COMMON AREAS OF DENTAL LITIGATION
Litigation has involved all aspects of dental practice and nearly every specific type of treatment. A few types of dental treatment have a higher incidence of legal action. Removal of the wrong tooth usually results from communication breakdown between the general dentist, and oral surgeon or the patient and dentist. When in doubt the dentist must confirm the tooth to be extracted by radio graph, clinical examination, or discussion with the referring dentist. If opinions differ regarding the proposed treatment, the patient and the referring dentist should be notified and the outcome of any subsequent rsation documented. A short follow-up letter contirming the final decision may also be helpful in docu mentlng this decision. If the wrong tooth is in fact extracted, this should be handled in. the manner
described earlier in this chapter. Nerve injuries are often grounds for suits, with attorneys claiming that the nerve. injuries resulted from extractions; implants, endodontic treatment, or other procedures. These allegations are usually coupled with allegations of ipsufficient informed consent. Because nerve injuries are a known complication of mandibular extractions or mandibularimplants posterior to the mental foramen, patient advocates claim the patient had a right to accept these risks as part of treatment. If the dentist can visualize conditions that increase this risk, the patient should be advised and the condition documented. An example would be to pecifically note the .elationship of the inferior alveolar nerve to the third molar tooth to be extracted, when these appear to be in very close proximity. ‘ Failure to diagnose can be related to several areas of dentistry: One of the most common problems is a lesion that is seen on examination but is not adequately documented and no treatment or follow-up is instituted. If the
lesion causes further problems or a subsequent biopsy documents long-standing pathology or a malignancy, this may be viewed as negligence. This problem can be avoided by following up on any potentially abnormal
finding. The clinician should chart an initial diagnosis or. !leek a consultation from a specialist. If the lesion has resolved by the next visit, the clinician should record that fact so the issue is closed. If the patient is referred to another doctor, the referring clinician should follow up
to documet the’ patient’s progress, including whether cr .not the patient’s condition was successfully treated. Failure to diagnose periodontal .discase is often the area of criticism and legal action. A periodontal examination
should be a part of routine dental evaluations and therefore becomes the primary responsibility (If the general dentist. The status of the problem, suggestions for treatment, referrals, and progress or resolution of the
problem must be clearly documented, Implant complications or failure b another c omrnon area of litigation. As with any procedure the patient
..should be informed of the compltcauon’s ..ssociated reconstruction and long-term outcome. TI)(‘ need for careful long-term hygtene and follow-up should be explained. The potential ‘detrimental ctfect (If patient habits such as smoking should be, explained and documented. Dentists placing implants should consider. using a customized consent form, summarizing common com- .plicatlons, and stressing the importance of patient follow-up care and oral hygiene, Failure to pre vide appropriate referral to another dentist
or specialist can be a source of legal problems. Dentists usually determine the appropriate time to refer a patient to a specialist for initial care or management of a complication. Failure to refer patients for complicated
treatment not routinely performed by the dentist -or delayed referral for management of a complication frequently becomes the basis for litigation. Referrals to specialists can greatly reduce liability risks. Specialists re accustomed to treating more difficult cases and complications.
Specialists with whom the dentist has a good relationship can also .diffuse patient management problems by being objective and caring and by reassuring angry patients. ‘The general dentist and spedalist may discuss
ways of relieving the expense of addressing a complication and completing treatment. Temporomandibular joint (fMJ) disorders sometimes become more apparent after dental procedures duriring prolonged opening or manipulation, such as tooth extraction or endodontic treatment. It is important to document any preexisting condition in the pretreatment assessment. The risk of TMJ pain or other dysfunction as a result of a
procedure should be included in the informed consent when iridicated. If the patient is in dire need of care that may aggravate or cause a TMJ condition, a customized consent form should be drafted and signed. It should clearly define the problem, giving the .patient options and con confiing the patient’s authorization to proceed.