Dental Malpractice : Suggested Uses for Written Consent Forms

  It is suggested that dentists now consider having patients sign written consent forms for various in-office procedures and treatment. For example, it is suggested that dentists use written consent forms for root canal therapy. Root canal therapy has numerous inherent risks, including file separation, the need to re-treat the tooth, continued pathology, and the possible need for apicoectomy or extraction. If informed of those risks, fewer patients will be surprised by complications or poor outcomes and less likely to place blame on the dentist.

  Dentists should also consider using written consent forms for oral surgery performed in the office, including extractions and the placement of implants. It is well known that oral surgery has risks, including infection, bleeding, sinus perforation, and most significantly, nerve injury (parasthesia, dysthesia, hypersthesia, etc…).

 The risk of nerve damage is particularly of concern due to the alarming increase in dental cases involving nerve damage complications and the values that are being placed on them by juries and appellate courts. For example, in a recent dental malpractice action from Orange County, an appellate court upheld an award of $810,000 for alleged damage to the trigeminal nerve when the dentist administered a Novocain injection
to a patient.

  It is also suggested that dentists use written consent forms prior to restoring teeth. The placement of restorations, including implants, veneers, crowns, and bridgework have inherent risks. These risks include post-treatment sensitivity, the need to adjust the patient’s occlusion, the need for the patient to undergo subsequent root canal therapy, and the need to have those restorations replaced over time.

  Restorative work can also be very costly, and there are often multiple treatment alternatives that can vary significantly in cost depending upon the patient’s goals and preferences. We have also found that when patients have poor outcomes following full mouth restorations, there is often a claim that the patient was not informed of the reasons for such extensive treatment plans or less costly alternatives. Prior to performing restorative work, a suggested practice would be to put the various reasonable treatment alternatives in writing with an estimated cost for each option, have the patient sign a copy to acknowledge receipt of the treatment alternatives, and then indicate in writing which plan the patient chooses.

   This is particularly important because damages awarded for dental restoration claims can also be significant. A patient in Tompkins County, New York was not pleased with the outcome of restorative work that included implant placement. The patient claimed she had a change in facial contours, difficulty speaking, tongue crowding, and other damages. The jury found for the patient and an appellate court upheld an award of $540,000.