Dental treatment injuries in the Finnish Patient Insurance Centre in 2000-2011

Expert consensus on difficulty assessment of endodontic therapy

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Clinical and medico-legal considerations in endodontics

Endodontic treatment can be challenging for a number of reasons, including the microscopic nature of the clinical environment, reliance on tactile sensation and lack of direct visualization of the work being performed. Commonly, endodontic patients present with pain and distress, which can exacerbate an already difficult clinical situation. Complications may might arise prior to, or during treatment, despite practising with the utmost care and skill. Preventing and managing these complications can take considerable time and energy, and oftentimes assistance from or referral to more experienced colleagues is required. The aim of this review is to discuss medico-legal considerations in endodontics, with clinical correlations and a focus on the Australian legal landscape. [Correction added on 18 October 2023, after first online publication: The abstract was amended from a structured to an unstructured abstract.].

The nature of malpractice claims related to nerve damage after dental implants insertion in Israel during 2005-2020: A descriptive study

INTRODUCTION

Dental implant placement is a routine practice in dentistry, with a possible uncommon risk of neurosensory injury. The present study analyzed all dental implant claims involving sensory nerve disturbances between 2005 and 2020 in Israel. The study was conducted to understand implant risk management better and improve the patient's safety.

MATERIALS AND METHODS

All legal claims registered by Medical Consultant International (MCI) involving nerve damage claims between 2005 and 2020 were included in the study. The data included demographic details such as age, sex, event date, claim delivery date, and treatment settings. Information on the nerve damage included the damaged nerve, side of injury, and the number of implants performed in the same surgery.

RESULTS

There were 218 claims regarding nerve damage out of 1154 claims for dental implant therapy. The mean age for nerve damage claims was 54.1 ± 11 years. There were more female than male claims (p = 0.02), with 87% of cases concerning damage to the inferior alveolar nerve (p < 0.0001), out of those molar areas being more frequently involved in nerve damage (64.3%, p < 0.0001). The left side was 1.4 times more frequent than the right side (p = 0.043). The risk for nerve injury was 7.4 times higher when placing multiple implants compared to single dental implant (p < 0.0001).

CONCLUSIONS

Clinicians should be aware that placement of multiple implants, left-side implant placement, and patient gender may increase risk for a malpractice claim for neurosensory disturbances.

The Incidence and Nature of Claims against Dentists Related to Periodontal Treatment in Israel during the Years 2005-2019

BACKGROUND

In recent years, worldwide dental malpractice claims have dramatically increased. The purpose of the present study is to analyze periodontal therapy related claims in Israel that led to legal decisions.

METHODS

This retrospective cohort study includes malpractice claims against dental practitioners related to periodontology between 2005 and 2019. Only closed cases where a final decision was made were included. The chi-square test or Fisher exact test for categorical variables were performed and a p value of <0.05 was considered statistically significant.

RESULTS

During the study period there were 508 legal claims related to periodontal disease. Most plaintiffs were women (63.4%), and 71.3% of the patients were >35 years old. Most claims (82.8%) were settled out of court and ended in compromise. Claims concerning the treatment of periodontal disease by periodontists accounted only for 4.5% (23/508) of the cases while 95.5% (485/508) of the claims were for complications secondary to another treatment. Prosthodontic treatment was involved with the highest number 54.5%, followed by dental implants 17.7%, and endodontics 11.6%. The allegations were related to pain and distress (84.8%), aggravation of existent periodontal disease (83.3%), tooth loss (78.1%), and violation of autonomy (47%).

CONCLUSIONS

The main cause for lawsuits was related to aggravation of periodontal disease during prosthetic or implant therapy and related to suspected faulty or inexistent preoperative diagnosis and planning.

PRACTICAL IMPLICATIONS

Periodontal consultation before dental treatment may reduce malpractice risks, adverse events, and un-necessary changes of treatment plans.

The Incidence and Nature of Malpractice Claims against Dentists for Orthodontic Treatment with Periodontal Damage in Israel during the Years 2005-2018-A Descriptive Study

In recent years, dental malpractice claims have increased dramatically worldwide. The purpose of the present study is to analyze claims related to orthodontic treatment involving periodontal problems that resulted in legal decisions in Israel. This study analyzed legal claims registered by Medical Consultants International (MCI) between 2005 and 2018. Only closed cases of orthodontic claims involving periodontal problems in which a decision was made were included. The parameters studied included patients' demographic data, the main reasons of the claim, and complications. Statistical significance was found for aesthetic damage, which was more common in claims of females (p = 0.035) and in older claims (p = 0.004); tooth damage was more common in claims of older patients (p = 0.032); violation of autonomy was higher in private practice (p = 0.047) and in more recent claims (p = 0.001). As orthodontic treatment is becoming more popular in older patients, and as lawsuit claims become more common in recent years, the orthodontists should always analyze and document the periodontal status of their patients before and during treatment in order to maintain professional practice and avoid future claims.

Characteristics of medical disputes arising from dental practice in Guangzhou, China: an observational study

OBJECTIVES

Doctor-patient conflict is a phenomenon that has become one of the major social problems affecting China's medical system today. This study aimed to analyse the nature of medical dispute incidents arising from dental practice, discover the related factors that may have incited such disputes and explore measures whereby the incidents of patients' conflicts towards dentists can be reduced.

METHODS

A survey conducted in six public hospitals in Guangzhou, one of the largest cities in China, showed that more than two million patients received dental treatment between 2008 and 2012. χ2 test and binary logistic regression analysis were used to identify statistically significant differences in incident rates.

RESULTS

In a total of more than two million outpatients, 541 reported dental disputes and lodged complaints with the medical service centre. Male patients reported higher dispute rates than did females (χ2=9.74, P<0.01). Binary logistic regression analysis further showed that disputes developed into conflicts depending on five factors: patient gender, dental specialty, cause of dispute, mode of payment and resolution duration.

CONCLUSIONS

Gender, specialties, cause of dispute, mode of payment and resolution duration are associated with the incidence of dental conflicts, suggesting that medical quality is positively correlated to dental disputes, the coverage of stomatology in medical insurance should be expanded and detailed negotiation system should be developed for resolving dental disputes.

Operator-related aspects in endodontic malpractice claims in Finland

OBJECTIVE

We analyzed operator-related differences in endodontic malpractice claims in Finland.

MATERIALS AND METHODS

Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses.

RESULTS

Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists.

CONCLUSIONS

Operator-related factors had no impact on endodontic malpractice claims.