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Dental litigation is set to become a reality for Middle Eastern practices. The popularity of cosmetic dentistry, alongside pricey procedures such as implantology, is driving the risk of malpractice claims as clinics begin to branch into more complex treatment areas. Reviewing the trends in malpractice can help in effective risk management. By identifying common pitfalls, dentists can protect their practices against similar mistakes.

Paper protection

Dento-legal experts agree that accurate record-keeping is the cornerstone of a responsible practice. As importantly, it is the first line of
defence in a malpractice suit. It is absolutely essential for dentists to take full notes during, or directly after, every consultation and procedures with a patient. All details - even those as small as the type of instrument used - should be recorded. It's good practice to then review the information and check for any gaps in communication.

For Edgar Gordon, former dental risk management tutor at University of London and a founder of the UK-based Faculty Of General Dental Practice, the professionalism is in the paperwork. "All the work is done right at the beginning before you even touch [the patient]," he says. "After that, you're a plumber, and you're assumed to be a competent plumber. The real work is in the treatment planning, and if things alter in the middle of it, you tell them and you make a note of it. You make a note that you've told them and you invite them to ask questions. It's all about transparency and openness.

Accurate documentation is a clinching factor when a dental complaint develops into a lawsuit. Dental records are the first point of call for a lawyer, and the better the documentation, the better your defence, explains Jeff Tonner, dental risk management attorney and author of Malpractice: what they don't teach you in dental school.

"After every trial, I always talk to the juries and they always tell me that if it's in the records it happened, and if it's not in the records it didn't happen," he says. "If it's not in there, then we have a difficult burden trying to get them to accept the fact that something was done but not recorded.

On the record

Some simple rules underpin good documentation practices. Firstly, records should outline facts rather than opinion and be written clearly, using only standard abbreviations rather than the dentist's own brand of short form. The chart should document details of treatment advice, the alternative options available, and show that an opportunity to raise questions was offered. It can take more than a year before a complaint is heard at trial, and most dentists would be hard-pushed to accurately depict the details of a consultation that took place so long ago without written prompts.

Linda Hay is a dental malpractice attorney and author of The ten biggest legal mistakes physicians make regarding risk management in SEAK. "When the dentist is then asked to go back and explain what happened on this visit: ‘Did you have this discussion? Did the patient make a complaint? Did you make a referral?' If there's nothing on the chart, how is he going to know what happened?" she asks. "I always tell dentists that the records are our best witness, because they have no bias, they have no memory, there's no incentive to change it one way or another and it was done before anyone even knew there was going to be a problem."

Altering notes after the event is a cardinal sin, and is typically viewed as an admission of guilt by a disciplinary panel. "You could lose your insurance for that, it creates a whole host of other issues," warns Hay. "The best general advice is don't fudge, don't lie, try to be as honest as possible."

And good documentation practices don't end with dentists. Getting staff on board is vital. The whole practice unit should be adhering to the same risk management rules, providing a second set of eyes to point out any missed errors.

"The staff is equally important, as they are communicating with the patient," says Linda Harvey, president of US-based healthcare risk management consultancy Horizon Consulting. Harvey red flags the patient's medical history as a particular area to watch.

"First of all, are they collecting accurate and complete information on the patient?" she asks. "Typically, there's a dental history form that the patient can fill out that gives information about how they feel about their teeth, their smile, the whiteness of their teeth and how comfortable their bite is. They should gather that information and then really ask good questions, so when the doctor is reviewing this information with the patient, they are communicating effectively."

Cosmetic concerns

Cosmetic dentistry has proved to be a malpractice magnet in the US and UK, switching the perception of dentistry from a functional to an aesthetic service. The rise of the Hollywood smile means that consumer awareness is high, and dentists can struggle to match patient expectations to results. Offering a trial run before treatment, can help ensure patient and practitioner are on the same page. One way is to harness the use of ‘try-on' cosmetics and photography to preview results, and to confirm consent before proceeding with treatment.

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