State boards of dentistry across the United States may require that reports be submitted when a malpractice settlement or judgment involves a professional licensee. Depending upon the facts of the case and state board procedures, a dental board may or may not pursue an investigation of the matter. When a dental board proceeds to investigate, their findings may or may not justify disciplinary action under the state dental practice act, or other applicable laws and regulations. Although the professional liability lawsuit against this dentist settled before trial with no admission of negligent care, the dental board identified concerns that warranted investigation.
 
Claim Case Study 
Practitioner: General dentist
Claimant: 65-year-old female with a history of smoking, hypertension, hepatitis C with associated cirrhosis, supraventricular tachycardia (SVT) and periodontal disease.  
 
Risk management topics: Medical history/assessment, clinical/radiographic assessment, documentation, informed consent and specialist referral
 
Professional Liability Brief Facts and Outcome:
The professional liability matter resulted from alleged injuries associated with maxillary sinus lift procedures. The insured general dentist recommended the surgical procedures to prepare the maxilla for successful implant placement and integration. The treatment course involved right and left side sinus lifts performed separately over a two-week period. Due to less than desirable results, left and right-side revision surgery followed about a month later.
 
The patient’s poor overall health, smoking habit and surgically perforated sinus membranes contributed to delayed/inadequate healing and a left side oral-antral fistula. Expert review questioned patient selection, primarily based upon the patient’s health and a history of poor post-surgical healing that was revealed during discovery. Despite the post-operative issues, the dentist did not timely refer the patient for specialty consultation and/or treatment. However, the patient self-referred approximately three months after surgery, after suffering from ongoing pain, incomplete healing and infection.
 
After corrective surgery was performed by an oral surgeon and otolaryngologist, several dentists advised the patient against future implant placement. The patient sought care for traditional dentures after complete healing. The case settled at mediation with indemnity payment plus claim expenses (total incurred) of approximately $225,000.
 
Board Investigation, Findings and Actions:
After receiving a medical malpractice payment report (MMPR) pertaining to the settlement, the board proceeded to open an investigation. The board informed the insured dentist in writing of its intent to review the facts of the case and determine if the dentist violated applicable state laws or regulations in the course of patient care. To facilitate their investigation, the board requested:

• A copy of the patient’s treatment record, including radiographs and other diagnostic information
• A detailed narrative describing the treatment provided as well as the supporting rationale for clinical decisions and recommendations
• Description of treatment errors, complications, and/or adverse outcomes
• A critical self-analysis of the treatment provided
• A copy of depositions taken during the professional liability discovery process
• A copy of expert witness opinions and/or malpractice review panel opinions
• A copy of the professional liability settlement agreement

More than 18 months after receiving the professional liability claim details, the board responded with a proposed consent order. A counter proposal from counsel for the insured dentist led to a hearing on the matter, after which the board communicated that the original order would remain unchanged.
 
Key “findings of fact” documented in the consent order included that disciplinary actions against the insured’s license were issued under two previous consent orders. Furthermore, the order listed approximately fifteen state Code violations, including:

• Failure to complete and document an adequate clinical and radiographic pre-operative patient evaluation
• Negligence in prescribing medications that were contraindicated due to the patient’s history of significant liver disease
• Failure to document strengths and/or dosages for medications prescribed, including multiple controlled substances
• Billing for services not described in the patient healthcare information record
• Failure to document that informed consent was obtained, and no documentation of the discussion of treatment benefits, risks and alternatives, including the option for treatment by a dental specialist
• Failure to document surgical techniques and materials, including bone graft and membrane materials placed
• Failure to document multiple telephone conversations with the patient regarding post-surgical status, complaints, and recommendations

Analysis:
Dental licensure complaints (AKA “board complaints” or “license protection matters”) may result in profound consequences, up to and including license suspension or revocation. See Figure 1 for key points comparing license protection and professional liability matters for reference.
 
Board complaints may result from various sources, such as doctor-patient miscommunications and misunderstandings, a patient’s treatment concerns or injuries, or concerns from third parties (e.g., other dentists, other healthcare professionals, dental benefits companies). Regardless of the source, even a so-called “simple” board matter may take many months or years to conclude.
 
This dental board’s investigation revealed numerous instances of non-compliance with state requirements, leading to a disciplinary consent order. However, many license protection matters, including those resulting from professional liability judgments or settlements, are investigated and closed with no disciplinary action. A jury decision for the plaintiff (patient), or a settlement payment before trial do not necessarily confirm that the dentist failed to comply with state laws or regulations, or that the dentist failed to meet the standard of care.
 
Irrespective of the case facts or a state board’s investigative process, it is in each dentist’s best interest to seek legal representation for any licensing board investigation, since a board investigation may lead to serious allegations and disciplinary action. Inadequate documentation is one of the most common—and potentially serious—issues that may arise in licensing board investigations. Without appropriate documentation, the board may conclude that a dentist did not follow safe practices, putting patients at risk.
 
This case highlights a number of “failure to document” findings. States may adopt specific requirements on WHAT to document. For example, Illinois requires that dentists make a record of “all dental work performed for each patient. The record shall be made in a manner and in sufficient detail that it may be used for identification purposes” IL Dental Practice Act (225 ILCS 25/50). States may also include more stringent requirements. One example is the state of Florida, which requires that records justify patient treatment (Title XXXII Chapter 466.018(3)). Therefore, documenting WHAT you did without the WHY (diagnosis, clinical findings and assessment, treatment rationale, etc.) may be inadequate to comply with state law. Review, understand and comply with requirements specific to the state in which you are licensed.  
 
Also consider that complying with state requirements may NOT meet the standard of care. Dentists should always endeavor to document events comprehensively, including treatment decisions made and/or actions taken, with the supporting rationale. Describe what was heard, seen, said or thought in relation to patient assessment, treatment planning, informed consent, the care provided, and recommendations for future treatment.   
 
Outcome:
With a history of previous disciplinary action, the consent order called for license revocation. However, the board stayed the revocation and ordered a two-year suspension, followed by a two-year period of clinical oversight for implant-related surgery, including sinus lift procedures. Further, the board ordered the dentist to reimburse its investigation expenses and pay a $2,500 fine. The dentist had previously planned to sell his practice and discontinue patient care within a few years. Therefore, in lieu of these requirements, the board agreed to accept the dentist’s offer to voluntarily surrender his license to practice dentistry.      
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Article by: Ronald Zentz, RPh, DDS, FAGD, CPHRM
CNA Healthcare Risk Control
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Figure 1 (from the Dental Professional Liability Claim Report: 2^nd Edition)[https://www.dentists-advantage.com/Prevention-Education/Claim-Reports]   

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Disclaimer.
The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice.  Certain coverages may be provided by a surplus lines insurer. Surplus lines insurers do not generally participate in state guaranty funds, and insureds are therefore not protected by such funds.  The claims examples are hypothetical situations based on actual matters.  Settlement amounts are approximations. Certain facts and identifying characteristics were changed to protect confidentiality and privacy. “CNA” is a registered trademark of CNA Financial Corporation. Certain CNA Financial Corporation subsidiaries use the “CNA” trademark in connection with insurance underwriting and claims activities.  This material is not for further distribution without the express consent of CNA.   Copyright © 2025 CNA. All rights reserved. Published XX/2025.