The Health Professions Appeal and Review Board of Ontario recently released its final decision regarding a dispute between a dental patient and a local dentist1. The case, which began with a series of dental extractions in early 2022, involved allegations of clinical negligence, professional misconduct, and poor communication. The patient, Wilfred St. Amour, had asked the Board to review a previous decision made by the Royal College of Dental Surgeons of Ontario. That earlier decision had cleared the dentist, Dr. Deborah Paulette Saunders, of any wrongdoing. After a thorough review of the facts and the legal standards for professional investigations, the Board confirmed that the College acted reasonably when it decided to take no further action against the dentist.
The background of the case involves a patient who was managing a very serious health situation. Mr. St. Amour was undergoing treatment for metastatic prostate cancer. As part of his overall health management, his medical oncologist referred him to Dr. Saunders for dental care. In cases involving advanced cancer treatment, dental health is often prioritized because certain medications and treatments can affect the bones and the body’s ability to heal. Dr. Saunders, a general dentist with experience treating patients with complex medical needs and high levels of anxiety, saw Mr. St. Amour on three separate occasions. The primary treatment in question occurred at Health Sciences North, where Dr. Saunders performed the extraction of four specific teeth.
Following these procedures, Mr. St. Amour filed a formal complaint with the Royal College of Dental Surgeons of Ontario. His concerns were wide ranging and personal. He alleged that Dr. Saunders began pulling his teeth before the local numbing agent had actually taken effect. He described the experience as involving extreme pain and stated that he was left shaking and crying during the process. Furthermore, he claimed that the extraction sites bled for several hours after he left the hospital and that Dr. Saunders had left fragments of a tooth behind in his jaw. This alleged mistake, he claimed, made it impossible for him to get dentures later on. He also felt that Dr. Saunders spoke to him in a way that was belittling and bullying, and that the office staff made rude comments when he went to pay his bill. Finally, he was upset that a request for a refund had been denied.
In response to these allegations, Dr. Saunders provided a detailed account of the care she provided. She noted that while the patient appeared to have low health literacy and a history of dental neglect, he did not report any specific psychiatric illnesses that would have required special protocols beyond her usual care for anxious patients. She explained that the procedure was a routine extraction of four teeth. Regarding the pain, she noted that the patient did react to the initial injection of the needle, but she maintained that he did not express any other discomfort or concerns during the actual procedure on March 10, 2022. She also clarified the financial aspect, explaining that because the services were billed through government programs like the Ontario Disability Support Program and the Ontario Health Insurance Plan, she was not in a position to offer a private refund.
The Inquiries, Complaints and Reports Committee of the College took the lead on the initial investigation. This committee is responsible for screening complaints to see if a dentist should face a formal disciplinary hearing. To do this, they gathered a massive amount of evidence. They obtained Mr. St. Amour’s dental records from Dr. Saunders, his health records from Health Sciences North, and records from a subsequent dentist and a denturist who saw him later. They also interviewed a dental assistant who was present during the extractions. After looking at all these documents, the committee found that there was no evidence to support the claim that the dentist had acted improperly. They noted that the medical records showed that a significant amount of freezing was used and that the patient had tolerated the procedure well at the time.
When the case moved to the Health Professions Appeal and Review Board for a review, the Board had to decide two main things. First, they had to determine if the investigation was adequate. This means they had to check if the College gathered all the essential information needed to make an informed choice. Second, they had to decide if the decision to take no action was reasonable. A reasonable decision is one that is logical, transparent, and based on the facts found in the evidence. It is important to note that the Board does not hold a new trial to decide if the dentist was guilty of misconduct. Instead, they look at the work the College did to ensure it met the standards required by law.
Mr. St. Amour argued that the investigation was not adequate because the College did not interview a specific nurse who he believed would have supported his version of events. He also suggested that the dental records were fabricated or changed to hide the truth. He pointed out that the times and dates in the records were wrong and maintained that he was in the most pain he had ever felt in his life. He told the Board that the freezing was only allowed to sit for two minutes before the dentist started pulling his teeth while he still had an active infection. He felt that the College was simply taking the dentist’s word over his own.
The Board, however, found that the investigation was indeed adequate. Under Ontario law, a committee is not required to interview every single person who might have a tiny bit of information. They only need to make reasonable efforts to get the records and documents that are relevant. In this case, the College had obtained the records from the hospital where the surgery took place. Those hospital records included an internal investigation by the hospital itself, which found no concerns with how Dr. Saunders performed the extractions. Because the hospital records and the dental assistant’s interview already provided a clear picture of what happened, the Board decided that interviewing another nurse was not necessary.
When it came to the clinical issues, the Board found that the College’s decision was reasonable. The dental records showed that Dr. Saunders used seven carpules of local anesthetic, including Lidocaine and Citanest. The Board noted that this was a significant amount of numbing agent, which suggested that the dentist was very aware of the patient’s need for pain management. The contemporaneous records, which are the notes made at the time of the appointment, specifically stated that the patient tolerated the procedure well and that the bleeding was controlled before he was discharged. The Board explained that these types of medical records are considered very reliable because they are created by professionals at the time of the event, long before any legal complaint is filed.
Regarding the allegation that tooth fragments were left behind, the Board looked at the evidence from the patient’s subsequent healthcare providers. Mr. St. Amour had seen another dentist, Dr. KD, and a denturist, Dr. YR, shortly after the extractions. Neither of those professionals recorded finding any broken bones or tooth fragments in his mouth. In fact, the denturist was able to finalize a plan for dentures just a few months later. While the subsequent dentist did recommend pulling more teeth, the Board noted that different dentists can have different professional opinions on which teeth can be saved and which should be removed. This difference in judgment does not mean that the first dentist did anything wrong.
The Board also addressed the complaints about unprofessional communication. It noted that communication is often a “he said, she said” situation where it is very difficult to prove exactly what was said or what the tone was. Because the Committee does not take evidence under oath and does not see the witnesses in person to judge their honesty, it often cannot make a final ruling on who is telling the truth in a personality clash. Since there was no independent evidence to prove the dentist was a “bully”, the Board found it was reasonable for the College to take no action on that specific point.
In its final analysis, the Board expressed sympathy for Mr. St. Amour. They acknowledged that he had a very difficult experience and was dealing with significant health and emotional trauma. They noted that pain is a subjective experience, and what feels manageable to one person might feel like extreme agony to another. However, the legal role of the Board is to look for evidence of professional misconduct or a failure to meet clinical standards. Without medical records or witness statements to back up the patient’s claims, the Board concluded that the College had no choice but to close the file. The decision issued on January 2, 2026, officially confirms that Dr. Saunders will not face further disciplinary action regarding this specific complaint. The file will remain on her private record with the College, but no public sanctions will be issued.
Read more cases about proceedings in regulated professions here.
