Misdiagnosis and Recommendation for Unnecessary Dental Treatment
A dental licensing board complaint may be filed against a dentist by a patient, colleague, employer, and/or regulatory agency. Dental licensure complaints may result when a patient’s concerns with treatment are not addressed, or when they are unable to obtain legal counsel to represent them in a malpractice lawsuit. Regardless of the source of the complaint, dental licensing boards are often required to investigate every complaint filed against a licensee. Dental licensing boards’ primary purpose is to protect the public, so if a violation is found, dental licensing boards may take action against the dentist’s license, all the way up to and including license revocation. The following scenario involves a general dentist accused of misdiagnosing a patient and recommending unnecessary treatment.
The patient, a woman in her late thirties, presented to the general dentist’s office for an initial visit, comprehensive examination, and cleaning. According to the chart notes from that visit, the dentist diagnosed the patient with isolated areas of slight periodontal disease. The dentist’s treatment plan included local scaling and root planing with gingival irrigation codes for three sites. In the periodontal charting for the patient, the dentist noted pocket depths of 4mm or greater in each quadrant, with the largest number of 4-5mm measurements in the upper left quadrant. The dentist presented these findings to the patient and proposed local scaling and root planing. There was a dispute between the patient and the dentist about the appropriate treatment plan for her. The patient signed a Refusal of Periodontal Treatment form and requested a second opinion.
Three weeks later, the patient sought a second opinion and a comprehensive exam from another dentist. The patient record from the subsequent provider included radiographs that show no horizontal bone loss for the teeth, no radiographic calculus, and no periodontal pockets greater than 3mm. The radiographs that the subsequent provider reviewed did not support the general dentist’s diagnosis of periodontal disease, nor the treatment plan that he proposed. The provider explained this to the patient, who later filed a complaint against the general dentist with the state dental licensing board (“the Board”).
Board investigators subpoenaed the patient’s records from dentists who treated the patient prior to and subsequently to the dentist. Records from both prior and subsequent providers demonstrated that the appropriate diagnosis for the patient was gingivitis, not periodontal disease, and that scaling and root planing were not appropriate treatments. Radiographs and progress notes from providers dating back four years from when the general dentist saw the patient show bone levels that appeared to be stable. Chart notes from prior providers consistently indicated that the patient had a gingivitis diagnosis.
The Board concluded that the dentist breached the standard of care by failing to adequately assess, diagnose, and treat the patient, and by recommending unnecessary treatment. The Board found that the dentist’s treatment record for the patient lacked in detail and data, radiographic or otherwise, that would support his diagnosis and the treatment plan that he recommended to the patient. Therefore, the Board also concluded that the dentist failed to adequately document his findings and record data to support his diagnosis and treatment plan. The Board placed the dentist’s license on probation for three years and issued a $1,000 fine.
© Dentist’s Advantage, 2021 © The National Society of Dental Practitioners, 2021
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