This case study examines communication 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.
A 34-year-old male with unspecified gum and tooth disease presented to his 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 next day, the patient returned and complained that he continued to have severe pain in the same location of his mouth. Although the patient stated that he had not worn the denture since the previous day, the dentist adjusted it again. No x-rays were taken, and the patient was released. The dentist was unable to produce documentation regarding the patient’s concerns, the dentist’s examination and treatment, and the differential diagnosis on the cause of the continued pain.
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 a dental record for the patient. 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 concerns and to assess the post-procedure complications correctly. The lack of documentation—also a key factor—rendered the dentist unreliable in his own defense.
Effective communication is crucial to ensure that patients can make informed decisions regarding their care and to help them understand how to participate in their treatment. It requires validation that the message has been appropriately heard and understood.
Communication is not only a key component of successful patient safety initiatives; 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 the treatment plan and participate in their treatment, and they are more reluctant to file a claim in the event of an adverse or unexpected outcome.
The following strategies can help dental professionals improve patient communication skills and dental record documentation:
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.