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Alberta Dental Association and College
Hearing Tribunal Decision
August 13, 2013
On August 13, 2013, an Appeal Panel of the Council of the Alberta Dental Association and College
found Dr. Tammarie Heit guilty of unprofessional conduct and she was sanctioned.
On June 12, 2012 and January 23, 2013, the original hearing and decisions of the Hearing Tribunal
were made. The findings of the Hearing Tribunal regarding unprofessional conduct were upheld by the
Appeal Panel of Council.
The Hearing Tribunal found that Dr. Heit was guilty of unprofessional conduct that displayed a lack of
knowledge of, or judgment in, the provision of dental services that contravened Principle 1 and Article A5
of the Code of Ethics and constituted unprofessional conduct pursuant to sections 1(1)(pp)(i), 1(1)(pp)(ii)
and 1(1)(pp)(xii) of the Health Professions Act because:
In relation to the placement of nine veneers, Dr. Heit failed to obtain informed consent from the
patient prior to proceeding with treatment, including failing to properly and fully explain the
risks of failure or complications prior to treatment; and failing to provide the patient with
reasonable expectations in relation to potential treatment outcomes.
The Hearing Tribunal also found that Dr. Heit was guilty of unprofessional conduct that displayed a lack
of knowledge of, or a lack of skill or judgment in, the provision of dental services that contravened
Principles 2 and 3 of the Code of Ethics and constituted unprofessional conduct pursuant to sections
1(1)(pp)(i), 1(1)(pp)(ii) and 1(1)(pp)(xii) of the Health Professions Act because:
In relation to the placement of nine veneers, Dr. Heit failed to provide adequate and proper
treatment to the patient and left the patient in a worse state than if no treatment had been
provided.
Between June of 2008 and October of 2008, Dr. Heit provided cosmetic treatment by placing nine
veneers on nine generally healthy teeth that did not require any restorative procedures for oral health
reasons. The placement of the nine veneers required very substantial and aggressive reductions in tooth
structure that removed large amounts of enamel and significant amounts of dentin from the nine healthy
teeth in order to place the veneers which would close the diastemas between the patient’s upper and
lower central incisors.
The Hearing Tribunal found that within one year of the placement of the veneers, a general dentist and
an endodontist recognized that a substantial number of root canals were required on the teeth that had
had veneers placed. The endodontist identified at least 5 teeth where endodontic treatment was required
to save the teeth. There were concerns about two additional teeth where the endodontist suspected that
endodontic treatment would be required.
The Hearing Tribunal also found that in less than two years after the completion of Dr. Heit’s treatment,
the patient suffered further deterioration of the health of these teeth and would require extensive
restoration work on almost all of the teeth treated by Dr. Heit.
Alberta Dental Association and College
Dr. Tammarie Heit, August 13, 2013
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The Hearing Tribunal noted that in her evidence, Dr. Heit recognized there was a large risk of root
canals and was not surprised that root canals were ultimately required. The Hearing Tribunal also noted
that in her evidence, Dr. Heit suggested that the amount of tooth structure removed for the veneers was
the minimum amount required to get the esthetic result that the patient wanted.
The Hearing Tribunal found that the post-operative radiographs made it clear that large amounts of
tooth structure were removed for all of the teeth and Dr. Heit’s preparation went into the dentin. In at
least two of the four lower teeth, the preparation came very near to the pulp. The Hearing Tribunal found
that this was a very different procedure than what is described in the brochure material provided by Dr.
Heit to the patient and that there was no documentation to support that Dr. Heit made it clear to the
patient that her brochure on veneers did not accurately describe the procedure she intended to carry out
on the patient’s teeth.
The Hearing Tribunal found that the patient’s nine teeth were over-prepared and over-reduced by Dr.
Heit and that far too much tooth structure and dentin were removed by Dr. Heit. The dental abscesses
that resulted in the pulpal necrosis and the need for multiple root canals arose because of the overpreparation and over-reduction of the teeth. The Hearing Tribunal found that the margins of the teeth
were poorly prepared by Dr. Heit and that this resulted in open and poorly fitted margins after the
veneers were placed.
The Hearing Tribunal acknowledged and agreed that Dr. Heit’s preferred procedure would have been to
close the patient’s diastemas by orthodontic treatment before placing veneers. The Hearing Tribunal
found that given the amount of tooth enamel and dentin that was removed from healthy teeth, this
procedure should not have been attempted without the orthodontic treatment because the risk to the
health of the teeth that were reduced was so severe.
The Hearing Tribunal found that the patient was not fully informed about the difference between
proceeding after orthodontic treatment and proceeding without orthodontic treatment. The Hearing
Tribunal found that a discussion about a referral to an orthodontist in 2004 was not sufficient to
constitute informed consent about a procedure proposed in 2008.
The Hearing Tribunal wished to stress that it is not acceptable and is contrary to the Code of Ethics to
seriously damage healthy teeth for cosmetic purposes. Also, a dentist must clearly explain and document
all of the potential risks of the cosmetic procedure and all of the likely and potential impacts on the
health of the teeth involved. The Hearing Tribunal did not agree that the fact that a procedure is
considered cosmetic means that esthetic considerations can justify the over-reduction of enamel and
dentin that severely impact the long term health of the teeth.
The Hearing Tribunal emphasized that in every case, including cosmetic cases, a dentist must be careful
to take into regard the overall dental health of the patient and to avoid treatments that impair dental
health. The Hearing Tribunal stressed that even with cosmetic treatment, the overall health of the
patient’s teeth and the impact of the proposed procedure on the health of the existing teeth are
important and must be considered.
The Appeal Panel ordered that:
Dr. Heit be reprimanded;
Dr. Heit repay the patient the sum of $13,500.00 for the fees paid for the placement of the nine
veneers; and
Dr. Heit pay costs of the investigation and hearing of $130,723.00.
Alberta Dental Association and College
Dr. Tammarie Heit, August 13, 2013
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