Case Study: Dental Jousting and a Bridge Too Far

This case was originally printed in our Fourth Quarter 2022 issue of The Scope: Dental Edition. Read more articles from the publication here. For background information on this case study involving dental jousting, read our article on the definition, implications and guidance regarding jousting in dentistry.

This case involves a 54-year-old female who presented to our insured for a consultation to replace old fillings and a preexisting three-unit bridge from #2-#4. The plan was to place a new three-unit bridge porcelain fused to a high noble crown abutment. During the exam, pulp decay was noted. The teeth were prepped, and a provisional bridge was made that was placed with temporary cement.

The patient was seen a few weeks later for try-in and the bridge was sent back to the lab for adjustments.

The patient returned a month later with complaints of pain at #4. The dentist took films and confirmed root canal treatment (RCT) was needed. The dentist started the RCT but did not finish it due to inflammation of the pulp. A referral to an endodontist was given for completion of the RCT. As per the referral letter, the patient completed RCT treatment with the endodontist a few days later.

While the dentist’s office made multiple attempts to contact the patient to return for final bridgework, the patient subsequently went to another dentist for a second opinion. This dentist was highly critical of the insured’s preparation of teeth #2 and #4. She commented that she “couldn’t believe that tooth #4 was like that, that there was no tooth anymore” and even suggested peer review to the patient to try to recover fees paid to the first dentist.

The patient did not want to go to peer review, so the second dentist re-prepped the teeth and replaced the temporary bridge with a new one. Ultimately the patient had crowns placed at #2 and #4 and an implant at #3.

The patient filed a lawsuit alleging that the defendant negligently over-prepared teeth, performed unnecessary RCT, provided an ill-fitting bridge and failed to recommend an alternate treatment plan of the implant at #3.

The defense experts opined that it was wrong for the subsequent dentist to criticize the preparation of the first dentist as she had no idea what the teeth looked like to begin with. The experts also opined that the temporary bridge placed by the first dentist was ill fitting, but it was only a provisional and not the permanent bridge. Unfortunately, the first dentist’s records did not document discussions with the patient regarding alternate treatment plans nor did they have an informed consent for the RCT.

The District Claim Committee agreed that, while it seemed that the teeth were not as over-prepared as indicated by the subsequent dentist, the insured’s records were problematic. The plaintiff’s demand was $75,000 and the case was ultimately settled for $26,000.

In this case, the second opinion dentist’s criticism of the tooth preparation, as well as the suggestion of peer review, validated the patient’s dissatisfaction and clearly encouraged the patient to bring a malpractice claim. In addition, the facts illustrate how jousting, connected with documentation issues, can lead to the settlement of a potentially defensible case.

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