The Unfortunate Results of “Textbook Malpractice”

Repurposed from The Scope: Dental Edition, Fourth Quarter 2023.

Initial Treatment

A 56-year-old male presented to the dentist’s office to address concerns with his smile. He completed his medical and dental history forms during the initial visit. He also signed consent forms for intended dental procedures, including films and bridgework. Although it is not documented, the dentist stated that he explained the risks, benefits and alternatives to the proposed treatment to the patient. The examination revealed that the patient required the extraction of seven teeth as well as crowns on his remaining twenty teeth. Impressions were made for temporary upper and lower bridges.

Over the next few months, the seven teeth were extracted. At each visit, a Z-pak was prescribed for the patient. Shortly thereafter, the dentist prepared for crowns on the remaining lower teeth (#20–#22, #24, and #26–#29). A temporary bridge was then cemented with acrylic, temporary cement and permanent cement. Two weeks later, the bridge was re-cemented with permanent cement and temporary cement.

The upper arch was started four months after the patient’s initial visit, with crown preparation and a temporary bridge for teeth #2–#6, which was cemented with acrylic and temporary cement. The bridge for teeth #7–#13 was cemented a month later with acrylic and temporary cement. One month later, this temporary bridge had to be recemented. The dentist then took impressions for the permanent upper and lower bridges.

Later Treatment

Permanent bridgework was cemented. However, over the following eight months, the patient was seen multiple times for the try-ins and re-cementing of the upper and lower bridges. Over the next three years, the patient sporadically returned to the dentist for annual cleanings. During the following two years, the patient saw the dentist for inflamed gums, re-cementation of the bridge and various adjustments. The patient also received several prescriptions for a Z-pak.

Ultimately, the patient had extractions of two more teeth (#7 & #13), and he underwent RCT to teeth #6, #10, and #11. This occurred over five visits spanning two months. Ten days after posts were inserted, the dentist was advised that the patient missed his appointment due to hospitalization for a heart infection. During this hospitalization, the insured was advised that the source of his endocarditis was likely the patient’s dental work. He was also simultaneously diagnosed with diabetes mellitus. This was the last contact the dentist had with the patient.

New Dentists Seen and Lawsuit Filed

After the patient was discharged from the hospital, he went to a new general dentist who observed decay throughout his mouth, noting that nothing was salvageable in the maxilla. The patient was referred to an oral surgeon but could not afford to get the recommended treatment, which consisted of the removal of his remaining teeth with bone surgery. The patient sought a second opinion from another dentist, who agreed that his teeth were infected, rotten and decayed down to black and yellow nubs. He documented this with photographs. This dentist ultimately extracted fourteen teeth in total and inserted eight implants in the upper arch and six in the lower to support the dentures. As a result, the patient filed a lawsuit against the original dentist. He alleged that the defendant dentist did not perform sufficient examinations of his teeth, nor take films over an eight-year period. This resulted in rampant decay, RCTs, infection and endocarditis, which necessitated his hospitalization and treatment with IV antibiotics.

Expert Review

Our expert reviewed the original dentist’s care and noted that his treatment was “textbook malpractice in every possible way.” The records contained sparse documentation and insufficient films, and there was an absence of periodontal charting. Extractions were performed with insufficient films, and there was no documentation of recommendations for frequent cleanings or home care.

Documentation did not include informed consent for the RCTs or any other treatment after the initial consent form was signed during the patient’s first visit. A rubber dam was not utilized during the RCTs, nor were measurement films taken. It did not matter that the RCTs appeared to look clinically acceptable since the teeth were decayed to, or below, the gum line. Additionally, the bridges never fit properly, as evidenced by the repeated need to re-cement them.

Settlement

The defensibility of this case was focused on the dentist’s lack of informed consent documents and the very poor documentation in general of the care he rendered. Our expert review was critical of the films and the dentist’s failure to obtain a full mouth series. Had the films shown that the bridges fit well, and the dental record contained better documentation and an updated medical history, the dentist would have been able to point to, and back up, an alternative explanation for the breakdown. Unfortunately, this dentist never personally documented the chart; it was done solely by his assistant. All the chart entries were handwritten and difficult to read. The dentist did not perform well at his deposition since he was unable to fill in the blanks of his very sparse dental record. As a result, our dental claims specialist felt the case should be settled. The demand from the plaintiff was $650,000, and the case was within the insured’s policy limits.

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This document is for general purposes only and should not be construed as medical, dental or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical, dental or professional obligations, the applicable state or federal laws or other professional questions.