and her
    improving periodontal condition, meant that such a referral was in the event non-essential,
    and you are not criticised on this non-referral.
    The use of electromyography for measuring the occlusion, whilst not in itself criticised by the
    General Dental Council, is an unorthodox diagnostic method, the unconventional nature of
    which was not clearly explained to the patients, nor described in your own notes. The
    Committee found your own evidence on this diagnostic method, and on the rationale behind
    it, confused and unconvincing, and was concerned by your reliance on the results to provide
    extensive invasive treatment.
    Your breaches of the ethical guidance were such that the Committee can only view them as
    serious. It is no part of this Committee‟s function to pronounce on the clinical validity or
    otherwise of any particular treatment philosophy, and the Committee is anxious to avoid
    stifling the development of new techniques. Moreover, we are convinced that it is our duty
    to judge all practitioners against the same standards. These include their inescapable
    obligations to act in the best interests of the patient, to provide a high standard of care, and
    to obtain informed consent. In particular, where dentists advocate forms of treatment which
    are out of the mainstream of professional opinion, are unsupported by an informed evidence
    base, or are otherwise unproven, they must meet the highest standards to ensure that the
    patient fully understands the treatment proposed, the risks involved, and the alternative
    treatment options. All dentists must constantly question their own skills and knowledge base
    in relation to diagnosis, prescription and treatment. They must also consider whether
    invasive and irreversible courses of treatment which lie outside the mainstream of
    professional opinion may legitimately be embarked upon without prior consideration and
    clearance by a properly established Ethics Committee.
    In all these respects you failed to meet the standards required of you as a member of the
    dental profession. The consequence of your failures was misconceived, lengthy and
    unnecessary treatment which was irreversible and of little or no benefit in terms of intended
    outcomes, which failed to resolve the patient‟s symptoms, and which cost some of the


BRAY, SJ            Professional Conduct Committee July 2008 – July 2010                  Page 7
    patients considerable sums of money. Taking all of its findings into account, the Committee
    finds you guilty of Serious Professional Misconduct.
    The Committee finds that you allowed your unchecked enthusiasm for particular
    methodologies to cloud your professional judgment. It is concerned by both the lack of
    insight you have shown into your failings in this case, and by your lack of critical evaluation
    of the philosophies of treatment which you have espoused. You should be in no doubt that
    your conduct has fallen far short of the standard expected of a member of the dental
    profession.
    The Committee recognises that its duty is not primarily punitive, but is designed to protect
    the public, maintain public confidence in the profession and maintain proper standards of
    behaviour by dental practitioners. The Committee has made its determination on that basis.
    In considering sanction the Committee has taken into account all the mitigation which has
    been presented on your behalf including the witnesses who have given evidence as to your
    good character, and the written testimonials. It noted, however, that a large amount of your
    CPD still focusses on the narrow field of practice in which you have displayed a keen
    interest.
    The Committee has also noted that the allegations relate to events which happened four
    years ago and there is no evidence before it that in the interim there have been any other
    failings on your part.  The Committee also took into account the number of admissions
    made, although it remained concerned regarding your lack of insight.
    The Committee has considered each of the options available to it in turn. The function of the
    Committee is not primarily punitive and it has borne in mind at all times the need for
    proportionality in its decision, balancing your interests against the need to protect patients,
    maintain public confidence in the dental profession and the need to maintain high standards
    of behaviour by dental practitioners.
    The serious nature of the findings means, in the judgement of the Committee, that to
    conclude the case would be inadequate. The Committee carefully considered whether
    postponement would be an appropriate and proportionate sanction, and decided that this
    would be sufficient to protect the public interest whilst giving you the oportunity to prove to
    the Committee that your performance has improved. It has therefore decided to keep your
    conduct under review and to postpone determination of this case for a period of 12 months,
    with a formal admonition to express its disapproval of your behaviour and practice as
    outlined above
    At the resumed hearing, the Committee will expect you to provide tangible evidence of:
        A Personal Development Plan (PDP), arrived at in conjunction with your Postgraduate
         Dental Dean or Tutor. This should include an IRMER Course, a Minimal Restorative
         Intervention Course and an Ethics/Consent course;
        Guidance in treatment planning, supervised by a consultant in restorative dentistry
         locally;
        Evidence of interaction with mainstream colleagues locally, which may include
         involvement with BDA section meetings, independent practitioner groups and peer
         review groups in your area;
        An externally verified audit of radiography, especially bitewing radiographs, to include
         reports on the outcomes of the radiographs;
        An externally verified audit of clinical records;

BRAY, SJ          Professional Conduct Committee July 2008 – July 2010                   Page 8
         Up-to-date information leaflets that are objectively justifiable, accurate and balanced;
          and
         Up-to-date consent forms
     You should be in no doubt that at the resumed hearing, the re-formed Committee will retain
     all the powers of disposal that were available to this Committee at this hearing.
     That concludes the case for today.”


On the 31 July 2009 the Chairman announced the determination as follows:

     “Mr Bray,
     The Committee has heard the submissions made by Mr Larkin on behalf of the General
     Dental Council and by Mr Cridland on your behalf. It has accepted the advice of the Legal
     Adviser.

     On 5 August 2008, the Professional Conduct Committee found you guilty of serious
     professional misconduct by reason of facts found proved against you. That Committee
     decided to postpone judgment for a period of 12 months to enable the Committee, at a
     resumed hearing, to decide whether your performance had improved.
     At today‟s hearing the Committee has heard that two new complaints have been received by
     the General Dental Council which have not yet been investigated.
     The Committee has noted that both Mr Larkin and Mr Cridland are in agreement that this
     hearing should be adjourned in the light of this development.
     The Committee understands that the two new complaints are of relevance to the existing
     matters before it today. The Committee has, therefore, decided that is has no alternative but
     to postpone judgement of your case for a further period of 12 months, or until the earlier
     resolution of the complaints. The Committee very much regrets the delay which will occur as
     a result.
     The Committee would wish for this case to be relisted at the earliest time following the
     investigation of the new complaints.
     At the resumed hearing you will be expected to provide the evidence detailed in the
     determination made on 5 August 2008.
     That concludes the case for today.”




On 15 July 2010 the Chairman announced the determination as follows:
     “Ms Barnfather and Ms Paterson,
     On 5 August 2008, the Professional Conduct Committee found Mr Bray guilty of serious
     professional misconduct. That Committee decided to postpone judgment for a period of 12
     months to enable the Committee, at a resumed hearing, to decide whether his performance
     had improved.

BRAY, SJ           Professional Conduct Committee July 2008 – July 2010                 Page 9
    In July 2009 there was a joint application to adjourn the case for 12 months due to two
    outstanding complaints received by the General Dental Council (GDC). This application was
    granted. The Investigating Committee considered those allegations and no further action was
    taken.
    At today‟s hearing the Committee has heard that two further complaints have been received
    by the General Dental Council which have not yet been investigated.
    The Committee has noted that you are both in agreement that this hearing should be
    adjourned in the light of this development.
    The Committee considers that the two new complaints are directly relevant to the issue with
    which this Committee is seized. Whilst the Committee is most concerned that this postponed
    judgement relates to events in 2003 -2004 it considers that it is plainly in the interest of
    justice that this matter is further adjourned so that the Investigating Committee can consider
    these new allegations. The Committee has been informed that these will take place on 12
    August 2010 and 2 September 2010.
    The Committee has, therefore, decided that it has no alternative but to postpone judgement
    of Mr Bray‟s case for a further period of 12 months, or until the earlier resolution of the
    complaints. The Committee very much regrets the further delay which will occur as a result.
    The Committee believes it is in the interest of justice for this case to be relisted at the earliest
    time following the investigation of the new complaints.
    At the resumed hearing Mr Bray will be expected to provide the evidence detailed in the
    determination made on 5 August 2008.
    That concludes the case for today.”




BRAY, SJ           Professional Conduct Committee July 2008 – July 2010                       Page 10

				
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