Dental malpractice question

[odieoh]

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Hello all-

I'd like to ask a question about a dentistry case. I'm not asking for health advice or anything like that. I'm just wondering at what point something would be considered malpractice by a general dentist. I understand in general it can be hard to determine this as none of you were there and you don't know the intimate details. That aside, I was pretty upset to learn about this.

My sister ended up needing a root canal. She had the root canal done by a general dentist. Some time later the tooth started hurting again. She went back to the same dentist and he/she said it needed to be redone, and went ahead and redid it. Some time later the tooth started hurting again. Again she went back and again the dentist told her it needed to be redone. At this point she was quite concerned and asked the dentist if she should see a specialist. The dentist told her it was fine and that he/she "could handle it." They went ahead with the third "redo," and shortly thereafter the dentist went out of town on vacation. However, the tooth continued to hurt. This time my sister went to an endodontist who found the tooth to be perforated and infected, as well as the underlying bone. He recommended removing it and informed her she needed a bone graft and further work.

I'm an ophthalmologist and I perform surgeries myself. I understand that mistakes happen to everyone, and complications happen to everyone, despite best intentions. However, I also understand the important principle that if you're in over your head, you get help.

I understand that many general dentists do root canals. But it seems a bit sketchy to me to "redo" it without suggesting or offering an endodontist consult, and extremely iffy to go ahead the third time. To me this smells like malpractice. I've never recommended that anyone sue anyone else, but this has me a little upset and I'd like some input on whether I'm right or if maybe I'm overreacting because this is a family member. Any thoughts?

 

[djeffreyt]

I don't know if this thread will close, but it seems fine to ask these kind of things to me so I figure I'll answer.

Is this malpractice? Not to me. Is it poor judgement on the part of the dentist? Probably. After the first retreat of the root canal (by the way, he only retreated twice...you kept saying third redo, but he did it the first time and "redid" it two times). if it had continued to cause problems and everything else looked like it was done right, I would have referred it. I also would have refunded the cost of the RCT and reimbursed the insurance company if there was one. That is what I would have done, but that doesn't mean the dentist committed malpractice by trying a third time. There are plenty of general dentists out there who have taken enough endodontic CE that they may have well had enough credits to have gone through specialty school and who have done so many RCTs that they are as well trained as some specialists. I don't know this dentist, but that is very possible. That being said, you are right (IMHO) that he should have at least offered to refer her if she asked during her third visit with him.

You could pursue a malpractice claim or even request to have the cost of the RCT refunded if you want, but she may want to ask for a copy of any informed consent forms she signed...there is a good chance that it says something about possible complications like perforations and infections. As in all surgical fields, there is no guarantee of success. I underwent a $12,000 neck surgery for pain and numbness in my left arm. Although the numbness is better, the pain is more or less the same, maybe even a little worse. There's obviously no asking the doctor for a refund as this was a known complication. Even in this case with your sister, there may not be enough evidence that the doctor did anything wrong. He kept trying to fix her problem, it didn't succeed, the complication that occurred is a known possible complication, she's kinda out of luck.

So what do i consider Malpractice...stuff like straight up lying. For example, and I have no way of knowing, if he knew he perforated the tooth but filled it anyway and hoped it wouldn't hurt her or bother her and when she came back, he continued to not tell her and try and fix it, now that's malpractice by definition. I've perforated a tooth doing root canals before...and there is a way to fix it that can be successful, and I've done it, both successfully and unsuccessfully, but you cannot lie or omit that information to the patient, that's where the malpractice cuts in.

Or, I'd consider it malpractice if he was negligent. For example, he finished the RCT and it came back hurting and he took no radiograph to see if there was a problem. Not if he misread the radiograph, cause that can happen, but if he didn't follow standard protocols to get a radiograph and consider the problem. He might have taken that radiograph and not seen the real problem and decided to try and retreat the RCT to see if it was a problem he couldn't see in the radiographs. Again, he isn't neglecting her, just not being perfect. If on the other hand he said, well, I don't see the problem, this looks fine, you should just go home and see if the pain goes away on its own and I'm not referring you to a specialist...well, that is supervised neglect, and I'd consider that malpractice.

There's a lot of other things I consider malpractice, and as a medical provider, I'm sure you know what those are as well.

 

[odieoh]

Thanks for the reply. I got a little more information that gave me some perspective too. This all happened over a 5 year period, not over a year as I had originally thought. That seems less problematic to me, given she was doing fairly well over long periods of time.

I spoke with an endodontist friend of mine, he essentially agreed with what you said. The one thing he pointed out was that the dentist should have known when he perforated the tooth, and should have told her immediately.

Apparently she had also had another tooth done by this same dentist and when she saw the endodontist he felt that tooth would need a revision as well. Not that that has any bearing on the tooth in question, aside from the fact that maybe this guy should consider not doing root canals.

I don't think there's going to be any legal goings-on about this-- but I am going to tell her to ask that he not charge for her most recent visit. Seems like the reasonable middle-ground.

 

[doc toothache]

Rendering a diagnosis without the benefit of, at least, pre and post radiographic evidence is a risky business. Was the perforation iatrogenic or does the endo failure have a different explanation? Memories have a way failing us more often than we care to admit.