Posted on by summerfoster
Practice More Safely // Risk Tips // Dentist’s Choice of Radiographic Technique Leads to Lawsuit

Dentist’s Choice of Radiographic Technique Leads to Lawsuit

Marc Leffler, DDS, Esq.
February 27, 2026

Reading time: 8 minutes

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.

			WP_Query Object
(
    [query] => Array
        (
            [post_type] => post
            [showposts] => 3
            [post__not_in] => Array
                (
                    [0] => 10240
                )

            [post_status] => publish
            [has_password] => 
            [cat] => 1365
        )

    [query_vars] => Array
        (
            [post_type] => post
            [showposts] => 3
            [post__not_in] => Array
                (
                    [0] => 10240
                )

            [post_status] => publish
            [has_password] => 
            [cat] => 1365
            [error] => 
            [m] => 
            [p] => 0
            [post_parent] => 
            [subpost] => 
            [subpost_id] => 
            [attachment] => 
            [attachment_id] => 0
            [name] => 
            [pagename] => 
            [page_id] => 0
            [second] => 
            [minute] => 
            [hour] => 
            [day] => 0
            [monthnum] => 0
            [year] => 0
            [w] => 0
            [category_name] => practice-more-safely
            [tag] => 
            [tag_id] => 
            [author] => 
            [author_name] => 
            [feed] => 
            [tb] => 
            [paged] => 0
            [meta_key] => 
            [meta_value] => 
            [preview] => 
            [s] => 
            [sentence] => 
            [title] => 
            [fields] => all
            [menu_order] => 
            [embed] => 
            [category__in] => Array
                (
                )

            [category__not_in] => Array
                (
                )

            [category__and] => Array
                (
                )

            [post__in] => Array
                (
                )

            [post_name__in] => Array
                (
                )

            [tag__in] => Array
                (
                )

            [tag__not_in] => Array
                (
                )

            [tag__and] => Array
                (
                )

            [tag_slug__in] => Array
                (
                )

            [tag_slug__and] => Array
                (
                )

            [post_parent__in] => Array
                (
                )

            [post_parent__not_in] => Array
                (
                )

            [author__in] => Array
                (
                )

            [author__not_in] => Array
                (
                )

            [search_columns] => Array
                (
                )

            [ignore_sticky_posts] => 
            [suppress_filters] => 
            [cache_results] => 1
            [update_post_term_cache] => 1
            [update_menu_item_cache] => 
            [lazy_load_term_meta] => 1
            [update_post_meta_cache] => 1
            [posts_per_page] => 3
            [nopaging] => 
            [comments_per_page] => 50
            [no_found_rows] => 
            [order] => DESC
        )

    [tax_query] => WP_Tax_Query Object
        (
            [queries] => Array
                (
                    [0] => Array
                        (
                            [taxonomy] => category
                            [terms] => Array
                                (
                                    [0] => 1365
                                )

                            [field] => term_id
                            [operator] => IN
                            [include_children] => 1
                        )

                )

            [relation] => AND
            [table_aliases:protected] => Array
                (
                    [0] => wp_term_relationships
                )

            [queried_terms] => Array
                (
                    [category] => Array
                        (
                            [terms] => Array
                                (
                                    [0] => 1365
                                )

                            [field] => term_id
                        )

                )

            [primary_table] => wp_posts
            [primary_id_column] => ID
        )

    [meta_query] => WP_Meta_Query Object
        (
            [queries] => Array
                (
                )

            [relation] => 
            [meta_table] => 
            [meta_id_column] => 
            [primary_table] => 
            [primary_id_column] => 
            [table_aliases:protected] => Array
                (
                )

            [clauses:protected] => Array
                (
                )

            [has_or_relation:protected] => 
        )

    [date_query] => 
    [request] => SELECT SQL_CALC_FOUND_ROWS  wp_posts.ID
					 FROM wp_posts  LEFT JOIN wp_term_relationships ON (wp_posts.ID = wp_term_relationships.object_id)
					 WHERE 1=1  AND wp_posts.ID NOT IN (10240) AND ( 
  wp_term_relationships.term_taxonomy_id IN (11)
) AND wp_posts.post_password = '' AND wp_posts.post_type = 'post' AND ((wp_posts.post_status = 'publish'))
					 GROUP BY wp_posts.ID
					 ORDER BY wp_posts.post_date DESC
					 LIMIT 0, 3
    [posts] => Array
        (
            [0] => WP_Post Object
                (
                    [ID] => 10262
                    [post_author] => 180159417
                    [post_date] => 2026-02-19 02:56:58
                    [post_date_gmt] => 2026-02-19 07:56:58
                    [post_content] => 











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.


                    [post_title] => How to Stay Passionate in Your Dental Career
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
                    [post_password] => 
                    [post_name] => how-to-stay-passionate-in-your-dental-career
                    [to_ping] => 
                    [pinged] => 
                    [post_modified] => 2026-02-25 08:18:48
                    [post_modified_gmt] => 2026-02-25 13:18:48
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => https://medprodental.com/?p=10262
                    [menu_order] => 0
                    [post_type] => post
                    [post_mime_type] => 
                    [comment_count] => 0
                    [filter] => raw
                )

            [1] => WP_Post Object
                (
                    [ID] => 10195
                    [post_author] => 180159417
                    [post_date] => 2026-01-09 04:03:29
                    [post_date_gmt] => 2026-01-09 09:03:29
                    [post_content] => 











In this case study, dentists will discover how a patient’s preference to complete treatment in a single stage—rather than the clinician-recommended two-stage approach—combined with antibiotic selection and non-clinical staff advice, ultimately 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.


                    [post_title] => Clindamycin Side Effects Lead to Dental Malpractice Lawsuit
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
                    [post_password] => 
                    [post_name] => clindamycin-side-effects-lead-to-dental-malpractice-lawsuit
                    [to_ping] => 
                    [pinged] => 
                    [post_modified] => 2026-03-13 09:01:17
                    [post_modified_gmt] => 2026-03-13 13:01:17
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => https://medprodental.com/?p=10195
                    [menu_order] => 0
                    [post_type] => post
                    [post_mime_type] => 
                    [comment_count] => 0
                    [filter] => raw
                )

            [2] => WP_Post Object
                (
                    [ID] => 10163
                    [post_author] => 180159417
                    [post_date] => 2025-12-23 09:28:00
                    [post_date_gmt] => 2025-12-23 14:28:00
                    [post_content] => 











Description / Intro                                                     





Ever wondered what happens when dentists step into sleep medicine without the right safeguards? This real-life case study shows how an Obstructive Sleep Apnea (OSA) treatment went wrong - leading to broken appliances, unexpected costs, a dental board complaint, and a malpractice claim.









Key Concepts





    

  • Practicing within your scope
    • 




  • Malpractice litigation which includes Dental Board findings 
    • 




  • Attorney analysis in dental malpractice claims
    • 










Background facts





C presented to the dental office of Dr. M, based upon Dr. M's social media advertising that C's adult children had seen. At the time, C was 71 years old, obese with a large neck circumference, and, according to his wife, a frequent and loud snorer. Although retired, he often felt tired and struggled to get through the day without a nap. Upon meeting with his new patient, Dr. M expanded upon his online ads, explaining how he had managed many patients with sleep disorders that negatively and significantly had impacts upon their sleeping and waking lives. Dr. M initially suspected, based upon C's outward physical appearance and related history, that C was suffering from some degree of obstructive sleep apnea (OSA).





Dr. M did an oral examination, noting enlarged tonsils, a seemingly large tongue, dental wear consistent with bruxism, and mild mandibular retrognathia, all of which are frequent findings in patients with OSA. To work toward determining the validity of a presumptive OSA diagnosis, Dr. M suggested that C undergo home sleep apnea testing (HSAT) by using a kit that Dr. M was able to obtain from an overseas manufacturer and source. The process would involve C self-applying a device at home - just prior to going to sleep – with a number of sensors that measure parameters associated with assessing oxygenation, airflow, and breathing effort/patterns, among others. Dr. M explained that, if the OSA diagnosis was confirmed, he would be able to treat C dentally and reduce his life-disrupting symptoms. C was fully on board.





Dr. M obtained the HSAT device, instructed C on its use (which would involve applying it for only one night), and asked him to return upon its completion so that he could analyze the raw data. C did as he was asked, leading to Dr. M diagnosing what he characterized as "moderate to severe OSA." Dr. M fabricated an acrylic oral appliance to be worn while sleeping, the stated purpose of which was to pull the mandible and tongue forward, thereby opening the oral airway space and keeping it that way during sleep. After wearing the device for several weeks, C (and his wife) saw no benefits; rather, C was experiencing TMD-type muscle pain, which was new for him. Dr. M's response to C was that the process takes time, so he should continue on.





At approximately 3 months after the appliance was first used, C suddenly awoke to severe coughing and feeling a sharp edge on the appliance, which had clearly broken into pieces, likely (according to Dr. M's later statements) due to C's heavy bite and grinding. C was unable to locate some of the broken pieces, and he had persistent coughing and sharp pain in his throat. An emergency room physician determined that C had swallowed a few pieces of cracked acrylic; an endoscopy under general anesthesia was required for their removal, after which C remained hospitalized for a day, to be certain that there was no latent bleeding from the esophagus or stomach. His discomfort remained for some time, and he never returned to Dr. M for a new appliance to be made.





C submitted his bills to his medical and dental insurance carriers. While some of the hospital costs were covered, neither carrier reimbursed for Dr. M's fees, stating that Dr. M was not the type of provider fit to diagnose OSA without collaboration with a physician; as such, the high costs of the HSAT, the dental work-up, and the appliance had to be fully borne by C.





Legal action





C was upset about the costs that he had not anticipated, so he sought out a lawyer's opinion as to whether and how they could be recovered. In speaking with the attorney, the discussion led to C's "choking" experience, his hospitalization, and his subsequent discomfort.





Both agreed on an approach to sue Dr. M for dental malpractice (in fabricating the type of appliance that would be subject to breakage – and its consequences - due to C's known bruxing tendencies), and filing a Dental Board complaint, employing the concepts C heard from the insurance companies, that Dr. M had practiced beyond his lane. C's attorney was of the view that a Board finding against Dr. M, for essentially practicing outside of the dental profession's limits, would help the cause in the parallel malpractice case.





The attorney was correct. Following a Board hearing, at which Dr. M was represented by the attorney defending the malpractice case against him, Dr. M was sanctioned, with the Board determining that, in the State where Dr. M practiced, dentists are not permitted to diagnose OSA on their own, with that being solely within the purview of physicians; the Board reasoned that OSA is a medical (not dental) diagnosis, and while dentists may properly treat OSA using dental modalities, the process of testing and analyzing test results is not part of the practice of dentistry. Concerned about the potential impact of that finding by the Board upon a malpractice trial jury, Dr. M agreed with the suggestion of his attorney that the malpractice case should be settled, which it was. The monetary amount of settlement was modest, given that it was limited to the actual out-of-pocket medical and dental costs, a relatively small degree of pain, and the lack of any permanent injuries.





Takeaways





States might differ as to what they consider to be within the bounds of dentistry, and that might sometimes be even more tailored based upon specialty training and experience. As an example, treatment of the zygoma might be acceptable for an oral surgeon, but perhaps not for other dental practitioners. The bottom line is that dentists are wise to check into definitions of the "practice of dentistry" prior to engaging in areas outside of what is thought of as "traditional" dentistry. The same goes for related diagnostic testing, as explained in this case study by the Board. It is worth noting that it is far from unusual that an acrylic oral appliance might break due to occlusal stresses, which would most likely not be negligent (although it might be argued as such here in the face of C's bruxism); but bruxism aside, the difference here is that the breakage event took place as a by-product of – at least according to this Dental Board – a rule violation, which some lawyers might refer to as negligence per se, giving the malpractice case an entirely new complexion (, one that can be explored more deeply in a future case study).





Specifically with regard to the facts involved here, and as obvious as this sounds, OSA is a serious medical condition, with general systemic implications that go well beyond dentistry. If the facts of this case study were to have changed, such that, instead of the injury being a broken acrylic appliance and its associated complications, C had suffered an MI or a stroke as a result of inadequately addressed OSA that was thereby allowed to worsen, the results for both C and Dr. M could have been far more severe.





While often overlooked, a significant driver of malpractice claims is a money-based issue, whether it is fees seen by a patient as excessive, or non-reimbursement by a health insurance carrier (as here), or attempts by a dentist to collect unpaid fees, or unanticipated subsequent costs, or prolonged time out of work so as to cause loss of income. Looking below the surface, it is not necessarily only these financial considerations that come into play in malpractice lawsuits; they may well serve as the basis for a patient to seek legal counsel, which then extends to more avenues of investigation, which then leads to different and more components to the suit. Money disputes can spur a patient's initial actions, but they are often not the end of the story.





We end with some thoughts about the analytical processes engaged in by attorneys, who are significant players for both the patient-plaintiff and the dentist-defendant. Attorneys for plaintiffs, especially those who are seasoned, understand, and often apply a multi-pronged approach against dentists on behalf of their clients. That might be seen by some as a "whatever sticks to the wall" tactic, which can be distasteful to defendants. This is far from unusual, particularly at the start of cases; as cases mature, though, the stronger aspects remain, while the weaker ones fall away: the discovery component of litigation is a critical factor in developing the points of focus which will be the heart of the trial. C's attorney reasoned, in good faith (as attorneys are required to do), that the pressures placed by both a Board action and a malpractice suit would work to his client's benefit in the end; that is not always the case, either in approach or result, but defendant-dentists ought not be surprised if they find themselves on the receiving end.





Attorneys for defendants go through their own analyses, sometimes to answer strategies by their counterparts, but other times to steer the ship independently, which can effectively thwart the actions of plaintiffs' attorneys and take them away from planned techniques. The world of litigation is cat and mouse, working with facts, law, and personalities. All told, litigation styles are unique, with those employed in a given case needing to comport with the available facts, the law, and the people involved. It is complicated but rarely dull.





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







                    [post_title] => Dental Malpractice Risks in Treating Obstructive Sleep Apnea
                    [post_excerpt] => 
                    [post_status] => publish
                    [comment_status] => closed
                    [ping_status] => closed
                    [post_password] => 
                    [post_name] => dental-malpractice-risks-in-treating-obstructive-sleep-apnea
                    [to_ping] => 
                    [pinged] => 
                    [post_modified] => 2026-01-16 12:16:45
                    [post_modified_gmt] => 2026-01-16 17:16:45
                    [post_content_filtered] => 
                    [post_parent] => 0
                    [guid] => https://medprodental.com/?p=10163
                    [menu_order] => 0
                    [post_type] => post
                    [post_mime_type] => 
                    [comment_count] => 0
                    [filter] => raw
                )

        )

    [post_count] => 3
    [current_post] => -1
    [before_loop] => 1
    [in_the_loop] => 
    [post] => WP_Post Object
        (
            [ID] => 10262
            [post_author] => 180159417
            [post_date] => 2026-02-19 02:56:58
            [post_date_gmt] => 2026-02-19 07:56:58
            [post_content] => 











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.


            [post_title] => How to Stay Passionate in Your Dental Career
            [post_excerpt] => 
            [post_status] => publish
            [comment_status] => closed
            [ping_status] => closed
            [post_password] => 
            [post_name] => how-to-stay-passionate-in-your-dental-career
            [to_ping] => 
            [pinged] => 
            [post_modified] => 2026-02-25 08:18:48
            [post_modified_gmt] => 2026-02-25 13:18:48
            [post_content_filtered] => 
            [post_parent] => 0
            [guid] => https://medprodental.com/?p=10262
            [menu_order] => 0
            [post_type] => post
            [post_mime_type] => 
            [comment_count] => 0
            [filter] => raw
        )

    [comment_count] => 0
    [current_comment] => -1
    [found_posts] => 77
    [max_num_pages] => 26
    [max_num_comment_pages] => 0
    [is_single] => 
    [is_preview] => 
    [is_page] => 
    [is_archive] => 1
    [is_date] => 
    [is_year] => 
    [is_month] => 
    [is_day] => 
    [is_time] => 
    [is_author] => 
    [is_category] => 1
    [is_tag] => 
    [is_tax] => 
    [is_search] => 
    [is_feed] => 
    [is_comment_feed] => 
    [is_trackback] => 
    [is_home] => 
    [is_privacy_policy] => 
    [is_404] => 
    [is_embed] => 
    [is_paged] => 
    [is_admin] => 
    [is_attachment] => 
    [is_singular] => 
    [is_robots] => 
    [is_favicon] => 
    [is_posts_page] => 
    [is_post_type_archive] => 
    [query_vars_hash:WP_Query:private] => 6d9f2f50d869c2593887eb3515556569
    [query_vars_changed:WP_Query:private] => 
    [thumbnails_cached] => 
    [allow_query_attachment_by_filename:protected] => 
    [stopwords:WP_Query:private] => 
    [compat_fields:WP_Query:private] => Array
        (
            [0] => query_vars_hash
            [1] => query_vars_changed
        )

    [compat_methods:WP_Query:private] => Array
        (
            [0] => init_query_flags
            [1] => parse_tax_query
        )

    [query_cache_key:WP_Query:private] => wp_query:c6fab358efcd5d85d5f8c6a1941fcdaa
)

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.

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.

Dental Malpractice Risks in Treating Obstructive Sleep Apnea

Learn how a dentist’s OSA treatment led to malpractice claims. Explore legal risks, informed consent strategies, and key lessons for dental professionals.

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.