What Caused Claims in 2003
By Tawny Watkins
Risk Management Support Specialist, TDIC

A review of TDIC's 2003 closed professional liability claims revealed that root canal therapy continues to be an area of concern with regard to claims frequency. Allegations included failure to properly treat endodontic cases, separated instruments during endodontic treatment, and perforation of the tooth or root during treatment. Overfill of the root canal was a component in many claims. Data indicated that overfills may be caused by the dentist's failure to review radiographs during the procedure or rushing through the procedure.

Bridges, which had not made last year's list, were the second-most frequent claim category this year. The chief complaint was alleged bad result following placement of a bridge. Most often, the patient was dissatisfied with the fit or aesthetics of the bridge. Perhaps the color was off, or the patient expected the teeth to be a different shape. Communication and documentation are the best defense against problems related to unrealistic patient expectations. Documenting all informed consent discussions in the patient's chart and including any signed consent forms may avoid such allegations. Be clear with patients about reasonable expectations and outcomes, especially when cosmetic results are a factor.

The most severe claims last year involved posts. While there were few incidents such claims are typically expensive. The most significant claim happened when a dentist used an ultrasonic device to remove a post. The post overheated during removal, burning bone and tissue. Investigation into that claim revealed the dentist was not using the ultrasonic device properly, which caused the equipment to overheat.

Extractions had the highest average amount paid. Allegations under extractions included failure to properly treat extractions, paresthesia following extraction, retained root tip and post operative complications from a lack of follow up. Wrongful extraction cases are often more costly because they frequently lead to implant surgery. When faced with a difficult extraction that may be beyond your ability to perform, it is best to stop and refer the patient to a specialist, even if you have already begun treatment.

The data show that endodontists, periodontists, oral surgeons and orthodontists experienced claims relating to their respective specialties more frequently than did general dentists. However, general dentists experienced more severe claims, especially those involving extractions of third molars.

On the property insurance side, burglary claims continue to be an area of concern. Copiers, laptops, cash boxes, dental equipment, fax machines, and nitrous oxide tanks stored in the insureds' storage sheds were stolen. TDIC will give risk management attention to helping dentists prevent thefts both inside and outside the office. TDIC recommends as deterrents alarming offices and sheds, installing flood lights and storing nitrous oxide tanks inside the office where they are not in public view.

Fires also caused problems for policyholders in 2003. Damage was reported to radiograph equipment, operatories and furniture. Two claims were arson related. The most expensive claim came from a fire suspected to have started from the autoclave in the laboratory and spread throughout the office.

TDIC employs several different vehicles for educating members about potential risks and how to prevent claims. They include seminars, self-study courses, Liability Lifeline newsletter, reference materials, sample forms and letters, technical bulletins, and our Web site, thedentists.com.

While the above information was compiled at year's end, TDIC's risk management and claims departments are in constant communication throughout the year bringing members current information on what causes claims and how to prevent them.