Common Dental Negligence Cases
Originally published in September 2014
Actions against dentists are often brought by patients who, sometimes wrongly, attribute less than ideal treatment outcomes to negligence. Not surprisingly, therapies with the highest risks of complication or failure generate the most patient complaints.
The purpose of this article is to describe the most common clinical issues arising in PLP cases and some ways in which members can protect themselves from or defend against allegations of malpractice in relation to those and other situations.
THE TOP FIVE
The following areas account for the majority of PLP files over the past few years:
Patients alleged inadequate workup, improper diagnosis and treatment planning, compromised treatment, root resorption, occlusal disharmony and poor aesthetics.
Allegations of negligence included failure to diagnose and/or treat periodontal disease, caries or oral cancer.
Claims advanced for retained instruments, sodium hypochlorite accidents, inadequate obturation, post-operative infection and nerve, sinus and tooth perforations.
Oral and implant surgery
Allegations included wrong tooth extraction, post-operative infection, lingual and mandibular nerve injury, sinus perforation and mandibular fracture. Implant dentistry claims have increased and arise from post-operative infection, paraesthesia, non-restorable implants and bone graft and implant failure.
Crown and bridge treatment
Patients sought compensation for occlusal disharmony, lack of retention, open margins, overhangs, fractures of teeth and prostheses, loss of teeth and improper implant restoration. Poor treatment planning or provision of treatment beyond the member’s capabilities was also alleged, especially in full-mouth reconstruction cases.
Other recurring themes are adverse drug reactions, sedation and anesthesia complications, injection-related paraesthesia, instrument ingestion and inhalation and soft tissue injury.
The majority of files involved general dentists. Of these files, more than two-thirds related to crown and bridgework, oral and implant surgery and endodontic therapy.
KEYS TO DEFENSIBILITY
Managing patient expectations
It is important that the patient understands the diagnosis and treatment options, the practitioner’s recommendation, what can go wrong and how much it may cost in the worst case scenario.
Document, document, document
No matter how detailed the discussion with the patient, the fact that it took place may be hard to prove months or years afterward. And many patients do not remember or refuse to acknowledge having been told of the risk of a complication once it occurs. Defensibility of an action for dental negligence therefore often turns on the quality of the member’s record-keeping.
Whether a member performed appropriate investigations is also an important factor in determining if a matter should be settled or defended. For example, inadequate imaging, failure to measure and/or record periodontal pocket depths, failure to diagnose and/or treat periodontal disease or failure to perform and document the results of oral cancer check will generally render a supervised neglect case impossible to defend on standard of care.
Knowing one’s limitations
Finally, the number of actions against general dentists venturing into specialized areas of dentistry, e.g. endodontics and implant surgery, is on the rise, and more of those have to be settled than cases against specialists performing the same work. In such circumstances, the general dentist is held to the same standard as a specialist, and if he/she lacks the knowledge, training or skills to properly carry out the treatment in question, a finding of liability is likely.
Before straying into unfamiliar territory, all dentists should realistically assess their competence and experience. Knowing when treatment is beyond one’s abilities and referring the patient to a colleague with the appropriate expertise can prevent problems before they start.