Unethical Treatment Leads to Lawsuit and Dental Board Action

This case study involves a dentist whose excessive treatment and ethical violations resulted in a malpractice claim and dental board actions. The discussion includes strategies that can help dental professionals keep patients safe while mitigating risk.

An adult was evaluated by a general dentist, who conducted an examination with x-rays. The dentist determined that two dental surfaces were decayed, and one tooth had a possible fracture. Excessive wear to the teeth was not evident, and pretreatment photographs revealed good stippling of the gums.

Five days later, the patient consulted a second dentist, who practiced general dentistry with advanced training in cosmetic procedures. This dentist was widely known through appearances in multiple television commercials, coverage on reputable news channels, and his website. The extensive media exposure created an assumption by the patient that the dentist’s professional qualifications were undeniable. According to the patient, this publicity was a determining factor in selecting this celebrity dentist to continue the treatment.

During the initial evaluation, the patient complained of a “gummy” smile, as well as chipped and discolored teeth. A later review of the dental record indicated that the celebrity dentist repeated the patient’s medical history, initial examination, x-rays, and photographs prior to treatment. According to the second assessment, the patient had decay on 45 dental surfaces, tooth fractures on 77 surfaces, and 31 teeth worn down by one-third to one-half. Gingival recession and tetracycline staining were also noted.

Although the diagnosis and treatment plan were vastly different from those of the original dentist, the patient agreed to undergo the procedures. The celebrity dentist performed restorative procedures that resulted in patient fees of $47,000.

Following the restorations, the patient remained unhappy with the appearance of the cosmetic procedures and experienced unrelenting pain. As a result, five additional dentists ultimately examined the patient. The ongoing pain led to gum surgeries, multiple root canals, and significant weight loss. The five dentists all agreed that the procedures performed by the celebrity dentist were below the standard of care. The estimated cost of the additional examinations and treatment was $63,000.

The patient successfully pursued a professional liability claim against the celebrity dentist and filed a complaint with the state’s dental board.

Risk Management Discussion

The dental board complaint stated that the dental record supported only the recommendations of crowns to nine teeth, veneer treatment on 11 teeth, laser treatment on six teeth, a bridge on three teeth, and one implant. Diagnostic imaging and other pretreatment photos did not support the need for the multiple restorations, and several teeth that had been diagnosed with decay and/or fractures were not treated. Additional accusations were also made about ill-fitting restorations on multiple teeth.

The complaint contained ethical declarations—including that the dentist failed to address the patient’s complaints of pain appropriately—and charges of unprofessional conduct, excessive treatment, and repeated acts of negligence.

The dental board determined that the celebrity dentist had provided substandard care that was indefensible, unnecessary, and incomplete. The allegations were compounded because it appeared the dentist had altered a portion of the chart and that critical evidence had been destroyed. This rendered the dentist unreliable in his own defense.

The dental board also determined that the celebrity dentist had violated the profession’s ethical obligations. The American Dental Association’s Principles of Ethics and Code of Professional Conduct (ADA Code) notes that “the dental profession holds a position of trust within society.” In this case, the dentist’s celebrity status and the media coverage displayed on his website indicated that the patient could rely on this dentist and trust him more than other dentists. The dentist violated each of the five fundamental principles of the ADA Code: patient autonomy (“self-governance”), nonmaleficence (“do no harm”), beneficence (“do good”), justice (“fairness”), and veracity (“truthfulness”).

The following strategies can help dental professionals keep patients safe and mitigate risks:

• Provide tests and treatments that are reasonable and necessary, with documentation to support the necessity of services provided.
• Research and follow state regulations related to advertising and dental practices.
• Exercise caution in advertising to avoid false or misleading claims about treatments, experience, certification, or credentials that might misinform patients about the qualifications of a provider.
• Represent credentials clearly and accurately. General dentists who perform complex prosthodontic or periodontal treatments or practice as experts or specialists may be held to a higher standard of care than general practitioners.
• Do not alter or destroy dental records. In the event of a claim or litigation, the alteration will likely be perceived as a deliberate act to deceptively reflect care or explain a less than perfect outcome. Altering the dental record may also result in a regulatory agency disciplinary action and create lasting reputational damage. Attempts to conceal damaging evidence will render a case indefensible.
• Refer to the ADA Code for guidance on dental advertising and conduct.
• Refer to the ADA Dental Board Complaints for tips on responding to a board complaint.

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.