Takeaway: Dental malpractice claims are often not merely the result of individual oversights but reflect broader systemic issues, such as lapses in infection control, documentation, and patient assessment protocols.1 Establishing and maintaining strong practice processes for patient communication, informed consent, and documentation can help improve patient safety and protect the practice from liability.
The Case: A patient with a history of diabetes and smoking presented to the dentist for a consultation. The patient wanted to replace their lower teeth. The dental examination was significant for severe periodontal disease with pocket depths up to 10mm and an infection in the upper arch. The dentist recommended extraction of the remaining lower teeth, the placement of implants, and a cemented bridge. The dentist failed to document the treatment plan or the discussion of other treatment options. The patient agreed to proceed with the plan, and the procedures were performed. Unfortunately, the dental record lacked contemporaneous documentation of the procedures, and in fact, the procedure note was documented almost two years later.
Post procedure, the dentist recalled that the patient had no complaints of any numbness or bone loss. Several months after the procedure, however, the patient consulted with another dentist complaining of numbness, pain, and drainage around the lower bridge. The dental exam revealed that the bridge was fractured, along with severe bone loss around the implants, and a severe bacterial infection in the upper arch. The bridge and implants were removed, and the patient’s dental infection was treated. As a result, the patient complained of ongoing numbness in their lower lip.
Analysis: This case example includes both the top dental allegation, which was improper performance of a treatment or procedure, and the top dental procedure, which was prosthetic dental implant found in The Doctors Company’s recent study of 1,277 dental malpractice claims.
Expert reviewers of this case were critical of the initial dentist proceeding with the implants with an ongoing active infection. In addition, the patient had comorbidities including diabetes and tobacco use. There was no documentation in the dental record that these risks were discussed with the patient. The initial dentist’s documentation was lacking and delayed. The subsequent treating dentist documented that the implants had been placed too close together and the patient had limited bone, resulting in implant failure.
Risk Mitigation Strategies
The following patient safety and risk mitigation strategies can help improve dental treatment and patient outcomes in situations like the above case.
Communication. The dentist plays an important role on the patient’s care team, and this role requires communication with the patient, their family if indicated, the primary care practitioner, and specialists as needed. Almost 10% of the claims in the study were found to include a communication issue between the dentist and the patient about the expectations for their care. This finding illustrates the need for communication improvements. For communication strategies, see the guide Effective Patient Communication: Strategies for Challenging Situations and the article “Referral and Negligent Referral in a Dental Practice.”
Informed Consent. The informed consent process is essential in ensuring the patient understands the plan of care, the procedure(s) recommended, and the risks, benefits, and alternatives to the procedure. The informed consent process also offers an opportunity for the patient and family to ask questions. This analysis revealed that almost one in four patients sought care from another practitioner due to dissatisfaction and poor communication about expectations. The informed consent process provides an opportunity to build trust with patients, set realistic expectations, and foster patient-centered care. Patient understanding of the treatment and procedure is essential, and as evidenced in the analysis, many patients found this understanding lacking. Conduct conversations in plain language, avoiding speaking in medical terminology, and use tools such as Ask Me Three and the teach-back method. To avoid confusion about costs, have your staff provide a detailed itemization of the estimated cost for the patient to review and agree to prior to the next scheduled appointment.
Patient Assessment. Take time to verbally review the patient’s history with them prior to treatment. Inquire about any recent illnesses, especially focusing on any affecting the airway. Confirm allergies. Ask about any medications the patient may be taking, including over-the-counter medications, supplements, or recreational drugs. Stress that accurate reporting of information is important to avoid any medication interactions or increased risks of injury.
Documentation. Continuity of care and defensible dental records require documentation of your rationale for patient selection and clinical decisions, patient assessment, the treatment options offered to patients, and patient adherence. Implement a quality improvement process to review dental record documentation. For more documentation strategies, see the Medical and Dental Records Guide.
Reference
1 Tribler S, Frendved C, Benfeldt E, Jørgensen RM, Mikkelsen KL. Patterns of errors and weaknesses in the diagnostic process: retrospective analysis of malpractice claims and adverse events from two national databases. BMJ Open Qual. 2025;14(1):e003198. doi:10.1136/bmjoq-2024-003198
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.