Dental malpractice claims can arise from treatment or procedural complications, missed or delayed diagnoses, inadequate informed consent, incomplete documentation, communication problems and other issues related to patient care. Understanding where malpractice claims tend to arise can help dentists strengthen risk-management procedures and make sure their professional liability coverage still reflects the way they practice.

What Are Common Reasons for Dental Malpractice Claims?

Dental malpractice allegations vary by case, but recurring areas of concern include:

• Treatment errors and procedural complications
• Missed or delayed diagnosis
• Failure to refer when specialized care may be appropriate
• Inadequate informed consent
• Incomplete or inaccurate patient records
• Communication problems and unmet patient expectations
• Inadequate follow-up after treatment or complications

The exact standard of care and legal requirements vary by jurisdiction and circumstances. For dentists, the practical question is not simply whether a complication can occur, but whether clinical decisions, communication, documentation and follow-up support the care that was provided.

What Do Dental Malpractice Statistics Tell Us?

Searches for dental malpractice statistics often look for a single number that defines the risk. In practice, claims data are more useful for identifying recurring areas of exposure than for predicting whether an individual dentist will face a claim. Claims experience can vary by procedure, specialty, patient population, practice setting and insurer.

For that reason, dentists should be cautious about relying on one statistic or an older claims study. A more durable approach is to focus on the issues that repeatedly appear in professional-liability risk management: treatment planning and execution, diagnosis, informed consent, documentation, communication, referral and management of complications.

1. Treatment Errors and Procedural Complications

Many dental procedures carry recognized risks and the possibility of complications. Professional liability concerns can arise from the procedure itself, treatment planning, patient selection, how a complication is handled, or whether consultation or referral was appropriate.

Before undertaking a procedure, consider whether the case falls within your education, training and experience. The American Dental Association (ADA) notes that appropriate referrals may be necessary when a patient’s care would be better delivered by another dentist with greater experience in a particular area.

Follow-up matters as well. If a patient reports unexpected pain, infection, numbness or another complication, timely assessment, communication and appropriate treatment or referral may help prevent a difficult clinical situation from escalating.

2. Missed or Delayed Diagnosis

Professional liability allegations can arise when a patient believes a condition should have been identified, monitored or treated earlier. Examinations, appropriate diagnostic procedures, treatment planning and documentation can help establish what was observed, what was recommended and why a particular clinical decision was made.

When a patient declines recommended diagnostic procedures or treatment, document the recommendation, the refusal and the potential consequences discussed with the patient. The ADA specifically advises documenting informed refusal and the related conversation.

3. Inadequate Informed Consent

Informed consent is more than a signed form. Here again, the ADA describes it as a process and discussion between the dentist and patient. Depending on the treatment and applicable state law, that conversation may include the proposed procedure, potential benefits and risks, reasonable alternatives and the consequences of declining treatment.

The patient should have an opportunity to ask questions, and the discussion should be documented in the dental record. This can be especially important when a procedure carries known complications or when expectations about the outcome need to be clearly established.

4. Poor or Incomplete Documentation

If a treatment decision or outcome is questioned months or years later, the patient record may become one of the most important sources of information about what occurred. Good records also support continuity of care.

Depending on the circumstances, documentation may include:

• Medical and dental histories
• Diagnostic records, dental x-rays and clinical findings
• Treatment plans and progress notes
• Discussions of treatment risks, benefits and alternatives
• Informed consent or informed refusal
• Referrals and consultations
• Patient complaints and significant communications
• Noncompliance, missed appointments and follow-up
• Postoperative instructions and management of complications

Records should be timely, factual and objective. The ADA also recommends retaining appropriate supporting materials, such as dental x-rays and informed-consent or informed-refusal documents, as part of the record.

5. Communication and Patient Expectations

Communication problems can turn a challenging clinical outcome into a dissatisfied patient relationship. Before treatment, patients should understand what is being recommended, why it is being recommended, reasonable expectations for the outcome and important risks or limitations.

Communication remains important after treatment. Dental practices should have clear procedures for handling complaints, postoperative concerns and requests for urgent assistance. Team members should know which situations need to be brought promptly to the treating dentist and how significant patient communications should be documented.

How Do Malpractice Risks Differ by Dental Specialty

The fundamentals of malpractice risk management apply across dentistry, but the procedures performed and potential complications differ by specialty. This is why a general discussion of dental malpractice should be supplemented by specialty-specific guidance.

Malpractice Risks for Orthodontists

Long treatment periods and ongoing monitoring create considerations involving treatment planning, informed consent, documentation, patient compliance and management of changes or complications that could arise during treatment.

Malpractice Risks for Periodontists

Periodontal care may involve considerations surrounding diagnosis and progression of periodontal disease, surgical treatment, implants, maintenance, patient compliance and coordination with referring dentists.

Malpractice Risks for Endodontists

Endodontic professional liability considerations can involve diagnosis, treatment planning, procedural complications, persistent symptoms, retreatment and decisions about when additional treatment or referral may be .

Malpractice Risks for Oral and Maxillofacial Surgeons

Oral and maxillofacial surgery may involve considerations related to surgical complications, nerve injuries, infection, anesthesia or sedation, informed consent and postoperative management.

Malpractice Risks for Pediatric Dentists

Pediatric dental care may involve considerations related to behavior management, sedation, diagnosis and treatment planning, informed consent, communication with parents or guardians, and managing complications in young patients.

Malpractice Risks for Prosthodontists

Prosthodontic care may involve considerations related to treatment planning, dental implants, crowns, bridges, dentures, complex restorative procedures, patient expectations, and complications involving the function, fit or longevity of restorations.

7 Ways Dentists Can Help Reduce Malpractice Risk

2. Practice within your training and experience. Recognize when consultation or referral may be appropriate.
3. Document clinical decisions thoroughly. Record findings, diagnoses, recommendations, referrals and important patient communications.
4. Treat informed consent as a conversation, not simply a form. Discuss material risks, benefits and alternatives in language the patient can understand.
5. Document informed refusal. When a patient declines recommended treatment or diagnostic procedures, document both the recommendation and the refusal.
6. Set realistic expectations. Help patients understand the goals, limitations and possible complications of treatment.
7. Have a process for complaints and complications. Make sure your team knows how patient concerns are escalated and addressed.
8. Review your professional liability coverage as your career and practice change. As your career evolves, make sure your insurance coverage keeps up.

Does Your Malpractice Insurance Match the Way You Practice?

Professional liability insurance is one part of managing the financial risk associated with a malpractice allegation. But coverage needs can change over the course of a dental career.

A dentist’s specialty, procedures performed, employment arrangement and practice structure can all be relevant when evaluating coverage. Practice owners may also need to consider whether the business entity itself requires professional liability protection in addition to coverage maintained by individual dentists.

It is important to review your professional liability protection when you change jobs, add procedures, enter a specialty, bring on associates or become a practice owner. Make sure to consult with your malpractice carrier about your specific situation.

Frequently Asked Questions About Dental Malpractice

What are common reasons for dental malpractice cases?

Dental malpractice allegations may involve treatment or procedural problems, missed or delayed diagnosis, inadequate informed consent, insufficient documentation, failure to refer, communication problems or management of complications. The circumstances vary from case to case and by dental specialty.

What is considered dental malpractice?

Generally, a dental malpractice claim alleges that a dentist failed to meet the applicable standard of care and that the failure caused harm to a patient. Whether malpractice occurred is a legal and factual determination based on the circumstances of the individual case and applicable law.

Does a bad outcome automatically mean dental malpractice occurred?

No. Dental procedures can have known risks and complications even when care is appropriate. An undesirable outcome alone does not establish that a dentist was negligent.

Can a dentist face a malpractice claim for failing to refer a patient?

Referral decisions can become relevant when a patient’s condition or treatment needs would benefit from specialized skills, knowledge or experience. Dentists should consider their own training and experience and document referrals and related patient communications.

What should dentists document to help manage malpractice risk?

Records may include diagnostic findings, treatment plans, procedures, informed-consent discussions, treatment refusals, referrals, patient communications, complications, follow-up and postoperative instructions. Records should be timely, accurate and objective.

Are malpractice risks different for dental specialists?

Yes. Core principles such as documentation, informed consent, communication and appropriate referral apply across dentistry, but different specialties perform different procedures and encounter different clinical risks.

Does a dentist’s malpractice insurance automatically cover the dental practice entity?

Not necessarily. Individual professional liability coverage and coverage for a legal business entity are separate considerations. Practice owners should review their business structure and policy terms with a knowledgeable insurance professional.

Learn more about entity malpractice coverage for dental practices.

Treloar & Heisel has worked with dentists and dental specialists for more than 65 years. If your practice or career has changed since you purchased your professional liability policy, a coverage review can help determine whether your protection still reflects the way you practice today.

Schedule a complimentary coverage review today.

About Treloar & Heisel

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