View - CTU

Bf¢rndal & Reit Endodontic malpractice in DK
1st common. In 108
'-categorization was
as judged not to be
ras found guilty of
if the dentist had
' to reach the very
:lue to difficult root
tot found guilty of
in 12 of 16 claims
nts. The DCBs con­
>ractice if the canal
filling around the
thology was persis­
'.. Some DCBs stated
995-2002)
Total n (%)
137 (28.4)
86 (17.8)
64 (13.3)
50 (10.4)
21 (4.4)
16 (3.3)
108 (22.4)
482 (100)
tion Total n (%)
44 (32.1)
16 (11.7)
9 (6.6)
4 (2.9)
12 (8.8)
23 (16.8)
12 (8.8)
14 (10.2)
3 (2.2)
137 (100.1)
that an instrument left in the canal could serve equally
well as a conventional root fiiling and thus gave non
malpractice verdicts. In no case was the presence or
absence of rubber dam commented upon by the DCBs.
A significant (P < 0.0005; x2 = 22.911) difference
in malpractice verdicts was found between cases
assigned to the 'technical complications' group (malpractice
frequency = 56%) and cases in the 'incorrect
treatment' group (malpractice frequency= 13.5%).
Age and gender of patients and dentists did seem to
exert influence on the pattern of complaints. Male
dentists were involved in 69% (11 = 331) of the
endodontically related complaints, which significantly
differed (P < 0.0005; x2 = 15.189) from the general
proportion of male GDPs (57.8%) during the period. In
contrast, the majority of complainants were women
(71.0%, n = 342), which significantly differed
(P < 0.0001; x2 = 77.543) from the general proportion
of females (50.8%) among patients who received
root canal treatment within the same time period
(Bj0rndal & Reit 2004). The age (mean ± SD) of the
female complainants (44.3 ± 14.3 year) was significantly
lower (P = 0.0327; t = 2.147) than that of
the male complainants (48.0 ± 12.4 year). Furthermore,
the mean age of the female dentists involved
in an endodontic complaint (47.6 ± 10.4 year) was
significantly lower than that of the male dentists
(53.0 ± 8.5 year) (P < 0.0001; t = 5.598). Female
patients most often complained about treatments provided
by older male dentists (P = 0.0189; x 2 = 5.675).
The frequency of 'young' female dentists who received
a malpractice claim was significantly higher than seen
in the male dentist group (P = 0.0098; x2 = 6.672). A
borderline statistical significance indicated that younger
female patients had a tendency to make complaints
about older male dentists (P = 0.043; x2 = 4.172).
Discussion
The present study includes all dental malpractice
claims registered in Denmark between 1995 and
2004. However, the authors had no access to original
material such as letters, office records and radiographs,
but only the formal reports issued by the DCBs and the
NDCB. The reports varied in quality and fullness, thus
interpretation and categorization of the claims was
sometimes difficult, a situation that might have biased
the results of the investigation. In cases that concluded
with a settlement between the patient and the dentist
detailed information was often not found. In 77.6%
(11 = 3 74) of the 482 claims focused on root canal
treatment (Table 3) the information was sufficient
enough to make further categorization possible.
The annual number of dental malpractice claims as
calculated per 100 000 patients was subjected to a
very small variation over the investigated period in
question. However, in the city area of Copenhagen the
frequency of claims was well over the mean of
Denmark taken as a whole (24.7 vs. 13.1, respectively).
A similar difference between urban and rural
areas was reported by Rene & Owall (1991) in a study
of Swedish malpractice cases.
In the first five years (1995-1999) of the investigated
period 725 claims resulted in verdicts of malpractice,
which corresponds to 4.2 annual malpractice
cases per 1000 GDPs. ln the second period there was
an increase to 4. 9 cases. In the US Milgrom et al.
(1994) compared the years 1988 and 1992 and found
an increase from 11 to 2 7 malpractice cases per 1000
dental practitioners. In Sweden Rene & Owall (1991)
studied the period from 19 77 to 1983 and found no
increase and only less than one malpractice case per
1000 dentists. However, the medico-legal systems vary
between countries and direct comparisons are difficult
to make.
ln agreement with the findings of Rene & Owall
(1991) and Hapcook (2006) the dental malpractice
claims most often concerned crown & bridge treatment
(22.9%). However, as was proposed in Hl, claims of
endodontic malpractice were frequently received by the
Danish DCBs. The proportion found in the present
investigation (13 .8%) corresponded to the Swedish and
US samples.
.In support of H2 a substantial part of the claims
(28%) were associated with substandard root filling
quality or technical treatment problems (Table 4). By
comparing the verdicts and the written judgments of
the DCBs in the 13 7 cases assigned to the 'technical
complications/incorrect treatment' category, an
attempt was made to find explicit or implicit verdict
policies. The dentist was found to be guilty of malpractice
in all claims when a paraformaldehyde product
was used in the root canal, a situation which often
resulted in severe bone and soft tissue damage. In eight
of the nine cases in which a root was perforated, the
dentist was also judged to be guilty. Malpractice was
stated in 70.5% of the cases (11 = 31) concerned with
the root filling quality (Table 4). In the DCB reports
reasons for malpractice verdicts were often that the
root fillings were too short, had defective quality of seal,
the canal was over filled as a result of over instrumentation
and that not all canals were filled. However, if
nal Endodontic Journal
© 2008 International Endodontic Journal
International Endodontic Journal, 41, 1059-1065, 2008