Practice More Safely // Risk Tips // How to Properly Handle Patient Refunds and Avoid Disputes

How to Properly Handle Patient Refunds and Avoid Disputes

Case Study

Marc Leffler, DDS, Esq.
January 16, 2025

Reading time: 7 minutes

Two hands holding a tooth and a credit card to demonstrate the exchange of dental care for money.

Background Facts

L was a 61-year-old woman, a retired elementary school music teacher, who had been a general dentistry patient of Dr. T for more than 20 years. Other than her taking a widely used bisphosphonate medication, prescribed by her gynecologist for generalized osteopenia, L was a patient with an essentially benign medical history.

Several years prior, L lost tooth #31 after she vertically fractured it when biting into a hard candy. In consultation with Dr. T, she decided at the time not to replace the tooth, and instead try to function without it. But, when tooth #30 developed an endo-perio lesion with furcation involvement, thereby necessitating its extraction, dentist and patient both agreed that this was an appropriate time to place and restore implants in the right posterior mandible. After a complete clinical and radiographic work-up, and a documented, interactive informed consent process, Dr. T extracted tooth #30, removed the associated granulation tissue, and immediately placed implants at the sites that teeth #30 and 31 had previously occupied.

Despite Dr. T having meticulously performed the procedures and having prescribed a course of suitable antibiotics at the time of surgery, the implant placed at the extraction site never integrated, so it was removed. Dr. T suggested that he could place a 3-unit bridge, incorporating tooth #29 and the implant at site #31 as abutments, and L agreed. During their discussions, L said that she was upset that she had to pay for the failed implant, so she asked for that portion of the fee to be refunded. Dr. T was willing to do that, but told L that he needed to prepare paperwork for her signature before doing so.

Dr. T contacted his malpractice carrier to explain the situation, and the carrier assigned local counsel to prepare a release that would be signed by L prior to a refund check being given. Most significant to the issues here, the release contained language stating that, in exchange for the refund, L released Dr. T from all liability and damages, presently known or unknown, relating to the treatment of tooth #30 and the implant placed at that location. L signed the document and Dr. T handed her a refund check, at the same office visit that preparation for the bridge began; that bridge was completed and inserted less than a month later.

Within a short time, L began to experience pain, swelling, and a whitish exudate from below the pontic. When Dr. T noticed this, he immediately referred L to an oral surgeon, who, based upon clinical and radiographic indicators, and a biopsy of the underlying soft tissue and bone, made a diagnosis of bisphosphonate-related osteonecrosis of the mandible. With non-invasive treatment methods failing to resolve the condition, the oral surgeon performed a small segmental resection of the affected area, which, in conjunction with local measures, led to resolution, but unfortunately caused an injury to the right inferior alveolar nerve – due to the need to excise tissue until healthy bone was reached – which created a permanent paresthesia of the right half of the lower lip and chin. L blamed Dr. T for the uncomfortable result.

Legal Actions

A close friend of L, who knew about everything that had taken place, encouraged seeking an attorney for consultation. After deeply considering, for some time, whether to look into suing the dentist with whom she had a relationship for decades, she decided to contact an attorney who advertised expertise with dental malpractice matters. L provided the attorney with copies of her clinical records from the gynecologist, Dr. T, and the oral surgeon, and those were sent on to a potential expert with whom the attorney had worked before. That expert dentist was of the opinion that Dr. T was negligent in failing to take prophylactic steps to prevent the development of the osteonecrosis, which directly led to the nerve injury.

The attorney was aware that the statute of limitations period for filing a case was quickly approaching its expiration, so with the expert opinion in hand that he needed to start the lawsuit, he opted to defer obtaining Dr. T’s complete chart until the discovery phase of litigation, and instead proceeded forward based upon the clinical records that L had given to him. As soon as Dr. T was served with papers, he reached out again to his malpractice carrier and to the attorney who had drafted the release document that L had signed in conjunction with receiving a refund.

Dr. T’s attorney employed an approach that is not often taken, but which is entirely proper: in lieu of the usual legal “answer”, Dr. T’s attorney filed a motion to dismiss the case on the ground that L had signed a release which held Dr. T harmless as against “all liability and damages”, then “known or unknown”, in exchange for the refund L sought and received. L’s attorney was taken aback when he saw the motion, as he had not been aware of that document due to his client having not told him about it and his not having obtained Dr. T’s full set of records before filing suit. In response to the motion, he argued that L could not have been aware, at the time she signed the release, that she would develop osteonecrosis and the nerve injury that arose from it and its eradication. The judge was unmoved by the argument put forth on behalf of L, ruling that L was an educated and savvy consumer, who had received the very benefit of the bargain she sought, namely a refund, in exchange for voluntarily releasing Dr. T against “all liability and damages, known or unknown”. The case was dismissed.

Takeaways

Refunds given to patients by their dentists are commonplace, and a realistic argument can be made that the good will exhibited by dentists in doing so greatly helps to ward off potential dental malpractice actions and Board complaints. But as common as refunding money is, obtaining a release in exchange is far less frequent. This case study demonstrates the value that a well-drafted release can provide, if not in every circumstance – because different judges often view such situations differently – then often enough to make the practice very worthwhile.

Dr. T understood the value that advice offered and protections provided by his malpractice carrier would confer, and he properly sought its involvement. While policy provisions might differ, dental malpractice carriers can often provide helpful advice and/or legal representation, even before a suit is filed, that is, at times, able to prevent such a suit or effectively address it at its very early stages, thereby mitigating costs, stress, and time lost from treating patients while litigation plays out. If Dr. T had, instead of working through his carrier and its assigned attorney, drafted the release document on his own, and it did not include the necessary language to serve as the legal basis for dismissal of the case, it might very well have been allowed to proceed and to potentially garner monetary compensation for serious physical damages.

Because of the dismissal of this case on procedural grounds, before litigation into the substantive issues began, Dr. T’s consideration and management of his patient’s bisphosphonate use was never explored, as it most certainly would have if the case were permitted to proceed and be decided on its merits. In our ever-aging society, the number of patients taking bisphosphonates continues to increase, so familiarity with its potential effects in a dental setting is critical. The same concept applies to a host of medical conditions and the medications employed to manage them. Dentists cannot reasonably be expected to be fully knowledgeable about every medical disorder, every medication, and every possible medical relationship to dental care; but what is expected, and what the standard of care generally dictates, is that dentists make appropriate and timely referrals to medical providers for obtaining clearance, or at least contact a patient’s physicians, to assure that their patients are best protected and that they best manage risk in their practices.

Finally, we touch upon a foundation for an informed consent process, during which a patient is to be made aware of the benefits of, foreseeable risks associated with, and viable alternatives to a planned invasive procedure, prior to allowing it to go forward. An implied predicate is the dentist’s awareness of all of those elements of the process which, significant here, is an understanding of how a bisphosphonate drug might affect the surgery to be undertaken. Had this case proceeded, it would have been a defense challenge to demonstrate that Dr. T was aware of the bisphosphonate-related risks, solely based upon his inactions in that regard, i.e., no medical clearance or communication with L’s physicians, and therefore educated L about those risks, so as to have been able to factor them into her decision-making process. Recall that, even when a procedure is performed according the standard of care, when damages result without the patient having been fully informed before consent is given, the dentist is liable for those damages. So, a dentist’s own education is critical to the patient’s education.

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.

[post_title] => Dentist’s Criticism of Prior Work Leads to Malpractice Claim [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => dentists-criticism-of-prior-work-leads-to-malpractice-claim [to_ping] => [pinged] => [post_modified] => 2026-06-11 08:38:57 [post_modified_gmt] => 2026-06-11 12:38:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://medprodental.com/?p=10624 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 10594 [post_author] => 180159412 [post_date] => 2026-05-28 15:10:13 [post_date_gmt] => 2026-05-28 19:10:13 [post_content] =>

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.

[post_title] => How Minor Patients Extend Dental Malpractice Case Timelines [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-minor-patients-extend-dental-malpractice-case-timelines [to_ping] => [pinged] => [post_modified] => 2026-06-08 10:40:56 [post_modified_gmt] => 2026-06-08 14:40:56 [post_content_filtered] => [post_parent] => 0 [guid] => https://medprodental.com/?p=10594 [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] => 10633 [post_author] => 180159412 [post_date] => 2026-06-08 15:18:38 [post_date_gmt] => 2026-06-08 19:18:38 [post_content] =>

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

[post_title] => How a Dropped Crown Led to a Malpractice Lawsuit [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-a-dropped-crown-led-to-a-malpractice-lawsuit [to_ping] => [pinged] => [post_modified] => 2026-06-10 06:35:05 [post_modified_gmt] => 2026-06-10 10:35:05 [post_content_filtered] => [post_parent] => 0 [guid] => https://medprodental.com/?p=10633 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 81 [max_num_pages] => 27 [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] => 1276b5d348a07e24690ee5832bd40279 [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:ca6c5602c93d1fcaeaecb1bdf61dd494 )

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.