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Patient Sues Dentist After Refusing X-Rays

Case Study

Marc Leffler, DDS, Esq.
June 26, 2025

Reading time: 8 minutes

Patient refusal is an aspect of dental care dentists must navigate. In this case study, a patient presents to her dentist with tooth decay but refuses x-rays. The dentist unsuccessfully attempts to treat the decay without x-rays. Later, the patient sues the dentist for negligence.

Key Concepts

Patient refusal in dental care
Informed consent and refusal
Dental standard of care

Underlying Facts

T, a 54-year-old woman, presented to her long-time general dentist, Dr. E, having not seen him for nearly 3 years, due in part to the COVID pandemic and in part to a “dislike” of going to the dentist. In the past, Dr. E had performed prophylaxis with spot deep scaling, as well as a number of 1- and 2-surface restorations. At the most recent prior visit, bitewings were taken, which were not concerning from the standpoint of decay. T’s oral hygiene had always left much to be desired, and her diet contained a good deal of sugary food and drink.

At the current visit, Dr. E performed a clinical examination. Several teeth had “explorer catches” on their occlusal surfaces, leading Dr. E to conclude that decay was present, at least occlusally, and he also saw indicators of potential interproximal decay. Dr. E explained that he needed to do a full-mouth series of radiographs, because it had been a number of years since they’d last been done, and to further assess the teeth of potential clinical concern. T said that she had been closely following a few online blogs which suggested that dental x-rays are damaging to the body and are not needed for dentists to make accurate diagnoses. Dr. E responded that he disagreed with those concepts, as did all of “mainstream dentistry.” He explained that there was no way to assess the condition of teeth by a clinical examination alone. But T persisted in her beliefs and insisted that Dr. E do whatever fillings he saw clinically fit.

Not wanting to leave obvious decay untreated, he relented and agreed to treat those teeth which he determined to be clinically decayed. With local anesthesia, he proceeded to excavate occlusal decay on teeth #s 19 and 20 and placed restorations in them. Dr. E then turned his attention to tooth #30. He found and removed a significant amount of occlusal decay which extended mesially and pulpally to the extent that it had invaded into the pulp chamber. When he explained to T that she would require root canal therapy, she became outwardly upset and demanded to know why she had not been advised of that prior to the start of treatment. Dr. E responded that T’s refusal to allow radiographs to be taken prevented him from knowing the extent of decay present. T eventually allowed the endodontic procedure to go forward, but when told that a post and crown would then be needed, she demanded that Dr. E perform those free of charge. He would not agree, so T left his care upon completion of the root canal therapy.

Nearly a year later, Dr. E received a call from a hospital dental resident who had admitted T for a severe infraorbital infection, secondary to a grossly decayed upper first molar. The resident explained that T advised her of recent treatment by Dr. E and wondered why that tooth had not been treated. Dr. E discussed the x-ray refusal, which heavily limited his diagnostic ability. T was treated with IV antibiotics and multiple I&Ds, remaining hospitalized for 4 days and incurring costs well above her insurance coverage.

Legal Action

Angered by those costs and her entire hospital experience, T retained an attorney to look into a potential dental malpractice suit against Dr. E. Once records were obtained, T explained to her attorney about the lower right tooth that started as a filling but ended up as a root canal, necessitating a post and crown which she could not afford. The attorney filed suit against Dr. E on behalf of T, asserting malpractice regarding his treatment of tooth #30 and his failure to diagnose decay on tooth #14 (thereby leading to the hospitalization and surgery). Following service of the legal papers, Dr. E advised his malpractice insurance company, which provided him with defense counsel.

In conjunction with filing an Answer, in which Dr. E formally denied all allegations, defense counsel filed a motion seeking summary judgment – essentially an early dismissal on the merits (or lack of merits) of the plaintiff’s case. Dr. E’s expert argued that Dr. E’s “hands were tied” by T’s refusal to allow any x-rays, thereby greatly limiting his ability to determine all that was going on in T’s mouth. In opposition to the motion, T’s counsel obtained an affidavit from an experienced dentist who would serve as an expert for T. The affidavit was to be included with the legal papers submitted to the judge in support of allowing the case to move forward. The thrust of T’s expert’s opinion was that Dr. E placed himself in a negligent position by acceding to the demands of his patient and proceeding with treatment that he acknowledged was based upon incomplete diagnostic information.

The judge denied Dr. E’s motion and allowed the case to move forward to be decided by a jury. Dr. E worked closely with his attorneys to weigh the strengths and weaknesses of T’s case and his own defense. In the end, Dr. E realized that, despite his best intentions, he had allowed his patient to dictate to him what he “must do,” rather than hold fast to principles he knew to be sound. Through negotiations, assisted by a court-appointed mediator, Dr. E consented to allow his carrier to pay, on his behalf, an amount of money which would, after attorney fees, reimburse T for her out-of-pocket hospital and medical expenses, but nothing more. T accepted that offer, resolving the case.

Takeaways

T fits into a category of a patient type sometimes referred to as “patient as dentist.” These patients, who tend to engage in litigation when the treatments they insisted upon do not turn out well for them, demand that their dentists go along with their dental treatment approaches. In effect, they are making decisions that are usually left to the discretion of the dentist. Patients have the absolute right to refuse any treatment they choose, but dentists ought not to allow a patient’s demand to carry the day. If a patient’s refusal places the dentist in the position that the dentist’s care (broadly viewed) would be compromised if carried out, then it is in neither the patient’s nor the dentist’s best interests to go forward with the demanded treatment.

Readers might reasonably stop at this point and rhetorically ask how this approach is not counter to the concept of informed consent, which contains the concept of advising patients of their options and then letting them decide which of those options they wish. The distinction lies in one word – “viable.” Obtaining a patient’s informed consent means allowing patient choices after advising them of the foreseeable risks, the benefits, and the viable options available. So, unless a patient like T were to insist upon an option that is dentally appropriate, that option is not viable, and therefore not one that falls within the bounds of informed consent. Here, the “option” that T created on her own – treating her caries without the benefit of radiographs – was not dentally appropriate, and therefore not viable, so it was not an option to have been exercised.

Dentists are ethically and legally bound to act toward their patients only in ways which fall within the standard of care, which is loosely defined as acting in ways that a reasonably prudent dentist would act under similar circumstances. While dentists will probably disagree as to how to interpret the components of that definition, it is fair to say that the vast majority of dentists would agree that this all boils down to doing what is in each patient’s best interests. And the vast majority of dentists will likely agree that – absent some rare, unusual circumstances – performing operative dentistry without having reviewed current radiographs first, is not in most patients’ best interests.

A thought process that likely passed through Dr. E’s mind was that, despite T’s refusal to allow x-rays, he was doing the patient a greater service than disservice by treating at least some of her decay. In that way, at least some teeth would be in a better state than if left untreated. Although arguably morally sound in concept, dental science generally does not subscribe to that reasoning, instead in favor of obtaining diagnostics before acting. That was the approach of T’s expert, and once hearing that, Dr. E realized that mainstream dentistry was not on the side of his compromise.

We conclude with a concept that is briefly and otherwise touched upon in this case study, namely the provision of dental services free of charge in order to calm down an upset patient. To start, that is a personal decision to be made in the face of very specific and individual people and events – there is no right or wrong. As with so many things in life, it involves a risk/reward analysis which is often far more subjective than objective. Dentists should consider that, at the time that such dentist-patient agreements are made, the patient is already dissatisfied and, depending upon personality, possibly thinking along litigious lines. So, when it comes to fee waivers, refunds, or the actual transfer of money to a patient, dentists can best protect themselves by engaging their malpractice carrier (or possibly a practice attorney) to make sure that any necessary paperwork is prepared and executed properly and to be certain that all state laws and regulations are fulfilled. The saying, “no good deed goes unpunished,” is best headed off prospectively.

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.

In this real-life case study, dentists will learn how a swallowed crown can quickly become a patient safety event and lead to a malpractice claim. See why prevention, timely follow-up, and patient communication are essential aspects of reducing risk.

Key Concepts

Swallowed crown led to malpractice lawsuit
Preventive steps to reduce swallow or aspiration risk
Compassionate communication and risk management

Background facts

E, a 64-year-old man who was markedly obese with type II diabetes and atrial fibrillation, presented for the insertion visit of a PFM crown on his upper right second molar, tooth #2. Getting to that point had been far from easy for both E and Dr. M, owing to limited opening ability and an excess of facial soft tissue. Preparation for the crown and impressioning had each taken a full visit for the very same reasons. Suffice it to say, as Dr. M later did, there was very little room to work in E's mouth. No local anesthesia was given for this visit; as Dr. M placed the crown for what would be the final try-in, his finger incidentally made contact with E's soft palate, causing him to gag and unexpectedly move forcefully, which then caused the crown to slip out of Dr. M's wet gloved hand, and out of sight. Dr. M, an experienced practitioner nearing the end of his career, who liked to work "solo", called an assistant into the room to suction the oropharynx of the supine patient, with the hope of finding the crown tucked into a tissue fold. The crown was not found.

Dr. M explained that he would need to take another impression because the crown had "slipped behind the mouth"; he did just that over the next hour. As E was being dismissed, Dr. M said that the crown will work its way down the intestines, to be voided in the stool: E should inspect his stool over the following few days, to the extent reasonable, but he shouldn't overly worry about it. E left the office, expecting to return in 10 days for the new crown to be inserted.

On the fourth day after this visit, E noticed that his stool was blood-tinged, so he called Dr. M to learn whether that might be related to the dropped crown, but Dr. M did not think so. He did, though, advise E to speak with his primary care physician if things worsened or even remained the same. The stool got redder toward the end of the week, so, that Sunday, he appeared at an urgent care center, where, upon hearing about the dental crown incident, the physician ordered an abdominal series of radiographs, which located the crown, appearing to be stuck in place at a sharp bend in E's colon. Arrangements were made for E to have a colonoscopy the following morning at a local hospital, where E was admitted for the night.

Under deep sedation, a gastroenterologist removed the crown from the colon by using a grabbing instrument. When the crown was examined after removal, the gastroenterologist reasoned that the metal edge of the crown that projected below the porcelain portion — the margin — had likely dug its way just a small amount into a fold in the wall of the colon, preventing it from moving beyond that point to be expelled. Because of E's underlying medical conditions, he was kept in the hospital until the next day, at which time he was discharged without any problems or complications.

Legal action

Although E was willing to let the situation end without any further action, his wife was particularly annoyed about the hospital, anesthesiology, and gastroenterology fees, which were not covered by E's high-deductible medical insurance policy, as well as what she viewed as Dr. M's lack of caring, as demonstrated by his having never followed up with E about what had occurred.

An attorney was brought on board to sue Dr. M for dental malpractice, so that the out-of-pocket costs and a sum for pain and suffering could be recovered. The attorney's first step was to contact Dr. M's malpractice carrier, specifically its regional claims consultant. When all records were obtained and reviewed, the claims consultant explained to Dr. M that a supportive defense expert was unable to be located, even by a local defense attorney, so that a liability defense could not be mounted, other than by way of Dr. M acting as his own liability expert.

Dr. M realized that this was far from an ideal approach, so he agreed to attempts to settle the case, which was accomplished for a relatively modest amount of money.

Takeaways

Under the best of circumstances, maintaining a grip on small objects placed in the mouth, using wet gloves, is fraught with the risk of losing control of the object — here a crown. When treatment is performed in the back of the mouth, that risk is magnified, and when the patient's anatomy makes the working space smaller than usual, the risk further increases. Adding to that, the gravitational considerations of a supine (rather than upright) patient maximize the likelihood of a dropped object being swallowed or aspirated. Each of these "weak points" can generally be mitigated: oropharyngeal packs are placed to try to physically block the backward and downward path, particularly when rubber dam cannot be used; working with a watchful, suctioning chairside assistant provides extra hands, extra eyes and extra protective devices; and seating a patient in as upright a position as possible can mean the difference between a dropped object falling harmlessly into the floor of mouth where it is easily retrievable, and a swallow/aspiration event.

Any and every time that an object is placed into the mouth, or one becomes free-floating in the mouth, and cannot be accounted for, it should be assumed to have been swallowed or aspirated unless proven otherwise, generally by radiographic evidence either way. As a general rule, the sooner the patient is able to be placed into the care of medical colleagues for locating and treating, the less the ramifications will be. That does not necessarily mean that dental procedures must always be stopped in their tracks, but it does mean that, as soon as it is safe for the patient to move on for definitive care, the better off they will usually be. Because physicians are often less than fully aware of dental materials and instruments, it is helpful to them if a photo example, or actual example, is provided to the patient to pass on to their physicians, so that they know exactly what they are looking to locate.

Two considerations which quite often lead patients to seek legal advice are unexpected and unreimbursed costs, and a perception that their dentist did not truly care about them, particularly when things did not go as planned. The former is unpredictable, and it ended up here as one of the main drivers toward legal action, but the latter can almost always be avoided. Prompt and repeated follow-up communication, by the dentist, rather than an office staff member, with patients; and demonstrating a genuine interest in patients, as people and not only "receivers of dentistry"; can go a long way toward heading off involvement of lawyers.

Not all patients and not all similar procedures are the same, whether because of underlying medical issues, patient anatomy, patient size, patient attitudes, or limited mobility. So, a one-size-fits-all approach is rarely, if ever, a helpful treatment mindset to adopt.

Finally, we address the circumstance here, where no liability expert could be found to help to defend Dr. M. While not very common in the defense of dental malpractice claims, it does occasionally pop up. In most, if not all, jurisdictions, dentists are legally permitted to serve as their own experts. But in the eyes of jurors, that is often a difficult sell. In this situation, as well as all other litigation-related issues, dentists are counseled by their defense attorneys, whether the news is easy to hear, or not.

Summary of takeaways:

Take an objective, measured approach to patient communication
Avoid criticizing prior care without full context
Maintain thorough documentation to support care decisions

Sometimes criticizing a patient’s prior dental work can expose dentists to malpractice risk. Understand where the line lies between appropriate patient education and “jousting,” and how communication choices, documentation, and professionalism can influence legal outcomes.

Key Concepts

How criticizing prior work can increase malpractice risk
Keep communication objective and professional
The importance of strong documentation during a claim

Background facts

Dr. Y was a general, restorative dentist who recently moved into a suburban community—with great public schools—to both live and work. The area's dentists were, generally speaking, busy but not bursting at the seams, so Dr. Y realized that it would not be easy for him to establish his practice with so much competition. His approach would be to sign on to as many dental insurance panels as he could, hoping to use that platform as a foundation upon which to build a patient base. It took a couple of years, but his practice grew.

It was not that Dr. Y would "manufacture" dentistry to perform upon new patients where that need did not exist, but he was what other dentists in the neighborhood described behind the scenes as "hyper-critical" in his evaluations of the dentistry that had been done by prior dentists. R had been a long-term resident of the area, having never had dental insurance until her recent job change. She had completed implant-supported bridgework on both arches some 6-8 months ago, which had cost her a significant amount of money, and she was in the midst of a very slow process of getting used to functioning with the prostheses. With her new employer now providing her with dental insurance—a plan which Dr. Y, but not her prior dentist, Dr. K, accepted—she presented to Dr. Y as a new patient.

At the initial visit, Dr. Y took a full mouth series of radiographs and did a thorough clinical examination. When R mentioned that she "just didn't feel comfortable" with the new dentistry in her mouth, Dr. Y told her that he knew why: the abutments and pontics were overbuilt, with inadequate embrasure spaces; some of the margins were open, although slightly; and the overall dental anatomy did not allow for self-cleansing, making it "a set-up for periodontal disease.” Dr. Y suggested that all of the prosthetics be removed and replaced. Even with R's dental insurance contributing a fair amount to the cost of the proposed treatment, she would still have to pay a large amount of money out of pocket and endure a months-long process. R was very upset, to say the least, focusing that displeasure on Dr. K; she had always known that a replacement of Dr. K's work would likely be required down the road, but she did not expect that so soon after it was inserted.

Dr. Y removed the existing bridges, replaced the implant abutments, re-prepared the natural teeth, impressioned and temporized the mouth, and ultimately inserted new upper and lower cases. R was no happier with the new work, but Dr. Y told her that there was only so much he could do with the underlying foundation that Dr. K had "inadequately established,” so R would simply have to adjust. She never fully did.

Legal action

With R continually complaining to family members and friends about how unhappy she was, not only dentally, but also because of the money she had paid both Dr. K and Dr. Y, while exhausting her annual dental insurance benefits so early in the calendar year, she was encouraged to seek out an attorney who might have some solutions for her. R's newly retained attorney obtained the dental records of Drs. K and Y, as well as a narrative from Dr. Y, in which he was quite critical of Dr. K's work product, which was directly responsible for the need to exchange it and for the inability to create a more ideal replacement (due to the underlying damage it/he had caused).

When Dr. K reported the contact from R's attorney to his malpractice carrier, he was provided with defense counsel, who was able to obtain the records and report from Dr. Y. Dr. K was in literal disbelief at what he saw in writing, but he knew that it would be a difficult task, from a dental standpoint, to demonstrate the quality of his work, with it having been removed and replaced. At the same time, he felt bad for R, his patient of many years, whom he believed had been sold an inaccurate story, for the sake of Dr. Y's financial gain.

With Dr. K's counsel functioning as an intermediary at Dr. K's request, an offer was made to refund to R all that she had paid to Dr. K, in order to stave off the prospect of a lawsuit. R, through her attorney, accepted that offer, with the money changing hands once R executed a Release of Liability document.

Takeaways

As healthcare professionals, dentists are ethically obligated to advise patients regarding the conditions of their mouths, including the status of existing dental work. But without having ever stood in the shoes of a prior-treating dentist, and not knowing what challenges and limitations might have been placed upon them, or how the patient took care of themselves dentally after that treatment, blanket criticisms that do not take any of these potential factors into account are known in the malpractice world as "jousting" —not the medieval game involving horses and lances, but with similar effect. Part of professionalism is being able to candidly communicate with patients without denouncing the work of others, absent full knowledge of all contributing factors. Here, while Dr. Y acted appropriately by advising R of his findings—presuming that he did, in fact, find deficiencies and problems—he stepped into the jousting arena by doing so in a manner that made certain presumptions of blameworthy wrongdoing. It is a fine line to walk, and one to be figured out by all practitioners. Jousting, as compared with notifying, is a significant driver of dental malpractice claims; why that practice is as common as it is, perhaps more so than in other professions, is a speculative exercise for consideration elsewhere.

Dr. K's decision to try to resolve R's complaints by offering, and ultimately providing, a refund was a personal one, considering all of the issues involved with defending a protracted dental malpractice case, as compared with taking all of that off of his plate quickly. Refunds are far from uncommon in dental practice; when provided, dentists are wise to protect themselves legally by obtaining a Release of Liability (ROL), signed by the patient, in exchange for the returned money. In essence, a ROL in this context states that the patient is willing to accept a monetary benefit, while relinquishing the right to later sue the dentist regarding the course of conduct that led to that refund. As with all legal documents, ROLs are best prepared and overseen by attorneys, who can assure that the process is carried out in the most appropriate manner, so as to afford the best level of protection. We do note, however, that no ROL will prevent a patient from subsequently making a complaint to a state Dental Board, as the right to report to government entities cannot be given up through a civil process, such as a refund or a settlement. For better or worse, that is the way it is.

Dr. Y's preparation of a narrative for an attorney is an everyday occurrence. In many jurisdictions, attorneys for patient-plaintiffs are required to obtain some sort of statement, whether written or otherwise, from a dentist, in which that dentist states, in terms of varying specificity, that the treating dentist who is being considered as a potential defendant violated the standard of care, thereby leading to damage to the patient. Such statements are opinions, and opinions vary much of the time, but that is how the system works. To add to the difficulties in defending cases like this, particularly involving restorative dentistry, the work that is later claimed to have been deficient will, by definition, have been removed and replaced, so there can be no after-the-fact reviewing of the criticized work by the defendant and/or his/her defense expert. That serves as yet another reason that documentation (including post-placement radiographs, when appropriate) is so important, as it might well be the only "living" evidence of steps taken and rationales for doing so. Time-consuming as it is, documentation is not something to shortcut: that includes dentists writing their own chart entries, rather than having an assistant or other staff member do it for them.

Summary of takeaways:

Criticizing prior work without full context can increase malpractice risk.
Keep patient communication objective and avoid assigning blame.
Thorough documentation is critical for defending care decisions.

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A teen patient’s persistent maxillary pain led to multiple root canal treatments, but the true cause went undiagnosed for months. The case highlights the risks of narrow diagnosis, missed referrals, and how treating a minor can extend malpractice exposure well beyond the expected timeframe.

Key Concepts

Malpractice risks associated with missed diagnoses
Minors and the statute of limitations
The importance of tail coverage

Background facts

Dr. S was a well-experienced dental practitioner who focused on the care of children, although not a pediatric dentist: she found the work challenging, yet rewarding, especially when those children later brought their own children to be treated. R, age 16, was one such patient, whose father, as a teenager, treated with Dr. S when she was new to practice. Severe, right maxillary pain, with persistent headaches led R to come to the office, outside of the routine of his usual 6-month recall visits. By way of evaluating appropriate periapical films of the upper right molars and premolars, as well as a clinical examination with multiple dental testing modalities that demonstrated equivocal findings, Dr. S concluded that the problem was most likely originating with tooth #3 and/or tooth #4, as both had deep MOD restorations placed approximately 3 years prior.

The more likely offending tooth, in the opinion of Dr. S, was the first molar, so, with the approval of R's father, root canal therapy was completed on that tooth, without any apparent complication, and with the finding of a vital pulp. Nearly a month later, R's symptoms continued as before the endodontic treatment, so, again with the father's agreement, Dr. S completed RCT on tooth #4, also without complication and also with a vital pulp. Despite both teeth being subsequently restored, R's initial presenting complaints remained, and were even subjectively worse, now approaching 6 months later; additionally, R began to have right-sided sinus congestion.

R's parents arranged for him to see an ENT, who, after performing a limited clinical assessment, sent R for a CT of the sinuses. The study clearly showed a well-circumscribed, lima-bean-sized mass in the right maxillary sinus, located seemingly entirely deep to the Schneiderian Membrane and just above the maxillary posterior teeth. Because of its localized appearance, the ENT expressed to R and his parents that the lesion was likely benign, so a plan was developed to perform an exploratory surgical procedure, through a Caldwell-Luc approach, to excise the mass and examine it microscopically. Surgery at a local hospital went forward under general anesthesia, with the lesion removed and the sinus debrided. The biopsy report determination was that the lesion was a polyp which was, as anticipated, benign and in need of no further treatment.

Within 2 weeks, R was, for the first time in the better part of a year, free of pain and headaches. The ENT concluded and stated to his patient and his parents that all of the symptoms were all along not due to any dental problem, but instead the sinus polyp. It was not until over a year after the RCTs were completed that R's father questioned Dr. S as to why she failed to diagnose "something" abnormal in the sinus, why she failed to consider any source for R's complaints other than teeth, and why she performed root canal therapy on 2 teeth without any objective basis for doing so. Although she apologized and expressed empathy for all that R had gone through, she was not able to provide any answers to the direct questions posed to her.

Legal action

R's father read online that teeth which have had root canal therapy are more likely to fracture, and therefore be prematurely lost, so he began to consider costs that would likely and unnecessarily need to be borne by R in the future, as well as the emotional distress he would endure if he had to go through multiple dental extractions and their replacements. He sought out and retained an attorney to act on his son's behalf by suing Dr. S for dental malpractice.

When Dr. S was served with papers that had commenced a lawsuit against her, she was immediately faced with a practical reality that she was aware of but had not realistically considered would arise: she had recently changed malpractice carriers but had not purchased extended reporting coverage – a "tail" – for the first carrier's claims-made policy; because the treatment of R which was at issue took place during the period of the earlier policy, she had no insurance coverage, either for defense or indemnification (payment). After looking at the legal costs she would have to personally bear as a result, she opted to represent herself – acting pro se – counting on some "unofficial" help from a close friend who was an attorney, although not one who had ever practiced in the professional malpractice arena.

Dr. S learned that the state in which she practiced dentistry had a 1-year statute of limitations period for dental malpractice cases, meaning, as she interpreted it, that no such suit against her could validly go forward if it had been started more than 1 year after the date(s) of the claimed negligent treatment, as this suit had. She asked her attorney friend what she could do to stop the suit in its tracks because it was not timely begun: her friend said that the mechanism for doing that was to make a motion to the court for dismissal, on that specific basis. With her friend unwilling to assist her beyond that sole piece of advice, Dr. S thoroughly researched how to place that before the court, realizing that this was her only true hope to be successful in defending the case, acknowledging that she had fallen short in diagnosing the actual problem R had, and instituting incorrect and unneeded treatment. Dr. S's motion was quickly and decisively opposed by the lawyer for the plaintiffs, R and his father.

The opposition made it clear that Dr. S had relied on only a portion of the law which guided the statute of limitations, ignoring the critical part here, namely that R, as a minor, was entitled to an extension of that time period, such that he was permitted to file his case until 1 year after he reached the age of majority; given that R was well short of age 19, the judge denied Dr. S's motion and allowed the case to move forward. This left Dr. S with 3 basic options: (1) hire a lawyer to represent/defend her (which she was not willing to do); (2) continue to represent herself through discovery and potentially trial; or (3) try to reach a settlement to end the case. She weighed the costs, likelihood of success, and an unknown amount of money to be paid out if R later prevailed, if she proceeded with her defense, versus taking the bitter pill right then and there, and resolving the case for a sum of money that would be acceptable to all involved. She opted for the latter, and was able to work with R's attorney to reach an amicable settlement amount, which covered out-of-pocket expenses and compensation for R's pain and suffering after Dr. S completed her treatment.

Takeaways

The statute of limitations is the amount of time a plaintiff has to initiate suit. States differ as to whether that time clock begins at the time of the negligent action, or when the effects of that negligent action are discovered, or small variations on those themes. But regardless of those differences, the amount of time allowed by each state is strictly fixed for the vast majority of cases. The most frequent exception in nearly all, if not all, of the states is that minors are entitled to an extended amount of time within which to begin a suit in dental malpractice, with the exact length of that time extension also specific to each state. As a tandem concept, many states also require that dentists maintain records for minors longer than for adult patients; practitioners need to be aware of these details, lest they destroy records prematurely, thereby setting up significant legal issues if they cannot produce records during litigation or in response to a Board complaint, at a time when they should still have been maintained.

This case speaks also to both the type and quality of radiographs. Here, while Dr. S was able to radiographically visualize the entirety of the teeth she treated, which is a generally agreed-upon requirement in the dental community, she was unable to visualize the neighboring maxillary sinus. While dentists might legitimately debate whether Dr. S should have taken or ordered a radiographic study (such as a panoramic or CBCT) that also captured the sinus, there is no such dispute that, regardless of how and with what diagnostics she went about it, it was her obligation to assure that she was treating the situation for which the patient was seeking treatment. According to the ENT – by way of what might reasonably be viewed as a joust – Dr. S did not do so. But whether a joust or simply a statement of symptom causation, it was that conclusion by the ENT which most prominently led Dr. S to settle the matter rather than fight it.

Finally, we address the factors which left Dr. S without professional liability coverage: her claims-made policy and her not having purchased a tail upon leaving that policy behind in favor of another. While an occurrence policy will forever protect a dentist – whenever a lawsuit might be filed – if a negligent action took place while that policy was in effect, a claims-made policy will only provide coverage if it is in effect at the time a claim of negligence/malpractice is made, unless a tail was purchased to extend the coverage umbrella of a claims-made policy which is no longer in effect. Some exceptions to the need for a tail – such as death, disability, or retirement – might exist, based upon the stated policy terms, but for the most part, it is the norm that a dentist will be left as Dr. S was if they close a claims-made policy without purchasing tail coverage.

Summary of takeaways:

Broaden the diagnosis: Persistent or unclear symptoms should prompt consideration of non-dental causes and appropriate referral.
Avoid unnecessary treatment: Repeating irreversible procedures without clear evidence increases patient harm and liability risk.
Know your legal exposure: Treating minors can extend the statute of limitations, and gaps in malpractice coverage can leave you personally liable.

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Key Concepts

Swallowed crown led to malpractice lawsuit
Preventive steps to reduce swallow or aspiration risk
Compassionate communication and risk management

Background facts

Legal action

Dr. M realized that this was far from an ideal approach, so he agreed to attempts to settle the case, which was accomplished for a relatively modest amount of money.

Takeaways

Summary of takeaways:

Take an objective, measured approach to patient communication
Avoid criticizing prior care without full context
Maintain thorough documentation to support care decisions

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Additional Risk Tips content

How a Dropped Crown Led to a Malpractice Lawsuit

A dropped crown became a malpractice claim. Learn how prevention, follow-up, and patient communication can help reduce dental risk.

Dentist’s Criticism of Prior Work Leads to Malpractice Claim

Criticizing prior dental work can heighten malpractice risk. Learn how communication, professionalism, and documentation influence legal outcomes.

How Minor Patients Extend Dental Malpractice Case Timelines

A misdiagnosed teen patient undergoes unnecessary root canals, revealing key risks in narrow diagnosis, delayed referral, and extended malpractice exposure due to minor status.

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.