This case study was originally printed in our First Quarter 2023 issue of The Scope: Dental Edition. Read more articles from the publication here. For an overview of high-severity dental liability, read our recent blog.

A 52-year-old male presented to the insured general dentist’s office with multiple dental issues. This dentist, who had no advanced training, completed a complex full mouth restoration on the patient that included sinus lifts, bone grafting, root canal treatments (RCTs), apicoectomies, extractions, implants and restorations.

Due to failure, many of these procedures had to be re-done, some over prolonged periods of time. Some procedures became progressively more invasive. For example, an RCT took eight visits to complete. A sinus communication with infection was treated over 15 visits. A tooth with a good prognosis received a filling and shortly thereafter needed an RCT, which then became infected and required extraction, grafting and an implant.

This implant then failed, requiring that treatment begin yet again. After five years of care with this dentist, the patient finally left the practice and sought treatment elsewhere.

The patient filed a lawsuit against the dentist alleging negligent full mouth restoration, failure to refer him to a specialist and a lack of informed consent. He claimed that the dental care provided by this dentist resulted in not only the need to retreat his teeth, but the loss of all his remaining natural teeth.

At his deposition, the dentist testified that he did not need to consider referring the patient to any other specialists and asserted that he could perform all the treatments provided despite his lack of specialty training.

MLMIC experts and the District Claim Committee reviewed the case and determined that there were serious issues involving the dentist’s ability to provide the treatment itself. They opined that the documentation was sparse and lacked comprehensive treatment notes.

The reviewers also found that he failed to develop a comprehensive treatment plan, did no periodontal charting, had no written informed consent forms and, finally, had made no referrals to specialists. Over a five-year period, the dentist had treated every tooth in the patient’s mouth. Some teeth were either retreated or later underwent more aggressive procedures with extensive restorative, endodontic, periodontal and surgical treatment.

It was quite evident to the reviewers that the patient should have been promptly referred to other specialists, especially when his initial treatment began to fail. Instead, the dentist performed multiple retreatments of those teeth. Finally, the reviewers found that this patient should have been referred to an oral surgeon for the sinus lift.

The plaintiff’s demand was $450,000 for expenses paid to this dentist and the current and future costs of care from other dental specialists. The lawsuit was ultimately settled for $260,000.

A Legal and Risk Management Analysis

The primary challenge to successfully defending this lawsuit was the lack of informed consent or offer of the option to transfer care to a specialist. Informed consent documentation should have included the need to have a specialist involved in much of the patient’s care. It is unclear whether this omission was due to the dentist believing he could successfully complete all treatment the patient required, or his concern about referring the patient for dental work that had to be redone.

This case exemplifies the extremely poor communication between the dentist and the patient. Prompt referral to a specialist would have saved the patient many appointments and dental bills over five years and, more importantly, some, if not all, of his natural teeth. Unfortunately, as is very evident in this case, the patient was also quite dilatory over a period of five years in seeking other dental care or opinions, to his detriment. Another weakness in this case was the very poor documentation in the dental record.

Finally, the lawsuit resulted in an expensive settlement, which was primarily due to the dentist acting as an expert in all areas of dentistry and providing specialized treatments despite his lack of proper specialty training in the multiple procedures he performed. His lack of communication did not allow proper informed consent from the patient because he was unaware that the dentist was exceeding his training and expertise in the many procedures he provided. This significant omission became apparent since the dentist had to redo much of the work.

Although it is unclear why the patient remained at this practice to have multiple repeated procedures, it is likely and understandable that patients trust and have confidence in a dental professional to provide appropriate treatment within the standard of care. The patient in this case lacked the awareness he needed to transfer to a more skilled provider with the necessary training and expertise to properly handle his dental needs.

Unfortunately, both the patient and the dentist made the erroneous assumption that no complications would result from the care and treatment rendered.

Keep an eye on our blog, sign up for our monthly newsletter and follow us on Twitter and LinkedIn so you don’t miss our next publication.