When Does a Complication in Dental Surgery Become a Question of Dental Negligence?

The stress felt by potential complaints and litigation has never been higher within our profession. 

Sometimes, though, I feel the increased levels of stress can be caused through a genuine lack of understanding of some dento-legal matters.

Consider a case with unintended consequences of a surgical procedure.

A complication can be defined as a foreseeable, unintended outcome of a procedure about which a patient should be warned in advance as part of the process of informed consent.

Bleeding and infections would be examples of such outcomes which may not be preventable, in spite of a reasonable standard of care.

A case in negligence arises if the outcome was unanticipated and resulted from a standard of care which fell below that which would be reasonably expected in the circumstances.

Post-operative pain is not uncommon after a root canal therapy, about which a patient should be warned in advance.

Separation of files is an unintended complication which unfortunately can occur but is not necessarily an indication of substandard dental practice.

Sometimes a deep restoration won’t settle, and RCT is required.

It’s unfortunate, but it happens.

Remember – whilst this can seem relatively obvious/routine to dentists, most patients don’t understand this without being told.

If you can master how to effectively manage patient expectations, you will notice your stress levels reduce significantly.

And remember – no-one is born a brilliant communicator. 

Yes, some are more natural at building rapport than others. 

But these are skills that can be learned.

The learning point from this case is that it is important for dentists to understand when there are unintended outcomes after medical intervention, it is essential to demonstrate there has been a breach in the duty of care, without which a case in negligence is unlikely to succeed.

Ultimately, communicating a complication, rather than the complication itself, will often dictate if a complaint arises.

Key Points:

• We can’t fix every tooth
• Warn patients before starting into any procedure
• High standard of record keeping is a must
• Consent is key – but this is much more than what is written in records.
• Slow down and take the time to have these conversations with your patients
• Manage expectations – before, during and after each procedure
• Always cover the basics first

Kind Regards,

Leonard

Dr Leonard J Maguire

BDS MFDS RCSEd MFGDP MDTFEd AFFMLM LL.M MBA CMgr MCMI PG Dip Med.Ed.

General Dental Surgeon  

P.S. Remember the basics.  What often happens now if a complaint arises, is that the entire set of dental records is requested.

So, whilst the dentist can be stressed about the RCT that did now settle, separated hand file or veneer that kept debonding, that element often comes to nothing. 

However, we are now regularly seeing complaints ‘moving sideways’. 

So, what started off as an RCT that did not settle, separated hand file or veneer that kept debonding, ultimately finishes up with a missed perio disease claim. 

So, for what it’s worth, my advice is to always remember the basics – radiographs, caries and perio disease.

“Success is neither magical nor mysterious. Success is the natural consequence of applying basic fundamentals.”

-Jim Rohn