Case Study: The Legal Pitfalls of Dental Patient Noncompliance

This article was originally printed in our Second Quarter 2022 issue of The Scope: Dental Edition. Read more articles from the publication here.

This case involves a 76-year-old male who presented to the MLMIC-insured dentist’s office on referral from an oral surgeon. The patient had a history of seeing many different providers for treatment. He previously had 10 implants placed, some of which had failed and been redone. Upon examination by the dentist, it was noted that two of the implants were not functional as they were too deep. All the patient’s teeth had bone loss and class II mobility.

The treatment plan consisted of a total mouth restoration (teeth #3-14 and #19-30), including extraction of #7, root canal of #8, splint #3-14 (porcelain fused to gold), a 12-unit upper bridge, splint #19-30 (porcelain fused to gold), a 12-unit lower bridge and the removal of the nonfunctional implants.

Impressions were made for upper and lower arches at this first visit. Over the next few weeks, #2-14 and #18-21 were prepped and temporary crowns placed. The dentist attempted to remove the two bottom implants but was unable and broke them. However, he advised the patient it would not interfere with the lower bridge. Almost three months later, the patient began to complain about #22. Adjustments were made over the next few visits, with the temporary bridge being sent back to the lab to re-porcelain.

One month later, the dentist removed the mandibular bridge and noted that implant #20 was fractured and #18 and #19 needed custom abutments. The patient again complained about #22 as being sharp. The dentist noted in the chart that the “…patient is very unreasonable and complains constantly. Patient was told to brush, floss, and improve oral care. Patient owes the office $10,000 and is making excuses not to pay. He is rude to staff and treats them poorly. Second opinion is recommended.” This was the last time this dentist saw the patient. At the time, the patient had three upper and three lower bridges.

The patient filed a lawsuit alleging that the defendant: failed to take proper films; failed to appreciate the significance of periodontitis; failed to diagnose and treat overhanging margins; failed to diagnose bone loss; placed a bridge over damaged implants; failed to refer the patient to a periodontist; and allowed multiple teeth to become hopeless. It was claimed that, due to our insured’s negligence, the patient sustained broken implants, advanced periodontal disease, and bone loss resulting in the need for a full mouth reconstruction.

After the patient left the care of our insured, he was seen by multiple dentists, including five prosthodontists, two oral surgeons and two general dentists in New York, Florida, London and Dubai. During his deposition, the patient indicated that the reason he saw so many providers was that he disagreed with their treatment plan and thought they were “crooked” or had “personality conflicts.” He did not go to periodontists because “he did not like them” and he stated periodontal cleanings were “torture.” The patient ultimately had the two broken implants removed, root canal therapy to all his remaining natural teeth and implants, crowns and new bridges placed.

The MLMIC-insured dentist believed that the patient made up his complaints to avoid paying the substantial balance. He attributed recurrent decay as the direct result of poor home care and claimed that he repeatedly discussed and instructed the patient on proper hygiene. However, this dentist was missing a portion of the chart and films due to multiple office moves; therefore, the only entry regarding the patient’s noncompliance was at the time of the last visit.

Our experts noted that photos documented the patient’s poor oral hygiene. Although the dentist did not cause the patient’s pre-existing periodontal disease with bone loss, they felt he should have addressed it by referring the patient to, and coordinating treatment with, a periodontist. The experts also noted the restorations displayed significant open margins and overhangs and were not cleansable.

The District Claim Committee was critical of the insured’s inability to explain his treatment, which was only made more difficult due to the missing portions of the chart and films. They also noted that while this may have been a difficult patient with pre-existing periodontal disease, this condition was never adequately addressed prior to or during treatment, causing all restorations to fail and ultimately needing to be redone.

The patient’s demand was $950,000, and the case was ultimately settled on behalf of the dentist for $260,000.

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