Introduction

Dental professional liability lawsuits are commonly known as dental malpractice lawsuits, historically they have been overshadowed by complaints filed against medical professionals, both for the frequency and amounts of compensation. (1)

It is important to mention that complaints for dental treatments can involve serious situations such as fractures of the jaw or maxilla, less complex situations such as failure of fixed prostheses (bridges), crowns or dental implants to complaints of unadjusted dentures or aesthetic results that did not meet the expectations of the patients. (2)

One of the main problems when performing the analysis of complaints is the lack of elements available in clinical records, according to a study carried out in 2019 in Costa Rica related to dental clinical records, it was determined that 53.3% of physical records and 33.3% of digital systems presented incomplete clinical examination and data. (3)

A detailed file makes it possible to determine by means of evidence whether there is really a causal link between the facts investigated so that the judge has real criteria when it comes to dispensing justice. (4)

Dentistry has had great technical scientific advances in all specialties, every day there are more procedures that involve examinations in three dimensions such as tomography(5) and intraoral scans,(6) additionally aesthetic procedures that were previously rare are increasingly used such as facial fillers that have increased during the last 10 years (7) as well as facial cosmetic surgery performed by specialists in maxillofacial surgery. (8)

Materials and methods

A detailed review of each of the cases analyzed by the Forensic Dentistry Unit of the Department of Legal Medicine registered in the SIMEL database (Legal Medicine System) was carried out in a six-year period from January 1, 2015 to December 31, 2020.

A table was designed in Excel with the following characteristics of the cases: year, related discipline, sex of the complainant and result of the expert analysis that was classified as positive, negative and inconclusive. The classification of “inconclusive" was defined for those cases in which the lack of elements did not allow an objective criterion to be issued.

Results

Classification of lawsuits by dental discipline

In the six-year period analyzed, a total of 124 complaints were recorded, the average was 20 cases per year. When classified by discipline, the oral and maxillofacial surgery procedures were the ones with the highest number of processes (49) representing 39.52% of the total. The second area with the most complaints is Dental Implants with 16.94% (21 cases), followed by Orthodontic procedures with 16 cases (12.9%), Prosthodontics 12.1% (15 cases), General Dentistry 13 cases (10.48%), Endodontics 7 cases (5.64%); Pediatric dentistry, Periodontics and other events (falls) had 1 case each respectively (0.80%). SeeFigure 1.

Figure 1 Complaints classified by discipline in the period 2015-2020. 

Distribution by year and sex of the complainant

The data analysis revealed that the year 2019 presented the highest number of complaints (27 cases), followed by 2016 (26 cases), the year 2020 (22 cases), 2018 (19 cases), 2015 (17 cases) and the year 2017 was the year with the fewest complaints (13 cases).

Regarding to sex, the claims filed by women corresponded to 66.12% (82 cases) of the sample against 33.87% of men (42 cases) out of the total of 124 complaints, representing a ratio of 2 to 1 of cases of women and men. This behavior predominates in most years except for 2015 where the ratio is practically 1:1 as shown in Figure 2.

Figure 2 Distribution by sex of the complainant. 

Result of the forensic analysis

As a result of the expert analysis carried out by the Forensic Dentistry Unit, it is observed that 12 cases were positive, representing 9.7% of the total, 40 cases were concluded as negative, that is 32.25% and finally 72 cases were classified as "inconclusive" that constitute 58.05% of all cases. SeeFigure 3.

Figure 3 Result of the forensic analysis 2015-2020 

Discussion

From the analysis of the data, it is observed that the behavior of complaints by discipline practically half of the cases are related to the most invasive procedures such as oral and maxillofacial surgery and dental implants. This behavior is similar in studies carried out in countries such as Chile,(9) Brazil,(10) and Spain. (11).

In relation to the result of the forensic analysis, less than 10% of the cases were positive, 32% are negative and 58% are inconclusive, which makes it indisputable that the absence of material evidence in the clinical file influences the results. From the expert analysis, these findings are compatible with those found in investigations carried out in Costa Rica regarding the performance of dental clinical records.(3)(12)

Regarding the sex of the complainants, women had a 2: 1 relationship with men, this percentage according to the literature may correspond to the fact that women use health services more frequently than men, these numbers are similar in studies carried out in countries such as Brazil, (10) Chile,(13) Mexico,(14) Italy,(15) and Spain. (16)

Within the complaints there is the classification of "other events", this was used specifically for the case of a user who suffered a precipitation (fall) after undergoing a surgical procedure.

It is important to mention that in many of the complaints filed, the lack of communication with the treating person is mentioned within the narrations and complaints, where no attempt was made to solve the main complaint or that the resolution time was not as expected, additionally another of the points described are the expectations prior to treatment that were not met, which highlights the importance of measuring the perception of user satisfaction.(17)

Conclusions

Within the legal processes for professional liability there is a common element that must be demonstrated to established if there is an omission of the duty of care and therefore determine if it is positive, this element is the so-called “causal link”.(4)

Regarding the expert report, it requires all the elements available in a clinical file to issue a scientific technical criterion in an objective manner, the lack of a complete clinical file makes it difficult to analyze cases and can leave both patients and professionals without tools for defense. Previous studies developed in Costa Rica have determined that the clinical record is not always carried out correctly.(12)

One of the facets to take into account within the professional practice of dentistry is the reduction of risks, since the literature establishes that practically half of the demands occur for events that are considered foreseeable and avoidable,(11)they must be previously explained and discussed during the realization of informed consent.

A good history and a good diagnosis, a detailed analysis of the main complaint and the expectations of the user are sine qua non requirements to achieve predictable treatments and reduce the possibility of lawsuits.