The most common patient complaints and claims – plus how to avoid them

Paul Lambden explains how to avoid patient complaints and clinical claims as a newly qualified dentist in the UK.

Starting out in dentistry is an exciting milestone. Years of hard work and dedication are about to pay off as you step into clinical practice. But alongside the rewards of the profession comes a responsibility that every dentist must take seriously: the risk of patient complaints and clinical claims.

This isn’t meant to alarm you. The vast majority of dentists practise professionally and treat their patients to a high standard. The reality, however, is that even the most conscientious clinician can find themselves the subject of a complaint, sometimes through no fault of their own. What makes the difference, time and again, is preparation: knowing the common pitfalls, taking straightforward steps to reduce your exposure, and having the right indemnity provider in your corner if something does go wrong.

As you build your career, the guidance below will help you understand the most common sources of complaints and claims, and what you can do to protect yourself and your patients. And remember, as set out in GDC Standard 7.2.1, you must only carry out treatment if you are appropriately trained, competent, confident, and indemnified.

What are the key principles for avoiding dental complaints and claims?

Every dentist should apply the following general principles to every patient encounter. Asking yourself these questions routinely is one of the most effective ways to reduce your risk of complaints and claims:

• Do the notes state all relevant information?
• Have you taken necessary radiographs?
• Do you have documented consent?
• Were your actions those of a reasonable dental practitioner?
• When discussing options with the patient, do not exaggerate the benefits of the favoured option. Exaggeration amplifies disappointment.

Why is root canal therapy a common source of dental claims, and how can newly qualified dentists protect themselves?

Root canal therapy (RCT) is one of the most frequent sources of patient complaints and indemnity claims. In the majority of cases, the problem is not the clinical treatment itself but the absence of adequate documentation. Every RCT case must be fully recorded. Key steps to follow include:

• Ensure you have a good pre-op X-ray
• Assess and discuss the case with the patient
• Explain it is a poor tooth and a last resort option
• Explain if RCT fails, extraction is the only option
• Explain the risk of instrument breakage
• Explain the risk of hypochlorite leak
• Ensure you always use rubber dam
• Explain the risks of delaying decision to treat
• Remember GDC Standard 7.2.1
• If RCT is unsuccessful, explain all options to the patient. Ensure all these points are clear in the record.

How do dentists avoid extracting the wrong tooth?

Extracting the wrong tooth is one of the most serious and distressing errors a dentist can make, and yet it is entirely preventable. It occurs more often than it should, typically as a result of rushing or over-reliance on memory. The following steps will help you avoid it:

• Never treat as ‘only an extraction’
• Don’t rush or rely on memory
• Always take a good quality radiograph
• Consent – explain all risks of extraction
• If in doubt, do not extract
• Be careful with other dentists’ charting
• If orthodontic, do not change. Consult orthodontist if doubts or queries
• Beware two molars. Chart as 6 and 8 (not as 6,7 or 7,8) to avoid wrong extraction.

What should newly qualified dentists know about periodontal disease and the risk of claims?

Failure to diagnose and manage periodontal disease is a growing source of indemnity claims in UK dentistry. Patients who lose teeth as a result of undetected or untreated gum disease may have strong grounds for complaint if it can be shown that appropriate monitoring was not carried out. At every routine examination, dentists should ensure:

• The examination includes a Basic Periodontal Examination
• If gum disease is present, ensure the patient has clear advice about oral hygiene and treatment and make any necessary referrals
• Ensure the patient is appropriately monitored.

How can dentists avoid claims relating to routine restorative care?

Routine restorative work is the foundation of general dental practice, which makes it all the more concerning that it remains a significant source of claims. Failures in this area are particularly difficult to defend because the expected standard is well established and widely understood. Claims typically arise from the following:

• Failure to diagnose caries
• Failure to remove all caries
• Failure to insert fillings of an adequate quality
• Failure to comply with the established standards of diagnosis, cavity preparation and restoration as taught.

Such failures are normally impossible to defend and reflect very badly on the practitioner.

What are the most common causes of crown and bridge claims, and how should dentists avoid them?

Crown and bridge claims tend to be both expensive and contentious, often because the patient’s appearance is directly affected. Disputes about shade, fit and clinical appropriateness are the most common triggers. To minimise your risk:

• Only undertake crown and bridge work if you are sure it is the most appropriate dental solution. Do not decide based solely on income derived
• Do not rush. If it is not right it will have to be redone.
• Shade is often disputed once the crown is fitted. Give the patient time. Involve others to confirm colour is right
• If the crown does not fit well at the margins, remake the crown. Do not patch the margins.
• If the shade is in doubt, fit with temporary cement and review after two weeks
• Do not be pressed into providing a crown or bridge if you feel that it is not clinically appropriate.

How should dentists manage patient expectations around immediate dentures?

Immediate dentures are a frequent source of patient dissatisfaction and complaints. Patients are often unprepared for how quickly dentures can become loose, how much they may affect speech, and how difficult eating can be. Clear and thorough pre-treatment counselling is essential. You should:

• Warn patients firmly of all the disadvantages of immediate dentures
• Explain the bone changes that will make them loose and ill-fitting
• Warn that a better solution will take six months, after healing has occurred
• Explain the problems of such dentures to family members to avoid unhappiness.

No dentist who acts competently, meeting the standards of a reasonable practitioner, need be anxious about complaints or claims. Although even the best dentist cannot avoid a complaint from a patient whose expectations exceed the ability of dentistry to achieve the desired outcome, it is important that any treatment is completed competently and to the recognised standard.

Find out how Densura can support you throughout your career

Whether you’re about to sit your finals or are already in your first associate role, having the right professional indemnity in place is one of the most important decisions you’ll make. Densura has been supporting dental professionals across the UK for many years, offering tailored indemnity cover alongside expert guidance when you need it most.

Visit www.densura.com to learn more about our cover for newly qualified and early-career dentists, or speak to our team directly. We’re here to give you the confidence to focus on what matters most: delivering great care to your patients.

This article is sponsored by Densura.