The general dentist in this matter owned his own dentistry practice and had been practicing for over 15 years. The patient presented to the dentist’s practice for an initial consultation. The dentist performed an examination and indicated to the patient that the prognosis for her remaining teeth was “hopeless”, recommending placement of implants and bridges. At the same visit, the dentist removed an implant that a prior unaffiliated dentist had placed at #5. However, the dentist failed to get the patient’s informed consent to remove implant #5 and failed to document removal of implant #5.
 
Over the next two months, the patient returned to the dentist five times for treatment. The dentist performed some contouring on the bone around the patient’s posterior teeth and extracted tooth #1. The patient’s record then states that at a subsequent visit the dentist prepared teeth #s 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 and placed provisional crowns. However, the dentist actually prepared teeth #s 2, 3, 4, 6, 7, 11, 12, and 15 and implants at positions # 5, 13, and 14 for a single fixed bridge, and he placed a temporary bridge. Later, the dentist extracted the patient’s lower teeth, placed implants at positions # 20, 24, 26, and 29, and placed an implant-supported bridge. After that, the patient presented to the dentist for delivery of her lower and upper bridges.
 
Starting a few days after the dentist seated the upper bridge, and continuing over the next 18 months, the patient periodically contacted the dentist’s office complaining of discomfort and sensitivity. She also stated that she had concerns regarding the thickness of the upper prosthetic, “heaviness” in her mouth, difficulties eating and speaking, an odor, and the color of her gums. In response, the dentist offered to remove and section the upper bridge and contour the lower bridge.  However, the dentist was ultimately unable to deliver prosthetics that met the treatment goals he had initially outlined for the patient, leaving her dissatisfied and uncomfortable.
 
The patient then visited a subsequent specialist dentist (unaffiliated with the dentist or his practice) for a second opinion. The specialist dentist noted open margins on the patient’s crowns, buccal overhang on several teeth, and extra cement on the bridges. It took the specialist dentist two separate hour-long appointments just to clean off the cement on the patient’s bridges. The specialist dentist eventually recommended that the patient get all of her implant and bridge work redone by another provider.
 
Dissatisfied with the care she had received from the general dentist, the patient filed a complaint with the State Dental Board (“the Board”), alleging that the dentist’s care for her fell below the standard of care.
 
Board investigators interviewed the dentist in a deposition and subpoenaed the dentist’s records regarding his treatment of the patient. At the conclusion of their investigation, the Board concluded that the dentist committed unprofessional conduct in that he:

• Failed to document probe readings, or any other rationale, for extracting the patient’s upper teeth.
• Left open margins on several crowns.
• Left extra cement on the bridges, requiring extensive cleaning.
• Left buccal overhang on teeth #s 2, 4, 6, 7, and 11.
• Over contoured the patient’s bridges, which resulted in an inability to perform periodontal probing and hygiene.
• Connected implants to natural teeth with a bridge.
• Failed to complete legible, accurate, and detailed records for the patient.

 
Upon determination that these violations of the standard of care provided the Board with grounds for imposing sanctions against the dentist, the Board decided to place restrictions on the dentist’s license to practice. During the restriction, which will last at least two years, the dentist must limit his implants, bridges and crowns practice or have a proctor, who has been pre-approved by the Board, oversee his practice. In addition to the restrictions placed on his license, the dentist also has to complete a 22-hour dental ethics course, pass a jurisprudence exam, pay a $5,000 fine and reimburse the Board $10,000.
 
 
Reference
Cortigiano, C. (2024). Washington dentist has license restricted for 'substandard care'. Becker’s Dental + DSO Review. Retrieved January 18, 2024 from https://www.beckersdental.com/dentists/42674-washington-dentist-has-license-restricted-for-substandard-care.html
 
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Risk Management services are provided by Dentist’s Advantage and the NSDP to assist the insured in fulfilling his or her responsibilities for the control of potential loss-producing situations involving their dental operations. The information contained in this document is not intended as legal advice. Laws are under constant review by courts and the states and are different in each jurisdiction. For legal advice relating to any subject addressed in this document, dentists are advised to seek the services of a local personal attorney. The information is provided "AS IS" without warranty of any kind and Dentist’s Advantage and NSDP expressly disclaims all warranties and conditions with regard to any information contained, including all implied warranties of merchantability and fitness for a particular purpose. Dentist’s Advantage and NSDP assume no liability of any kind for information and data contained or for any legal course of action you may take or diagnosis or treatment made in reliance thereon.}