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Table of Contents
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 39-43

Dental negligence: It is time to overcome it

1 Department of Orthodontics and Dentofacial Orthopaedics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Prosthodontics, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission20-Sep-2019
Date of Decision23-Dec-2019
Date of Acceptance06-Mar-2020
Date of Web Publication8-Jun-2020

Correspondence Address:
Dr. Sunil Kumar Mishra
Department of Prosthodontics, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_28_19

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Dentistry is an honorable profession, but the relationship between the patient and the dentist has changed drastically in the last 20 years. Anxiety has risen in the community and dental profession due to patients' increased tendency to file legal cases against dentists. Thus, awareness of ethics and medicolegal matters is essential for every dental practitioner. This review was conducted to find exact literature related to dental negligence, dentist awareness of negligence, dental consent, and the Consumer Protection Act. An attempt has also been made to inform dentists that they must follow certain protocols to avert lawsuits due to illegal and/or negligent dental practice. In December 2019, the PubMed, Medline, and EBSCOhost databases were electronically searched for published literature, and 648 articles were screened. A manual search was also conducted to retrieve articles of interest. Titles and abstracts related to the topic of interest and available in English were screened and included in the study. Patient consent must be obtained in written before any treatment procedure. Dentists must be aware of dental negligence, as well as the laws governing it, and should be insured under professional indemnity insurance (“defense costs”). In the event of legal proceedings, this provides protection and financial support for case settlement and other expenses.

Keywords: Dental negligence, dental records, dentistry, lawsuit, medicolegal issues

How to cite this article:
Kumari S, Mishra SK, Chowdhary R. Dental negligence: It is time to overcome it. Sci Dent J 2020;4:39-43

How to cite this URL:
Kumari S, Mishra SK, Chowdhary R. Dental negligence: It is time to overcome it. Sci Dent J [serial online] 2020 [cited 2023 Jun 9];4:39-43. Available from: https://www.scidentj.com/text.asp?2020/4/2/39/286186

  Introduction Top

Medicine is a noble profession, and doctors worldwide are responsible for saving lives[1] and looking after patient well-being.[2] Thus, medical profession is a service to humanity and possesses self-regulating rules and ethical codes.[3] The relationship between doctor and patient is a keystone and a medium for gathering data to make proper diagnoses and treatment plans.[4] Today, however, there has been a rapid shift toward profit making in portions of society, and the dental specialty has not been free from this reality.[5]

Vigorous economic growth, increased incomes, and the improvement and growth of private hospitals in the health sector have expanded health awareness in urban, compared to rural, areas, leading to an upsurge in demand for excellence in medical and dental healthcare services at affordable costs.[6] Globally, the public has become more aware of its legal, medical rights, and this has made the society increasingly compensation-oriented.[7] Over the last few years, India has been no exception to this, and the number of claims related to personal injuries in health services has increased.[8] Cases of negligence in the dental fraternity have also increased, which creates a significant void. To overcome such cases in dentistry, patients should be properly reimbursed. However, due to deficiency in full-bodied dental reimbursement insurance protection in many Asian countries, this job is fairly onerous.[6]

The Consumer Protection Act (CPA) was instituted in 1986, and in 1995, health professionals were added to it, protecting consumer interests and providing a quick and simple mechanism for redressing consumer grievances.[7] The present review has been undertaken to find extant literature concerning dental negligence, dentist awareness of negligence, dental consent, and the CPA. An attempt has also been made to inform dentists that they must follow certain protocols to avert lawsuits due to illegal and/or negligent dental practice.

  Selection Criteria and Search Strategy Top

The PubMed, Medline, and EBSCOhost databases were electronically scanned in December 2019, searching for published literature, specifically articles, concerning medicolegal issues, dental negligence, dental consent, and the CPA. A total of 648 articles were screened. A manual search was also conducted to retrieve articles of interest. The following combinations of keywords were used to conduct the searches: medicolegal issues, medicolegal negligence, medicolegal awareness, dental negligence, dental practice, dental consent, lawsuit, and dentistry. Titles and abstracts available in English were screened and selected for review.

  Incidence/chances of Dental Negligence Top

The incidence of dental negligence was reported by Manfredini et al. in their article and they stated that dental malpractice and legal claims for temporomandibular damage have increased over the years.[9] For instance, there was a case in which a patient inhaled a dental cutter, which was later removed by video-assisted thoracic surgery.[10] Dental negligence may occur in low-risk procedures, so scrupulous care and safety precautions must be taken.[10]

The literature also revealed discrimination and unfair treatment against HIV patients by a Massachusetts dental practice, which later agreed to pay $20,000 in civil penalties and offered free dental treatment to HIV-positive patients.[11] Similarly, dental healthcare workers are at a greater risk of acquiring hepatitis B. Therefore, dental employers must take required steps to protect the health of their employees, and failure to do so may lead to legal action against the employer.[12]

During root canal treatment (RCT), iatrogenic root perforation is a common complication, which sometimes leads to tooth extraction and results in legal actions against the dentist.[13] In such cases, it is best to inform patients about the risks associated with RCT. In addition, during local anesthesia or extraction of molars, lingual nerve damage may occur. This also leads to lawsuits for negligence if clinicians do not warn patients about all relevant risks before the procedures.[14],[15]

Today, oral cancer is one of the most widespread cancers globally and is a major cause of death.[16] Failure to diagnose, or a delay in proper diagnosis, can result in cancer morbidity or mortality and is consider a major example of dental negligence.[17],[18]

  Medicolegal Issues in Oral Implantology Top

Dental implant treatment, with a survival rate of 95%, is one of the most successful treatment modalities in medical sciences today.[19] Dental implant treatment is a costly and high-risk procedure for inexperienced dental surgeons. Even in the best hands and without negligence, complications can and do occur.[20] If, during implant placement, patients experience altered mandibular sensation, this may result in liability claims. However, if the nerve injury is transient, it rarely results in legal action.[21] If treatment is properly planned, if caregivers fully communicate with patients, and if complications are managed appropriately, such cases do not amount to negligence and are unlikely to lead to successful claims.[22]

  Dental Professionals' Awareness of the Consumer Protection Act Top

Today, Indian citizens are very aware of their rights as patients, so it is crucial for healthcare workers to be conscious of and attentive to laws.[5] In modern practice, dentists and medical specialists consistently face ethical issues related to patient–doctor relationships and confidentiality.[23] For example, Radhika et al. assessed dental professionals' awareness of the medicolegal realities and of the CPA, finding that most participants were aware of medicolegal points but had little knowledge of the CPA.[24] Prasad et al. also assessed awareness of the CPA among dental health professionals in the dental schools of Ghaziabad, India. They found that postgraduate dental faculty was more aware of the CPA than other dental professionals.[25] Another study, conducted by Singh et al., compared awareness of CPA provisions among dental and medical professionals in Udaipur, India. They found that medical professionals were more aware of the CPA than dental professionals.[26] A systematic review by Singh et al., concerning knowledge and awareness of the CPA among Indian dental professionals, found that most subjects knew that the CPA existed, but their knowledge about its basic rules and regulations was lacking.[27]

Sikka et al. stated that, although large numbers of dentists knew about the CPA, they were less aware of its basic rules and regulations. Written consent was also not usually obtained from the patients, which showed the dentists' negative attitudes and carelessness toward consent.[28] Kumar et al.[29] and Haripriya and Haripriya[30] inferred that there is an urgent need to update medical and dental healthcare professionals regarding medicolegal issues and the CPA to be on a safer side legally.

Today, malpractice and medical negligence are increasing, and therefore, even the dental profession is looked upon with doubt and contempt.[31] Dental professionals can find themselves under lawsuits for negligence if they fail to provide necessary information to patients before dental treatment.[32] The practitioner's treatment may be conducted with realistic, but not excellent, care. In such cases, the court will collect and consider all circumstances to determine whether the practitioner has been negligent. Negligence is considered very different from errors or mistakes in judgment.[33] Modern medical and dental practitioners should know the laws governing medicine because they share the same platform and practice in close association.[30] It is very necessary for dentists to upgrade their knowledge of the CPA and provide quality dental care to their patients.[27]

  Consent from Dental Patients Top

Usually, various treatment choices are available for patients during treatment planning, so dentists must discuss all options with patients, explain all risks involved, and ensure that whatever treatment plan is finalized takes the form of written consent from patients and their relatives.[33] Consent is of utmost importance before any treatment, and ethically and legally, it must be obtained before any physical investigation or dental procedures.[34] The key idea behind consent is that everyone has the right to take his or her own actions and make his or her own decisions.[35] Prior consent, therefore, is an invariably recognized, necessary indispensable, protection tool for standard ethical practice and helps, in possible conflicts with patients, to build solutions in the parties' best interests.[36],[37]

Various studies have reported practitioners' awareness about the importance of obtaining consent from patients in dental practice. For instance, Khare et al. researched the knowledge and attitudes of dental and medical practitioners toward informed consent in Bhopal, India, and found that dental professionals were less aware of patient consent. They recommended workshops and awareness programs be conducted for dental professionals.[38] Gupta et al. found similar results among private dental practitioners in Bathinda, Punjab, India.[39] Kumari et al. emphasized that dentists should receive enough training in legal medicine and jurisprudence to protect themselves from any legal proceedings.[40]

The literature has also revealed that medical practitioners are more aware of the CPA than dental practitioners, as they deal more with cases of medical negligence.[41] Although large numbers of dentists know about the CPA, they are less aware of its basic rules and regulations. Research has also found that written consent is not usually obtained from dental patients, which shows the practitioners' negative attitudes and carelessness toward consent.[28] Official records must be maintained to protect practitioners against medicolegal issues/actions.[42] Written records, including chief complaints in the patients' own words, detailed dental and medical histories, other oral findings, photographs, radiographs, and models should be properly kept, as they may serve as important evidence in possible negligence lawsuits. All records should be dated and contain the signature of a signing authority because, in legal cases, written records produced by the dentists carry more weight than patients' recollections.[43] According to the National Health Service in terms of service in the United Kingdom, dental records must be kept and maintained for at least 2 years. Defense organizations suggest that records should be kept permanently as, in many cases, claims of negligence can be made several to many years after treatment. Often, it is impossible to keep such a vast number of patient records, so further advice is given by defense organizations as follows:[44]

  1. Once treatment is completed, treatment records, study models, X-rays, and any correspondence must be kept for at least 11 years
  2. In cases of children, the records must be kept until the child turns 25 years of age
  3. In cases of orthodontic treatment, the original pre- and post-treatment orthodontic models must be retained for 5 years.

A case of occupational negligence is different from one among the professional negligence. A simple lack of care, an error of judgment, or an accident is not proof of negligence on part of the health professional. As long as the practitioner followed acceptable practice in that region on that particular day, there is no proof of negligence on his or her part, and he or she cannot be held responsible for negligence solely due to the fact that better, alternative treatment was also available.[7] Prisoners and persons released on bail can be treated without their consent in the interest of justice to society. However, patient consent cannot be a defense against medical or dental negligence.[45]

Goel et al. summarized some acts that are considered nonnegligent.[33]

  1. In emergency situations when consent forms were not obtained
  2. If the patient was not satisfied with the progress of the treatment
  3. If the patient did not experience relief to his/her satisfaction
  4. If the patient believes the treatment charges were very high
  5. If the patient does not obtain desired results because he or she did not follow the proper instructions given by the doctor.

  Dentist Response to Alleged Negligence Top

Dentists may take the following necessary actions if complaints are lodged by patients or their relatives over unexpected happenings after a diagnostic evaluation or treatment procedures.[33],[46]

  1. Evaluate and recheck whether patients' written records were completed in all particulars
  2. Straight forwardly and clearly inform patients and their relatives about any mishap and show sincere concern. Dentists should not concern themselves with the rough attitudes or abusive language used by patients or their relatives in certain situations but must answer all their queries. Open-minded doctors who communicate well with their patients may be forgiven for errors
  3. Take advice from other doctors or protective organizations. In such circumstances, dental associations can give advice and assist dentist in protecting their rights and safeguarding themselves.

  Dental Insurance and Its Importance Top

Dental insurance is widely available in Western countries; however, in India, it is still in its nascent stage, with very few insurance companies providing the service.[47] Maniyar and Umashankar assess awareness of and attitudes toward dental insurance, as well as trends in the utilization of dental services, among insured and uninsured patients visiting a dental hospital in Bengaluru, India. They found that the insured group utilized dental services more often.[48] Therefore, it is vital for dental indemnity insurance to be started in India in the interest of patients and to help dentists take better responsibility when providing services.[6] It is becoming legally and financially hazardous to treat patients with complex diseases for whom the outcome is uncertain and imperfect results are common. Lawsuits are not only steadily increasing in number and cost but are also demonstrably putting patient cures at risk. This litigious atmosphere has led to a practice called “defensive medicine.”[49] Defensive medicine is simply a practice which departs from normal medical practice by professionals in an attempt to save them from litigation. It occurs when a medical practitioner performs treatment or procedure to avoid exposure to malpractice litigation. Defensive medicine is damaging for its potential to poses health risks to the patient. Furthermore, it increases the healthcare costs and paves way for degradation of physician and patient relationship.[50]

India's Health Ministry must direct the Dental Council of India to make dental insurance compulsory when a dentist registers with the dental council. The government should provide indemnity insurance policies to all its dental employees, who treat patients. Fast-track courts must also be established to hear cases related to dental or medical indemnity for rapid judgment in the interest of this noble profession.[6]

  Conclusion Top

In the interest of the dental profession, it is advised that, as far as possible, dentists should avoid any legal proceedings and should explain to their patients that such proceedings are not in the best interest of both parties. Mistakes are part of life and are liable to happen in the dental profession as well; however, as far as possible, dentists must provide the best treatment to their patients. In case of legal issues, dental practitioners can enlist the services of capable legal advisors, who are trained in such legal proceedings. It is very important to maintain dental records so that they can be produced to settle claims from dental insurance companies or be used as evidence in consumer court if patients take legal actions.

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Conflicts of interest

There are no conflicts of interest.

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