One of the best risk management tools is for you to be aware of the targets of allegations of malpractice brought against other dentists. The number of suits has increased, the dollar amount of court awards and settlements have increased, and the targets of litigation have spread to almost every field of dental practice. The old targets, prior to the marked increase in litigation are still with us.

They include the following:  

• Dentures that “don't fit.”
• Faulty crowns and bridges.
• The extraction of the wrong tooth.
• Roots fractured following extractions and allowed to remain in the socket.
• Infections following the removal of teeth.
• Cut lips and tongues.
• Chemical burns.
• General anesthesia accidents.
• Aspiration of foreign objects (burs, crowns, etc.).
• Failure to diagnose caries.
• New targets of litigation that have emerged in the past decade include:
• Failure to diagnose, refer, or treat periodontal disease.
• Failure to diagnose, refer, or treat problems associated with the temporomandibular joint.
• Fractured file or reamer tips left in the canal during root canal therapy; compounded by not informing the patient.
• Paresthesia following the removal of bony impacted lower third molars.
• Failure to obtain the informed consent of the patient primarily in orthodontics, endodontics, implants, and when paresthesia is a possibility.
• Accidents following the administration of IV sedation.
• Untoward events related to history taking. The most damaging is failure to discover that the patient suffered from rheumatic fever. Others include drug allergies, and incompatibilities.
• Failure to prescribe.
• spiration of foreign substances, e.g., crowns in the process of their removal, root and tooth fragments during an extraction, instrument tips, etc. Some relate to the failure to use a rubber dam.
• Failures in the treatment of adult orthodontics to recognize periodontal disease and make the necessary referrals, and failure to refer for the treatment of caries.
• Overfills in the use of the Sargenti paste in performing endodontic therapy.
• Inadequate, faulty, or the total absence of informed consent to the treatment performed.
• Failure to inform the patient of the risks of not following the advice of the treating dentist.

There are several classes of cases that have brought extremely high settlements and awards. These include malpractice associated with the use of anesthetic agents, IV and IM sedative agents, aspirations, SBE problems, Sargenti Paste overfills, and adverse drug reactions.

The most effective way to prevent the patient from entering suit, even following an untoward event, is to maintain excellent interpersonal relations with the patient, by the dentist and the dentist's staff. High on the list of causation in dental litigation is suing to collect a fee, or the refusal to return a fee to a dissatisfied patient. The most effective preventive measure is to be careful and caring in treating patients. However, if sued, the dentist's best defense, assuming the absence of negligence, is to have maintained accurate and complete records.

Many potentially inflammatory situations may be defused by the return of a fee. A caution to be exercised if this opportunity presents itself is never to return a fee unless the patient first signs a release of claims form. If the release is properly executed, the dentist is relieved of legal responsibility for all acts that took place in the treatment of the patient prior to the time the release was signed.