Poor Response to Patient Concerns Contributes to Dental Claim

This case study examines communication and documentation factors contributing to an allegation of improper performance of a procedure involving extractions. The risk management discussion includes strategies to help dental professionals keep patients safe while mitigating risk.

An adult with unspecified gum and tooth disease presented to the dentist with tooth pain. After a discussion, the patient and the dentist agreed on a treatment plan that consisted of extracting upper teeth and placing an immediate denture. The teeth were extracted without incident.

The following day, the patient returned to the office and complained of severe pain in the upper jaw area. The dentist adjusted the denture and provided pain medication. The patient returned the next day, again complaining of severe pain in the same upper jaw location. Although the patient had not worn the denture since the previous day, the dentist adjusted it again. No x-rays were taken, and the patient was released.

Six days later, the patient presented to a second dentist. The subsequent dentist x-rayed the area and noted that the tip of one tooth remained in an extraction site. He incised the gum and removed the tooth tip. The patient reported that the pain dissipated.

The patient filed a claim of improper performance of a procedure against the original dentist. Defense of the claim was hindered because the dentist was unable to produce documentation of the patient’s concerns, the examination and treatment, and the differential diagnosis on the cause of the continued pain. A licensing board complaint was also filed; the board sanctioned the dentist.

Risk Management Discussion

Poor communication was a significant issue in this case. The original dentist failed to listen to the patient’s repeated concerns and to assess the post-procedure complications correctly.

Communication is not only a key component of successful patient safety initiatives, but it can also be a predictor when determining if a patient will file a malpractice claim. Patients who sense empathy and understanding from their healthcare providers are more likely to adhere to treatment plans and participate in their treatment—and they are more reluctant to file a claim in the event of an adverse or unexpected outcome.

The lack of documentation—also a key factor—rendered the dentist unreliable in his own defense. A well-documented record provides evidence of the dentist’s decision-making process, the treatment provided, and the patient’s response.

The following strategies can help dental professionals improve patient communication skills and dental record documentation:

• Show empathy by identifying the patient’s concerns and addressing them. Ask open-ended questions and acknowledge patient responses.
• Repeated patient visits for the same concern should prompt a thorough examination to determine the cause. Document examination findings and treatment plans.
• Train office staff to recognize complaints from patients or families that warrant immediate follow-up. (See our article “Telephone Triage and Medical Advice Protocols.”)
• Ensure that patients who experience complications are seen in a timely manner.
• Communicate information clearly and ask the patient to confirm understanding by repeating the information back. (See our article “Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication.”)
• Document all patient communication in the dental record regarding examination findings, differential diagnosis, treatment plan, and patient adherence. (See our articles “Defensible Medical and Dental Records” and “The Faintest Ink: Documentation to Defend Quality Patient Care.”)
• Follow state and federal regulations on maintaining patient dental records. (See our article “Medical and Dental Record Retention.”)

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.