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Practice More Safely // Risk Tips // Dentist’s Illegible Handwriting Leads to Malpractice Lawsuit

Dentist’s Illegible Handwriting Leads to Malpractice Lawsuit

Case Study

Marc Leffler, DDS, Esq.
January 16, 2025

Reading time: 8 minutes

Female Dentist Filling In Papers While Talking To Young Patient

Background Facts

K, now in her late 50s, has been a dental patient of Dr. B’s since K was a teen and Dr. B was fairly new in practice.  K had an essentially benign medical history, with one important exception: a history of having had a severe, life-threatening allergic reaction to Penicillin as a child.  Dr. B was well aware of the allergy, with K’s patient chart being clearly marked to reflect it.

Dr. B viewed himself as being in his last few years of practice, so he no longer accepted new patients but maintained his existing patients who had been loyal to him for so long.  When Dr. B was asked (socially) what his biggest weaknesses were, he responded without missing a beat – – awful handwriting and an aversion to technology (the latter of which led to his hanging on to handwritten records and handwritten prescriptions, for as long as the upcoming mandates for electronic prescribing would allow).

Over her last few dental examinations, K had shown a worsening overall periodontal condition, most prevalent in her 2 upper left molars, which had apices in very close proximity to the low-lying maxillary sinus.  Tooth #14 was becoming symptomatic, beginning to show signs of an endo-perio lesion.  At her most recent office presentation, #14 had several probe points nearing 8mm, with noticeable mobility and pressure tenderness, and slight sinus opacification radiographically.  Dr. B advised his patient that extraction looked to be the best solution, at least for #14 currently.  With travel plans coming up imminently, K wanted to try to “baby it along” until she returned home, at which time she would have the extraction performed.  Dr. B saw no problem with this approach, so he would prescribe an oral antimicrobial rinse and an antibiotic.

As she left the office, Dr. B handed K both handwritten prescriptions, one for the rinse and the other for an antibiotic which Dr. B found to be effective in such situations, Doxycycline, dosed at 100 mg twice daily.  On her way to dinner with a friend, K dropped the prescription forms at a busy chain pharmacy near the restaurant, planning to pick up the medications before traveling home.  The pharmacist was fairly easily able to discern the rinse and its dose, but the antibiotic was a different story: neither the name of the drug, save for the letters “D” and “x”, nor the dose was readable.  The pharmacist called Dr. B’s office, where only the receptionist remained at that time of the evening; the receptionist was able to tell from the chart that K had a periodontal infection, so she passed that information on to the pharmacist but nothing more in terms of the name of the antibiotic.  The pharmacist said that he had it figured out, in part based upon the condition being treated: he filled the prescription for Dicloxacillin, which he reasoned must be for 500 mg (rather than what looked to be 100 mg).

K used the rinse that night after brushing her teeth and took the first of the antibiotic pills before going to sleep.  She awoke in the early morning hours with shortness of breath and redness on the skin of her chest and torso.  She called an ambulance when the situation seemed to quickly worsen and was transported to a local hospital.  There, she was diagnosed with an antibiotic-induced allergic reaction which was treated with antihistamines, corticosteroids, and a short period of time being intubated.  Fortunately, K was discharged within a few days, and remained out of work for the rest of the week, but the fear put her into a tailspin.  She had not understood what caused the allergy until she closely read the antibiotic label and did an internet search, which revealed that she had been given a Penicillin-type antibiotic, Dicloxacillin.  Despite her long professional relationship with Dr. B, she was extremely angry with him and immediately wanted to sue him.

Legal Action

Based upon a referral, she found an attorney to review her records and advise her of her options.  With the input of an expert, the attorney told K that the fault began with Dr. B’s poor handwriting, that the pharmacist should not have filled the antibiotic prescription with the incomplete information he had, and that the office receptionist gave the pharmacist information about the patient’s dental condition which should have been transmitted only by a dental professional.  The attorney concluded that Dr. B, the pharmacist, and Dr. B’s practice entity (as the employer of the receptionist) were all liable and should all be sued.  K agreed and a malpractice lawsuit was begun on her behalf.

The respective reviews undertaken by the defense attorneys assigned, and their retained experts, all reached the same conclusion, which was that this situation could not realistically be defended.  Given that K’s related injuries were limited to a portion of the ambulance and hospital costs, a week of missed work, and the “pain and suffering” associated with the physical manifestations of the allergic event and the emotional component as well, the path to case resolution became apparent. With contribution from the malpractice carriers of each of the defendants, the case was resolved by settlement early in the process, without the need for depositions or a trial.

Takeaways

One can speculate as to the legislative intent behind moving to an electronic-based system of prescribing medications, but the facts of this case stand as a likely candidate for that reasoning.  Had K’s medications been electronically prescribed, rather than handwritten, it is difficult to foresee a way that the mistake which occurred here would have come to pass; such legislation provides a risk management tool to practitioners who provide medication prescriptions to their patients, whether the practitioners like it or not.  But even as the transition in prescribing technique has taken hold, or is close to fully taking effect, there might still be outlying situations where dentists have occasion to handwrite a prescription; to the extent that is the case, the situation described in this case study serves as a clear example of the potentially life-threatening dangers that can be posed when communication – whether written, spoken, texted or emailed – is not fully checked for accuracy and properly transmitted.

This concept is far from limited to medication prescription writing, but instead encompasses so many aspects of dental practice.  Every day, dentists send requests for appliances to dental labs; seek blood work for their patients, either through their physicians or directly from blood-drawing facilities; instruct their patients on premedication requirements; and provide pre- and post-procedure instructions.  Much of these types of information is routinely transmitted on handwritten papers, over telephones, or by way of face-to-face discussions; the takeaway here is that accurate communication is critical to safe and efficacious patient care, with the failure to adopt precise and consistent interaction techniques causing a weak link in overall patient management.  As basic and as non-clinical as this concept might sound, it is a solid practice foundation that cannot be overlooked in its importance.  The few extra seconds that it might take a dentist to write legibly could amount to literally saving a life.  And that comes in handy as well when jurors are evaluating cases with handwritten records: records that are easily read take away unknowns and send the message that the dentist is not trying to hide a thing.

We address here a concept that is not very frequently discussed in our dental case studies, because it is far less pervasive than with our colleagues practicing medicine.  Whereas practitioners of multiple practice areas function together often to provide patient care in medicine, dentistry is a profession in which the actions of individual dentists far less frequently cross over to include the actions of others.  That is not to say, by any means, that there is never any such crossover in dentistry, as this case demonstrates, so we raise the idea and explain how multiple practitioner interactions play out in litigation.  Without delving into underlying legal definitions, suffice it to say that, based upon individual State rules, the relative actions of multiple practitioners who share liability in causing injury, or even the patient’s own liability in leading to their own injury, may be apportioned by a jury to reflect the monetary portion of each player’s role in the undesired outcome, or it may be agreed upon between the parties and their lawyers in pre-trial settlements.  The manner by which cases ultimately resolve is not infrequently dictated by an investigation into and an assessment of the engagements of every person and entity involved.

It is beyond the scope of this study to comment upon standards of care guiding pharmacy practice, here or generally.  But it is valuable to consider the actions of Dr. B’s office receptionist, and non-professional office staff overall.  Dental office staff members are integral to the successful running of a practice: their roles in scheduling, administrative follow-up, billing, insurance filings, and serving as the faces and voices of the dentists who employ them cannot be overstated; many practice owners would find it hard to conceive of how their practices would begin to function without those members of the staff.  However, when their functions step beyond those of administrators and into those of clinical advisors, either at the behest of their dentist employers or not, they place those dentists into positions of potential legal peril, in a variety of ways.  It is up to the dentist to determine and make clear what actions non-professional staff members may take and what they must not.  In this case, the office receptionist provided what amounted to a clinical assessment – or at least insight – as to why K was given the unreadable antibiotic.  Had the receptionist not given what she took from the chart to be the reason for the medication, the pharmacist would not have had the information which led him to have “figured it out” and reach an improper conclusion as to what the medication was; had the receptionist simply refrained from giving any information other than she would have Dr. B return the call, malpractice would have very likely been averted.

Practice entity policies function to protect dentists when the (claimed) improper actions of the practice (meaning all under its employ) create an injurious result.  It is an invaluable tool in an overall professional liability protection approach, and one not to be glossed over.

Note that this case presentation includes circumstances from several different closed cases, in order to demonstrate certain legal and risk management principles, and that identifying facts and personal characteristics were modified to protect identities. The content within is not the original work of MedPro Group but has been published with consent of the author. Nothing contained in this article should be construed as legal, medical, or dental advice. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your personal or business attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

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A fulfilling dental career is powered by passion. In this article, Dr. Shafa Nathani, a member of MedPro Group’s Dental Advisory Board, offers insight on staying motivated and shaping a career that you’re passionate about.









Key Concepts





    

  • Job satisfaction and preventing burnout
    • 




  • Continuing education for dentists
    • 




  • Mental health and work-life balance
    • 










Cultivating your passion as a dentist can boost your job satisfaction throughout your career. When you genuinely enjoy what you do, it's easier to feel fulfilled and eager to come to work each day. Maintaining enthusiasm at work also helps keep you motivated, especially during difficult periods.





In addition, your passion for your dental career can trickle down into your care. Your upbeat demeanor can be contagious, helping to build trust and a sense of safety with your patients. This often leads to fewer appointment cancellations and a stronger commitment from your patients to stick to their treatment plans.





Building a dental career you love begins with securing reliable dental malpractice insurance – so you can practice safely and confidently with protection against potential malpractice claims. With trusted coverage from industry leader MedPro Group, you’ll get the peace of mind you need to deliver the best care to your patients and focus on fostering a fulfilling career.





Read this article for tips on how to choose the right dental malpractice insurance policy.





Q&A with a MedPro Group Dental Advisory Board Member





We interviewed Dr. Shafa Nathani, DMD, a member of MedPro’s Dental Advisory Board, to learn how she maintains her enthusiasm for her practice.





What’s your favorite part about working with patients?





"Every patient who sits in my chair comes with a story, and that’s something I never take for granted. On most days, the office is busy and fast-paced, and I may only get a few moments with each patient. Still, those moments often carry the most meaning. Whether it’s meeting a new patient for the first time, delivering complete dentures to someone we’ve been caring for over months or years, or seeing a recall patient after a long gap and catching up on their life, those brief connections matter deeply to me. Outside of the technical side of dentistry, it’s these human moments that ground me. After a day that feels like a total blur, they remind me why I chose this profession in the first place and how privileged I am to be trusted with someone’s care, comfort, and confidence.”





How do you prevent burnout as a dentist?





"I’m a little over a year into my career, and I’m currently in a phase of saying ‘yes’ as much as possible, working hard to gain experience and take full advantage of the momentum from dental school. While that growth has been exciting, it also comes with physical and mental challenges.” 





“There are days when my back aches, the mental load of running a busy office feels overwhelming, and the idea of taking time off sounds incredibly appealing. Early on, my routine after work was to go straight home, sit on the couch, and try to decompress. However, I quickly realized that I was still waking up tired and feeling like my life revolved entirely around work.”





“Making intentional changes helped shift that mindset. I joined a yoga studio, spent time at the library, and found ways to stay mentally and physically engaged outside of dentistry. Even though I was still tired, I felt fulfilled. That sense of balance has been essential in preventing burnout and helping me remain enthusiastic, motivated, and present for my patients."





Learn more about recognizing and preventing burnout in this article.





Can you share a pivotal moment that reaffirmed your passion for dentistry?





"Within my first month of practicing as a dentist, I treated an older patient whose upper bridge and partial had completely failed. He required full-mouth extractions, but financial limitations prevented him from receiving care from an oral surgeon. I wanted to help him, but I also questioned whether I was capable of managing a case of that complexity so early in my career.” 





“I reached out to a mentor who guided me step by step through the surgical process and denture delivery. While he was incredibly grateful for the care, that wasn’t the moment that truly reaffirmed my passion for dentistry. It was everything that followed. Over the next year, I saw him regularly for adjustments and follow-up exams, and during those visits we shared life updates and built a genuine connection. On my last day at that office, we tearfully said goodbye, and he offered me his blessings.”





“That moment reminded me that dentistry is about far more than procedures. It’s about relationships, trust, and long-term impact. He will be attending my wedding later this fall, a testament to how meaningful patient relationships can become."





How important is continuing education to staying passionate about your career?





"Continuing education is incredibly important to me, both professionally and personally. Dental school provides a strong foundation, but it can’t possibly cover everything. Depending on how you want to practice, CE can help shape you into a well-rounded dentist or allow you to focus deeply on a specific niche. I identify strongly with being a well-rounded practitioner.” 





“I’ve discovered countless resources and taken courses that reignite my excitement for learning and push me to try new techniques that lead to better clinical outcomes and smoother recovery for patients. Dentistry is constantly evolving, and staying current isn’t optional, it’s a responsibility. Engaging in CE keeps me challenged, curious, and inspired, which directly translates into better patient care."





How do you stay connected to the dental community? How does that affect your passion for your work?





“Having a supportive dental community is vital to my success and longevity in this profession. I’m incredibly grateful for the friendships I formed in dental school. We often joke that between all of us, we somehow cover every time zone in the country. Even though we aren’t geographically close, those friends are the first people I reach out to because they truly understand the challenges, pressures, and victories that come with dentistry. It’s a judgment free space where I can ask questions, vent, or celebrate wins.” 





“Additionally, my current role allows me to work within a DSO alongside a strong group of dentists. Through monthly calls and in person collaboration, we’ve built relationships rooted in mutual support and shared growth. This community has been essential in keeping my passion for dentistry alive because I never feel isolated. Instead, I feel supported, encouraged, and reminded that I’m part of something much bigger than myself.”





Passion starts with security 





You're passionate about your patients. We're passionate about protecting your good name. With over a century of dental malpractice expertise, we'll protect your practice so you can focus on building a career you love.





To learn more, contact our team or get a quote today.


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In this case study, dentists learn how an implant placement evolved into a malpractice lawsuit after the patient developed persistent postoperative nerve injury symptoms. The case demonstrates how clinical choices made at the planning stage can significantly influence the legal trajectory of a case.









Key Concepts





    

  • Understanding divergent opinions between experts
    • 




  • Determining standard of care for different radiographic techniques
    • 




  • Understanding the pure consent to settle clause
    • 










Background Facts





Dr. P practiced restorative dentistry in a suburban community, since her completion of dental school and a general practice residency. During her formal training and after, she engaged in didactic and clinical coursework involving implant placement and restoration and regularly recommended and employed dental implants in her treatment plans. That was the case when a new area resident, O, a healthy man in his 40s, presented for general care and consideration for replacing missing tooth #30, which was extracted years ago following a trauma-induced fracture.





O's mouth was in generally good repair, as he practiced good home hygiene and had been a regular dental patient for his entire adult life. Dr. P discussed the replacement options of a 3-unit fixed bridge and an endosseous implant, upon which a single crown would be placed. After taking and viewing a panoramic radiograph, Dr. P advised O that he had "plenty of bone" to support an implant, and she suggested that approach. The costs were similar, so O opted for the implant plan. Dr. P advised O of the usual risks of implant surgery, including a nerve injury which could even be permanent in "rare" situations. O agreed to go forward and set up an appointment within the next few weeks.





At the surgical visit, a chairside assistant presented O with a document entitled Implant Consent Form, telling O that this was exactly what Dr. P had discussed with him. O quickly perused the form and signed it. Based upon measurements she made on the panoramic film, Dr. P determined there to be 14.5 mm of mandibular bone superior to the inferior alveolar canal (IAC), so she planned for and placed a 13 mm fixture. Upon elevating a gingival flap, Dr. P noticed that the lingual height of bone was "a good deal" higher than on the buccal aspect. Other than O briefly wincing toward the end of the preparation phase, all went smoothly, with the implant covered with soft tissue and sutured. A post-placement periapical radiograph showed the implant in very close approximation to the IAC, but Dr. P saw "daylight," so she was not concerned.





One week later, at the suture removal visit, O complained of "pins and needles" and "numbness" on the right side of his lower lip and chin. Dr. P stated that she remained "unconcerned," explaining that this is common and all should be back to normal over the next weeks or months. O returned for crown placement 5 months after implant surgery, still with the same "annoying sensations." Dr. P was surprised that the situation had not normalized, but she continued to reassure O of a return to normal. That never came.





Legal Action





O always found the tingling and numbness to be uncomfortable, but he never thought to do anything about it until he met up with a college classmate of his, now an attorney, at an alumni event. The classmate did not practice law where O now lived but suggested that he consult with an attorney he knew who did "a lot of malpractice work." O met with that lawyer, who gathered all of Dr. P's records and sent O to a local neurologist to assess the extent of the injury. The neurologist confirmed that O's mandibular nerve was in fact injured and did not conceive of any improvement, now nearly two years after the surgical event.





O's attorney contacted an experienced dentist whom he knew, who had testified in dental malpractice cases in the past, and who, like Dr. P, regularly placed and restored implants, seeking to retain that dentist as an expert on behalf of O. Following a review of the records, the expert reported back to the attorney that, in his opinion, Dr. P had deviated from the standard of care, which in the expert's view required the use of CBCT radiography in order to accurately determine available bone for implant placement. The expert cited specifically to Dr. P's intraoperative finding of a sloped mandibular crest, which could not have been determined on the 2-D panoramic but would have been seen on a 3-D CBCT, had one been taken. The expert added to that opinion the concept that, once Dr. P noted that lingual-to-buccal slope, she should have immediately stepped back and reconsidered whether the planned-for 13 mm implant was appropriate, which it ended up not being, as the measurement was based upon the highest point of the crest, rather than lower points on that slope which were closer to the IAC.





The attorney quickly filed suit against Dr. P, as the statute of limitations was approaching. Dr. P contacted her professional liability carrier, which assigned defense counsel to Dr. P. O's attorney voluntarily shared his expert's report with defense counsel, hoping to demonstrate a strong basis for an early settlement. However, defense counsel retained its own expert, who opined that the standard of care allowed for 2-D panoramic films for the purpose of implant planning, although acknowledging a deep split within the dental profession. Some dentists and organized dental groups asserted that (exactly because of anatomic situations as Dr. P found) 3-D studies were required prior to posterior mandibular implant placement, with other dentists and dental groups agreeing with this defense expert's stance. In part, the latter view is supported by the statistical fact that, according to recent assessments, only 29% of U.S. general/restorative dentists have on-site CBCT availability, with less than 2/3 of dental specialists having such access.





Defense counsel recognized that a motion for summary judgment––one seeking dismissal of the case without trial––would not be fruitful because such a motion can only be successful when, among other things, there is no legitimate difference between opposing expert opinions.  Therefore, defense counsel thoroughly presented Dr. P with her options: (1) go to trial and ask a jury to determine whether she had run afoul of the standard of care, allowing them to award money to compensate O for his injuries if they determined that she did not meet the standard of care, and if that was causative of his injuries; or (2) trying to reach a pre-trial settlement, presuming that the carrier agreed with that prospect, which it did.





Dr. P frankly said to her attorney that, in multiple continuing education classes she had taken, the need for pre-implant CBCT studies was discussed, for the very reasons highlighted in O's treatment. She further acknowledged that she would have to testify to that experience if asked at trial. Dr. P was concerned, so she authorized attempts to resolve the case. Because O's injuries were viewed, even by his own lawyer, as not severe, evidenced in part by O having never sought subsequent evaluations or care other than at the direction of his attorney, a modest settlement was reached.





Takeaways





It is the rule, and not the exception, that experts for plaintiffs and defendants will disagree, and that is also the case for dentists, outside of the litigation realm. Those disagreements take center stage during dental malpractice trials, with jurors left to determine which of the opposing positions they accept. As Dr. P reasoned here, it is rarely, if ever, simply a coin flip, because a host of factors play into jury determinations, so the pre-trial "prediction calculus" takes into account a common sense approach as to how lay people will most likely come to their conclusions on matters of science and professional expertise. Sometimes demeanors of the parties and/or experts carry the day. Sometimes the bases of expert opinions are determinative, and sometimes, as might play here, particular professional experiences in the dentist's past are of significance. While legitimate (not fabricated) differences of expert conclusions generally preclude dismissal before trial by way of motions, those differences will need to be resolved by a trial jury. There is no getting around that.





This case study briefly touches on the concept of statute of limitations (SOL), so a short description is in order. The SOL is the time following a claimed negligent event (or sometimes the subsequent discovery of that event) within which a plaintiff must file suit or be forever time-barred. Of course, as with so many issues in the law, there are nuances and issues which can serve to lengthen the allowable timeframe, but they are exceptions, with the statutory SOL generally being the bedrock. The concept of SOL is perhaps the most variable legal issue as between the States––or at least close to the top of the list––but it is a consideration for attorneys (or self-represented plaintiffs) to grapple with, and not something with which dentists need to familiarize themselves.





As the body of this case study references, divergent views exist within dentistry as to what radiographic techniques are "best" for various planned procedures or diagnostic approaches, which in the litigation arena often translates to opinions as to standard of care. Articles in respected journals present competing ideas. Some take the approach that dentists are in the most ideal position to make patient-based, procedure-based, and circumstance-based decisions as to which radiographic techniques––whether CBCT, panoramic, periapical, etc.––are most appropriate clinically. Others are more rigid, asserting, for example, that nearly all invasive dental/oral surgical procedures require CBCT studies in advance. While we do not advocate here in either direction, dentists and oral surgeons ought to be aware of these opposing schools of thought and consider them in decision-making, realizing that jurors might get the final say.





We end on a note about the decision faced by Dr. P. Given that she had a "consent-to-settle" policy, it was her right to refuse any type of settlement, regardless of the input or advice of her counsel or insurer. Had she not had such a policy, that decision would not have been hers to make. This is yet another issue for dentists to consider when choosing a malpractice carrier and policy.





MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and/or may differ among companies. © MedPro Group Inc. All rights reserved.


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In this case study, dentists will discover how a rushed procedure, antibiotic selection, and non-clinical staff advice led to a malpractice lawsuit and patient harm. This article highlights the importance of informed consent, careful risk management, and keeping patient communications strictly professional.









Key Concepts





    

  • Antibiotic risks and complications in dental care
    • 




  • Non-clinical staff-patient communication
    • 




  • Patient choice vs. the standard of care
    • 










Underlying facts





D, a 26-year-old man, presented to an endodontist, Dr. Q, on referral of his family dentist, some 6-7 years following his having been struck in the face by a batted baseball. Over the past few months, tooth #8 had begun to darken and become episodically painful. Approximately a week prior to this visit, D developed a pea-sized swelling in the gingiva at the level of the tooth's apex. Radiographically, a periapical radiolucency on #8 was visible, and the tooth was non-vital. The endodontist suggested endodontic therapy, to which the patient agreed.





Upon entry into the pulp chamber, yellow, foul-smelling purulent discharge exuded through the tooth; the apical swelling immediately reduced in size. The tooth was thoroughly irrigated internally until no pus was visible. Because D was soon going out of town for work for several weeks, he asked the endodontist if she could "just finish it up" that same day, rather than returning a week later as Dr. Q had suggested. Dr. Q acceded. After the filing was completed, obturation with gutta percha was performed by Dr. Q, with the apical extent approximately 1mm short of the radiographic apex. NSAIDs were recommended as needed.





Two days later, D called the office and told the receptionist that he had a sudden increase in swelling and a low-grade fever; the receptionist reassured the patient by saying, "we see this all the time so it's nothing to worry about," without having consulted with Dr. Q. Three days after that, while still traveling and with the swelling now approaching the eye, D called the endodontist after hours and spoke directly with her; the patient reported an allergy to Penicillin, so Dr. Q called in a prescription for Clindamycin, which the patient started that same evening.





Now nine days after the initial treatment, the patient again called the office and spoke with Dr. Q, advising her that his facial swelling was much reduced and getting better continually, but he had spasmodic diarrhea; the endodontist told her patient that, as long as the dental symptoms were improving, which they were, he should continue and finish out the antibiotic and take over-the-counter anti-diarrheal medications. The patient did exactly that but ended up in a hospital emergency room a few days later for worsening and uncontrollable diarrhea with severe GI pain, where he was diagnosed with Clindamycin-induced pseudomembranous colitis. He was admitted for IV fluids/antibiotics and supportive care; he was monitored for a potential peritonitis, which never came to pass, and was discharged home after losing seven pounds. D was unable to secure the sales deal he had traveled for, as he was hospitalized during several scheduled meetings; the potential client made the transaction with another vendor.





Legal action





In addition to the physical upheaval that he had experienced, and the medical and hospital bills which were only partially covered by his insurance plan, D was mostly distressed by the fact that he had lost the opportunity for a large sale that he believed would have positioned him for an early-career promotion, with its associated salary increase. He sought out and retained an attorney.





The newly hired attorney forwarded the dental and medical records to two potential experts, an endodontist and a medical infectious diseases specialist. The endodontist was of the views: that under the existing conditions, the root canal treatment should not have been completed in one visit, but acknowledged that this was a judgment call such that other practitioners might well disagree; that if Dr. Q did agree to complete the procedure in one step, as she did, the prescribing of antibiotics at that time would have been preferred, but again recognized that some other endodontists would not agree; that Dr. Q's providing Clindamycin in the face of a potential Penicillin allergy, in a patient with a worsening infection and unable to be seen clinically, was an acceptable choice, although it was unclear whether Dr. Q adequately discussed the possible GI risks with D; and that the office receptionist was clearly and inappropriately acting beyond her non-professional status in providing the advice that she gave.





The medical expert confirmed that it was clearly the Clindamycin that was responsible for all of the GI symptoms experienced by D, as well as the hospital care that followed, and that the 3-day delay (and worsening infection) created by the receptionist's advice deprived both D and Dr. Q of the opportunity to have an antibiotic with less severe side effects than Clindamycin to have been used.





D's attorney opted for a simple litigation approach. On behalf of D, he filed suit against Dr. Q's practice entity – but not Dr. Q – based upon what the attorney viewed as strong arguments on both the liability and causation fronts as to the practice, with only "judgment call" issues available against Dr. Q. The damages claimed were the GI-based pain and suffering, the unpaid medical costs, the monetary values of the "lost" sale and the "loss" of salary increase. Given that Dr. Q's practice entity was covered for malpractice, the carrier provided defense counsel to put forth a defense for the practice, working with Dr. Q for that purpose, although not defending her personally.





After depositions were taken, the defense attorney applied to the Court to have the values of the lost sale and potential salary excluded from any potential damages able to be recovered. The Court agreed, determining those amounts to be entirely speculative, in that even if D would have had the chance to attend the meetings he missed, those were merely "opportunities,” so there is no way to prove that he would have been successful in his endeavor. The other claims in the case remained. Realizing the pitfalls of trying to defend the actions of the receptionist, Dr. Q and the practice's attorney, with the agreement of the carrier, worked toward and completed a settlement on behalf of the practice, for an amount which took care of expenses and physical pain and suffering, with no permanent after-effects, at a far lower value than had lost earnings been included.





Takeaways





In essence, D's expert endodontist determined that all of the actions taken by Dr. Q – the one-visit RCT, the non-prescribing of antibiotics at that time, and the choice of Clindamycin – were judgment calls, subject to opinions as to appropriateness on both sides of the fence, thereby leading D's attorney to refrain from pursuing those claims. [We note here that not all attorneys for plaintiffs would approach this in the same way.] Instead, the lawsuit was focused on what D's attorney viewed as a sole "winning argument," which was in fact the result. To reiterate a concept discussed in prior case studies, the general principle is that a plaintiff must prove through expert testimony that – with a general standard of "more likely than not" – a defendant dentist departed from good and accepted practice standards, thereby directly causing injury to the patient. For all issues except for the receptionist's involvement, the endodontist expert for D did not adequately meet that hurdle, at least in the eyes of D's attorney; the medical expert causally connected the receptionist's actions with the injuries to D.





There has been and continues to be controversy in the dental community regarding the use of Clindamycin. While its potentially severe side effects are well-publicized, it has therapeutic benefits as well: the classic double-edged sword. We do not comment upon the propriety of a given practitioner's choice to prescribe it in a particular situation, but just as with all choices, they are best made with a sound and deliberative thought process, so that a defense can be meaningfully put forward if untoward results come to pass.





As a side thought, we visit the issue of a case settling as against a practice entity versus the dentist him/herself; if such a potential ever exists during a malpractice case management, it is something to be coordinated between the dentist, liability carrier, and defense counsel. As a general rule, although potentially with exceptions, payments for professional liability against individual practitioners are reportable to national – and sometimes state – data banks and authorities, whereas those against an entity, as here, are not. To be clear, it is never a given that case resolutions of the type done here can always be made; to the contrary, it is not very common in the world of dental malpractice, with carriers constrained to do so only after an assessment that no specific provider bore any liability. But none of this negates the importance of dental practitioners assuring that dental/medical advice to patients must only be given by dental professionals, leaving only administrative tasks to non-professional staff members.





We end with a brief discussion about dentists acceding to performing procedures that patients "demand," even when those dentists do not believe that doing so is in those patients' best interests. Yes, patients have an absolute right to decide which of multiple alternatives they wish to pursue, but only if those alternatives are dentally and/or medically viable. Patients can refuse anything, but they should not dictate what a dentist must do.





Note that this case presentation includes circumstances from several different closed cases, in order to demonstrate certain legal and risk management principles, and that identifying facts and personal characteristics were modified to protect identities. The content within is not the original work of MedPro Group but has been published with consent of the author. Nothing contained in this article should be construed as legal, medical, or dental advice. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your personal or business attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.


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A fulfilling dental career is powered by passion. In this article, Dr. Shafa Nathani, a member of MedPro Group’s Dental Advisory Board, offers insight on staying motivated and shaping a career that you’re passionate about.









Key Concepts





    

  • Job satisfaction and preventing burnout
    • 




  • Continuing education for dentists
    • 




  • Mental health and work-life balance
    • 










Cultivating your passion as a dentist can boost your job satisfaction throughout your career. When you genuinely enjoy what you do, it's easier to feel fulfilled and eager to come to work each day. Maintaining enthusiasm at work also helps keep you motivated, especially during difficult periods.





In addition, your passion for your dental career can trickle down into your care. Your upbeat demeanor can be contagious, helping to build trust and a sense of safety with your patients. This often leads to fewer appointment cancellations and a stronger commitment from your patients to stick to their treatment plans.





Building a dental career you love begins with securing reliable dental malpractice insurance – so you can practice safely and confidently with protection against potential malpractice claims. With trusted coverage from industry leader MedPro Group, you’ll get the peace of mind you need to deliver the best care to your patients and focus on fostering a fulfilling career.





Read this article for tips on how to choose the right dental malpractice insurance policy.





Q&A with a MedPro Group Dental Advisory Board Member





We interviewed Dr. Shafa Nathani, DMD, a member of MedPro’s Dental Advisory Board, to learn how she maintains her enthusiasm for her practice.





What’s your favorite part about working with patients?





"Every patient who sits in my chair comes with a story, and that’s something I never take for granted. On most days, the office is busy and fast-paced, and I may only get a few moments with each patient. Still, those moments often carry the most meaning. Whether it’s meeting a new patient for the first time, delivering complete dentures to someone we’ve been caring for over months or years, or seeing a recall patient after a long gap and catching up on their life, those brief connections matter deeply to me. Outside of the technical side of dentistry, it’s these human moments that ground me. After a day that feels like a total blur, they remind me why I chose this profession in the first place and how privileged I am to be trusted with someone’s care, comfort, and confidence.”





How do you prevent burnout as a dentist?





"I’m a little over a year into my career, and I’m currently in a phase of saying ‘yes’ as much as possible, working hard to gain experience and take full advantage of the momentum from dental school. While that growth has been exciting, it also comes with physical and mental challenges.” 





“There are days when my back aches, the mental load of running a busy office feels overwhelming, and the idea of taking time off sounds incredibly appealing. Early on, my routine after work was to go straight home, sit on the couch, and try to decompress. However, I quickly realized that I was still waking up tired and feeling like my life revolved entirely around work.”





“Making intentional changes helped shift that mindset. I joined a yoga studio, spent time at the library, and found ways to stay mentally and physically engaged outside of dentistry. Even though I was still tired, I felt fulfilled. That sense of balance has been essential in preventing burnout and helping me remain enthusiastic, motivated, and present for my patients."





Learn more about recognizing and preventing burnout in this article.





Can you share a pivotal moment that reaffirmed your passion for dentistry?





"Within my first month of practicing as a dentist, I treated an older patient whose upper bridge and partial had completely failed. He required full-mouth extractions, but financial limitations prevented him from receiving care from an oral surgeon. I wanted to help him, but I also questioned whether I was capable of managing a case of that complexity so early in my career.” 





“I reached out to a mentor who guided me step by step through the surgical process and denture delivery. While he was incredibly grateful for the care, that wasn’t the moment that truly reaffirmed my passion for dentistry. It was everything that followed. Over the next year, I saw him regularly for adjustments and follow-up exams, and during those visits we shared life updates and built a genuine connection. On my last day at that office, we tearfully said goodbye, and he offered me his blessings.”





“That moment reminded me that dentistry is about far more than procedures. It’s about relationships, trust, and long-term impact. He will be attending my wedding later this fall, a testament to how meaningful patient relationships can become."





How important is continuing education to staying passionate about your career?





"Continuing education is incredibly important to me, both professionally and personally. Dental school provides a strong foundation, but it can’t possibly cover everything. Depending on how you want to practice, CE can help shape you into a well-rounded dentist or allow you to focus deeply on a specific niche. I identify strongly with being a well-rounded practitioner.” 





“I’ve discovered countless resources and taken courses that reignite my excitement for learning and push me to try new techniques that lead to better clinical outcomes and smoother recovery for patients. Dentistry is constantly evolving, and staying current isn’t optional, it’s a responsibility. Engaging in CE keeps me challenged, curious, and inspired, which directly translates into better patient care."





How do you stay connected to the dental community? How does that affect your passion for your work?





“Having a supportive dental community is vital to my success and longevity in this profession. I’m incredibly grateful for the friendships I formed in dental school. We often joke that between all of us, we somehow cover every time zone in the country. Even though we aren’t geographically close, those friends are the first people I reach out to because they truly understand the challenges, pressures, and victories that come with dentistry. It’s a judgment free space where I can ask questions, vent, or celebrate wins.” 





“Additionally, my current role allows me to work within a DSO alongside a strong group of dentists. Through monthly calls and in person collaboration, we’ve built relationships rooted in mutual support and shared growth. This community has been essential in keeping my passion for dentistry alive because I never feel isolated. Instead, I feel supported, encouraged, and reminded that I’m part of something much bigger than myself.”





Passion starts with security 





You're passionate about your patients. We're passionate about protecting your good name. With over a century of dental malpractice expertise, we'll protect your practice so you can focus on building a career you love.





To learn more, contact our team or get a quote today.


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Additional Risk Tips content

How to Stay Passionate in Your Dental Career

Insights on sustaining passion in a dental career through education, community support, work-life balance, and meaningful patient relationships.

Dentist’s Choice of Radiographic Technique Leads to Lawsuit

In this case study, radiographic imaging decisions for a dental implant procedure leads to a malpractice suit. Read the case to learn how the case unfolded.

Clindamycin Side Effects Lead to Dental Malpractice Lawsuit

A dental malpractice case reveals the risks of clindamycin, informed consent gaps, and the impact of non-clinical staff advice on patient safety.

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and/or may differ among companies.

© MedPro Group Inc. All rights reserved.