PRACTICE MANAGEMENT
Vulnerable areas: an analysis of Dental Protection cases Dental Protection’s recent ‘Learning from Cases’ report highlights the key areas that generated claims for compensation between January 2018 and December 2020.
This article explores a sample of the cases reviewed and identifies vulnerable areas in record keeping, consent, assessment and treatment planning, and radiographic practice, any of which can lead to difficulty defending a claim.
examination (BPE) scores; 4 failure to provide appropriate advice, e.g., oral hygiene/diet/smoking cessation; 4 specific measurements – working lengths, pocket depths, mobility;
Record-keeping issues
4 radiographic details – rationale for exposure, report, findings;
Good clinical records are the dentist’s best defence. A lack of systematic, detailed notes leaves a dentist vulnerable to allegations that the approach to treatment was not properly structured, or adequately planned and executed. The difficulty for any clinician is the lack of evidence of the standard of their care. A failure to record investigations, findings, or giving advice and warnings to a patient, leaves the clinician exposed to accusations that these were not carried out appropriately. The matter will become a contest between the patient’s version of events and that of the dentist. Given that patients are in the surgery far less than any dentist, in a dispute a patient’s recollection of an event could be perceived to carry more weight than the dentist’s if there is no detailed documentation. It is also important to remember that a significant proportion of claims arise several years after treatment was provided, when recollection of events will inevitably be compromised. Commonly overlooked areas include: 4 presenting symptoms – nature, site, findings, diagnosis;
4 antibiotic prescribing rationale;
4 discussions and consent process – risks, benefits, alternatives, prognosis, costs, etc.; 4 structured treatment plans; 4 failure to record periodontal screening indices, e.g., basic periodontal
Dr Martin Foster BDS MPH DipHSM
Dr Noel Kavanagh Noel is the Senior Dental Educator and Martin is Dentolegal Consultant at Dental Protection
336 Journal of the Irish Dental Association | Dec 2021/Jan 2022: Vol 67 (6)
4 informing patients of adverse events, e.g., file fracture, retained root; and, 4 post-op instructions or advice given. Key learning points 4 Records commonly lack detail that can be important; 4 the reason why treatment was carried out, as well as what was done, should be recorded; and, 4 records need to be contemporaneous – non-contemporaneous additions need to be clearly identified as such.
CASE 1 – alleged unnecessary treatment and failure to investigate pain This patient presented with an unrestorable UL2, which was extracted by Dr B. Following this, further treatment was provided over the course of five appointments, during which a total of 13 existing amalgam restorations were removed and replaced with composite restorations. Shortly afterwards the patient returned complaining of pain in the lower jaw, which was initially managed with antibiotics and painkillers, before referral to a facial pain specialist to investigate possible trigeminal neuralgia. The patient later advised that they had attended elsewhere for root treatment at LR6, which had addressed their symptoms. A claim was raised alleging failure to adequately investigate and diagnose the source of pain, as well as providing unnecessary treatment. The records gave no indication of why the restorations had been replaced, why treatment was necessary, what advice had been provided, or if any consent process had been followed. No intra-oral radiographs were taken at any point
