Who makes a conclusion about the dentist's mistake? Mistakes when removing teeth. General requirements for examination of the quality of dental care

Re: Is it possible to sue a dentist? January 21, 2010 at 01:17 pm By branches Why did you decide that your wife’s dental problems are the doctor’s fault, and not her personal fault - poor care, poor nutrition, predisposition to inflammatory whitening due to poor immunity, genetics in the end etc. By the way, crowns and bridges require hygienic cleaning once every three months - did your wife do it? Re: Is it possible to sue a dentist? January 21, 2010 at 2:24 p.m. Vetvyami may have thought so because she was approached for dental treatment, or because no matter how many times she was asked whether she should be in pain, what to do, she said that everything was fine, be patient, it would go away on its own. or maybe because I have experience when my teeth were healed, too, to the point of a cyst, and then they had surgery. or maybe because the dentist said that it was the fault of the one who treated.

Medical malpractice by a dentist: will the court protect it?

The man demanded compensation for the material and moral damage caused to him and an internal audit, but this request was completely ignored. Then the victim wrote statements to the police, Rospotrebnadzor, the Ministry of Health, the prosecutor's office - and to the court with a claim for the protection of consumer rights.
He asked to recover 100,000 rubles from the defendant. material damage, 200,000 rubles. moral, and another 50,000 rubles. for the services of a judicial representative. The Sovetsky District Court rejected the claim in November 2014, without finding any evidence of “the defendant committing unlawful acts against the plaintiff.”

The plaintiff did not provide evidence of applying to the named clinic for medical care and paying for services provided in the form of documents or testimony, noted Judge M. Kratenko.

How to sue a dentist?

Yesterday I had a wisdom tooth removed that had not sprouted; it was hiding in the gum and would never have come out because it was aimed at the neighboring tooth. Without a hammer, of course, but they tormented me for a long time until they dug it out. An excellent tooth, not rotten, so beautiful, they could eat it….

In short, it’s very painful, half of the muzzle is swollen, our ketanov is everything Once again - I sympathize with my wife. As for suing - don’t waste your time, you’re in the wrong country. Be glad that it ended like this, it could have been worse...

Well, then - medicine is an inexact science - who the hell can you prove... Re: is it really possible to sue a dentist? January 30, 2010 at 01:15 By branches In response to: Yesterday I had an unsprouted wisdom tooth removed, it was hiding in the gum, it would never have come out because it was aimed at the neighboring tooth. Without a hammer, of course, but they tormented me for a long time until they picked it out.
An excellent tooth, not rotten, so beautiful, they could eat it….

Is it possible to sue a dentist?

Attention

Frequent mistakes made by dentists include poor-quality fillings, removal of a healthy tooth instead of a diseased one, problems with prosthetics, and so on. What to do in such a situation and is it possible to recover compensation from such a dentist? Institutions you can contact for help:

1. A claim for medical malpractice can be filed with Roszdravnadzor.

Claims for free treatment in public dental clinics Many people think that when receiving free dental services in public institutions there is no way to hold the doctor accountable.

How to sue dentistry?

Info

Can a patient refuse a doctor he doesn’t like? - Maybe. The law gives him this right. In this case, the patient must contact the head of the medical institution, and he, after studying the situation, can assign him another doctor.

Important

By the way, a doctor also has the right to refuse treatment of a patient if he does not follow his recommendations and rudely interferes with the treatment process. – Is the patient able to assess its quality? - Of course not! He can evaluate the service component of a medical service - comfort, attitude of medical staff, cleanliness. Assessing the quality of treatment should be done by professionals.

Dentists' mistakes: responsibility and punishment

Among all services in the field of medical care, dental services are more likely than others to end in dispute and conflict between the parties. This is because there are more risks in dentistry than in any other medical field. Thus, the work of a dentist depends on the technical component. Patients may have complaints against dentists due to the fact that, for example, they did a poor-quality filling or installed a crown poorly, or, in general, did their job poorly.

Such problems are usually regulated by the Federal Law “On the Protection of Consumer Rights,” since the patient is also a consumer of dental services. How to prove a dentist's mistake? Dentistry legislation, what is it? If the dentist does not admit his guilt, and this does not happen rarely, then the best option for the patient is to go to court to protect his rights.

Disputes with dentistry, what types of disputes with dentistry are there?

The doctor did everything correctly, but against the background of general diseases and decreased immunity, the patient developed an exacerbation. Who is to blame in this case? Definitely not a doctor! Another thing is that he had to warn the patient about possible complications that could arise even with proper treatment. –

Your specialty is difficult... - And one of the most responsible. After all, we work in the most important part of the human body, and at the same time we pick up a tool that rotates at a speed of 300–400 thousand revolutions per minute! But there have been cases when this rotating tip head unscrewed and at great speed tore the entire mucous membrane of the patient’s mouth.

In another case, while treating teeth under a crown, the doctor accidentally cut half of the patient’s tongue... - What a nightmare! And what happened? Was the doctor sued? “Fortunately, in both cases the case did not go to trial.

Dentists' mistakes: how to hold a doctor accountable?

This is wrong. To hold the dentist accountable in this case, during the first visit you must ask for a treatment plan and familiarize yourself with it (the doctor has no right to refuse to provide you with a treatment plan). This rule also applies to paid dental institutions.

If a serious error is detected, an examination will be required to evaluate the treatment performed. To do this, you should contact expert institutions created by dental associations, or a specialized dental educational medical institution (medical institute).

You can also write a complaint to Roszdravnadzor to conduct an unscheduled inspection of this clinic. The complaint must be reviewed within a month. If after a month your actions have not brought results, feel free to go to court.
Help is needed? Get free legal advice in Moscow.

Court for a tooth

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When contacting the dental clinic, I indicated the removal of the LAST right lower tooth (the most accurate definition, as it seems to me), and the dentist decided that the diseased tooth was not the last, but the penultimate one, and without any warning she removed the penultimate one (although not the healthiest, but subject to repair rather than removal). An hour later, when it turned out that the wrong tooth had been removed, I had to go to the clinic again and pull out the one that was needed.

As a result, I cannot chew on this side (which would not have happened if they had given me what I asked for, and not what they wanted). Who will pay for prosthetics for the last tooth? Who should I contact? How to sue this arbitrariness? P.s.

Both teeth are preserved as evidence. And in the magazine there were paintings about the visit.

Dentists' mistakes

As well as professional liability insurance, which is practiced in many countries around the world. After all, a doctor, like any person, has the right to make mistakes.

The main thing is that this does not constitute criminal negligence. “AiF Health” recommends to avoid possible problems when receiving dental treatment: 1. When choosing a clinic, study its history. If it was organized recently and has been operating for less than a year, this should be alarming.

Find out whether the clinic you choose is licensed for the types of services you would like to receive. 3. The same applies to the dentist with whom you decide to be treated.

Especially if it is a foreigner or a native of the CIS countries. Experience shows that many of them work without nostrification (the procedure for establishing compliance of a diploma issued by a foreign university with Russian standards), which means they do not bear any responsibility for their actions. 4.

The police were unable to interrogate anyone from the management of Zdorovye Zubok, including the director (as follows from the text of the decision, a representative of the clinic did not appear at the trial). The Ministry of Health also refused to conduct an investigation into the facts set out in the plaintiff’s appeal, again citing the man’s lack of supporting documents.

Finally, Rospotrebnadzor stated that a license for the medical activities of Zdorovye Zubki LLC was not issued; there are no medical organizations or individual entrepreneurs licensed to practice medicine at the address indicated by the plaintiff. The plaintiff tried to include in the case reviews of visitors to the website www.krasnoyarsk.flamp.ru about the quality of treatment at “Zdorovye Zubki”, but the court considered such arguments to be inadequate due to the quality of the printout of the Internet page and the absence of a notary’s signature on it.

A highly qualified dentist with considerable experience can carry out effective dental prosthetics. But even the best doctors make mistakes! Of course, they can always be corrected, but it will take some time, and the patient will also require additional financial expenses.

Errors in dental prosthetics - classification

The most common mistakes made by dentists when making dental prosthetics:

1. Purpose for installation of a bridge prosthesis. Such an error may be associated with the patient’s desire to install this particular type of prosthesis for existing problems in the dentition. Dentists often follow the lead of their clients and this leads to sad consequences: the bridge is either not clearly fixed or has mobility, teeth are injured, and periodontitis develops.
2. Choosing porcelain crowns in the absence of indications. Porcelain crowns are considered the highest quality, most expensive and “prestigious” - it is not surprising that clients of dental clinics insist on installing them. But the doctor should not expand the list of indications for such a procedure - for example, installing porcelain crowns for malocclusion (deep-set upper teeth) will lead to their rapid wear and certain inconvenience when chewing.
3. Ignoring the need to treat gums and bone tissue when installing a complete removable denture. Under no circumstances should removable dentures be made, let alone prescribed for wearing, if there are existing inflammatory/infectious diseases of the oral mucosa! Such an unprofessional approach will lead to thinning of the bone tissue, jaw deformation, and the development of osteomyelitis.
4. Violation of dental treatment rules. Depulpation of a tooth before prosthetics is a mandatory procedure, which, if ignored, can lead to the development of pulpitis, tooth removal, and the development of severe inflammatory processes in bone tissue. And this, in turn, is fraught with surgical intervention and plastic surgery.

Solution

Errors in dental prosthetics usually occur due to improper work of the dentist. Any neglect of the necessary procedures preceding the actual prosthetics leads to irreversible complications. It will be impossible to correct/correct anything - you will have to remove the prosthesis (even permanent crowns and onlays), prescribe full treatment for the problem, and then repeat the prosthetic procedure again.

The dentist should never make concessions to patients - they often ask to install a prosthesis for carious teeth, not to pay attention to swelling of the gums (and this is a sign of inflammation), to choose the most expensive crowns. Such rashness has no place - the doctor must explain the situation to the patient in detail and inform the patient about the possible consequences. And patients themselves should be guided by the recommendations of professionals - this will be the key to obtaining the desired effect.

Tooth extraction is the most widespread and frequent surgical intervention performed by a dental surgeon. Errors during deletion can be due to various reasons.

Organizational problems: chair malfunction

la - if fainting occurs during tooth extraction, the patient cannot be placed horizontally; bad light; there is not a sufficient choice of anesthetics, forceps, suture material, needles, cardiac drugs, oxygen, etc. Under these conditions, surgery cannot be started, unless for health reasons.

Diagnostic errors: the surgeon diagnoses a pressure ulcer in which the root of the tooth is located that is to be removed, and after removal it turns out that it is a cancerous ulcer and extraction was contraindicated. Errors arise from an incomplete (“superficial”) examination of the patient’s teeth and jaws, or from an incorrect assessment of the tooth to be removed. If when deleting | 8 teeth elevator focus on | 7th tooth, but J 6th tooth is missing, dislocation of 7th tooth is possible. When deleting_4_| The doctor rotates the tooth and the crown may break off from the roots; with inept use of the elevator, especially in elderly and senile people due to the presence of “Synostosis dentls”, removal will be very traumatic: there may be separation of the alveolar process, profuse bleeding and even death of the patient. Too active work with the elevator without first separating the circular ligament of the tooth, especially_8_], can lead to rupture of the soft tissues of the palate, right up to the uvula, with the formation of emphysema of the buccal tissue. If the forceps are selected incorrectly, it is possible to remove the adjacent tooth as well, since the wide cheeks of the forceps also overlap the adjacent teeth. Sudden movements when removing 6 | teeth lead to a fracture of the antagonist crown due to a blow to them with forceps. An incorrect technique for tooth extraction can lead to a fracture at any level, bleeding, alveolitis, osteomyelitis, etc. When performing atypical extraction (it is carried out roughly, traumatically, using a chisel and hammer), the mucoperiosteal flap ruptures when it is detached. Applying forceps shallowly to the roots of deep-seated teeth can lead to their penetration into the maxillary cavity. I. B. Gurshal (1981) cites such cases of medical errors.

The doctor took a long time to remove_4_| tooth, after removal the wound did not heal for a long time, pain appeared, and the temperature was 38.2 °C. After a thorough examination, including x-ray, a foreign body 2.5 X 1 cm was found at the bottom of the socket, which was removed through the socket. It turned out that this was the tip of the working part of the hook for removing dental plaque. The postoperative course was uneventful. The mistake was that the doctor left a piece of metal in the hole. Perhaps the doctor did not notice what happened, which can be understood, but not justified.

When removing 8 | teeth, if their eruption is difficult, the doctor does not prescribe an x-ray examination in 2 projections, which is necessary to determine the position of the tooth relative to the branch of the jaw or adjacent teeth, the mandibular canal, and in the upper jaw, relative to the maxillary sinus, nasal cavity. It is impossible to cut the hood during PZM; it must be excised, freeing the entire tooth crown.

The doctor makes a mistake if he does not put the pieces of the tooth (root) being removed into a tray, but throws them into the spittoon. If necessary, the doctor cannot put the pieces together and check whether the tooth has been completely removed. Sometimes he looks for non-existent debris in the hole, causing additional injury to the patient.

Errors leading to alveolitis. Traumatic tooth root removal:

a) damage to the alveolar process, interradicular septum, leaving sharp edges of the alveolar process socket;

b) rupture (crushing) of soft tissues, their defect, in which it is impossible to cover the exposed bone with soft tissues without appropriate correction;

c) long-term removal and infection of wounds by the surgeon’s hands, instruments, and fragments of teeth;

d) leaving the socket without a blood clot. It is a mistake to scrape the bone wall of the socket with a spoon. If it is not filled with blood, then it is better to induce bleeding by scraping the edges of the gum so that the spilled blood fills the hole;

e) perform a revision of the socket without pain relief and radiography.

When a tooth is removed, bleeding always occurs, which stops on its own after a few minutes. Sometimes, due to damage to the mucous membrane or a blood clot being washed away, bleeding continues.

Child G., 11 years old, had 6 | tooth due to aggravated chronic periodontitis, severe bleeding occurred, which suggested the idea of ​​intraosseous hemangioma. The surgeon inserted his little finger into the hole, the bleeding decreased, but did not stop; After tamponade with gauze with hydrogen peroxide, a hemostatic sponge, and suturing the socket with catgut, bleeding continued. A plaster cast is applied to the wound; the patient was hospitalized in the maxillofacial department. After the plaster cast was removed, the bleeding resumed. Ligation of the external carotid artery on the bleeding side had no effect. The patient is exsanguinated, pale, inactive, the pulse is threadlike, 160 per minute. The child was transfused with 100 ml of single-type blood. X-ray of the right half of the mandible showed cellular patterns with thickening in the buccolingual direction. At a consultation with the participation of a professor, it was proposed to resect the right half of the lower jaw, which we did not agree with. A similar case is known in the literature, where the author managed to stop the bleeding by tight tamponade with catgut, which was in Lugol's solution for a long time. Several skeins of such catgut were introduced into the cavity of the hemangioma through the hole, then the soft tissues were also sutured with catgut. The bleeding stopped, the child’s condition gradually improved and after 12 days he was discharged healthy.

The doctor’s actions are erroneous if he, without finding out the cause of the bleeding, proceeds to tamponade the hole. First of all, you need to dry the bleeding area and if soft tissues are bleeding, they should be sutured; if there is bleeding from the depths of the socket, then it is better to tamponate it with self-absorbing hemostatic agents: a hemostatic sponge, a biological antiseptic tampon, catgut, but not an iodoform tampon, since after its removal the socket remains empty and subsequent infection is possible, etc. If If the bleeding is associated with a blood disease, then an attempt to stop it in an outpatient clinic or in a maxillofacial hospital is erroneous - immediate hospitalization is required in a specialized hematology department. In order to prevent complications that may arise as a result of tooth (root) removal, we have compiled a leaflet that we give to each patient.

How to behave before and after tooth (root) extraction

(Memo) 1.

Eat 2-3 hours before removal, go to the doctor’s appointment 10-15 minutes before the appointed time, preferably in the morning. 2.

After removal, do not rinse your mouth immediately, as this will prevent bleeding from stopping; You can rinse your mouth if there is pus as directed by your doctor. Take food no earlier than 3-4 hours after tooth (root) extraction. 3.

After 4-5 hours, rinse your mouth with any disinfecting solution (a faint pink solution of potassium permanganate, for which throw 2-3 small crystals into a glass of boiled water at room temperature, or a solution of baking soda - 0.5 teaspoon per 1 glass of boiled water) after Write each time to remove any remaining residue. 4.

To avoid bleeding you should:

a) do not sleep or chew on the affected side for 24 hours;

b) do not apply compresses or poultices to the affected side;

c) do not go to the bathhouse for 2-3 days, do not take hot (warm) baths at home, do not overheat in the sun;

d) on the first day after removal, avoid excessive physical activity. 5.

Do not touch the wound with your finger, cotton wool, toothpick, match, etc., so as not to cause infection.

Remember! Following these tips will help your wound heal without complications.

Compiled by M. L. Zaxon

There are cases when, in the postoperative period, the healing of the socket of an extracted tooth occurs with complications; for example, after a tooth is removed, pus is released from the socket for a long time, which the doctor tries to remove by repeated rinsing. The doctor should take an x-ray and try to find out the cause of the pus. It may be due to the fact that the socket contains granulation tissue, remnants of the root, and interdental septum. If the doctor cannot find the cause of the suppuration, he should consult with a more experienced colleague, otherwise the patient suffers.

In everyday practice, any dentist is not immune from mistakes. The dentist's ethical duty is to respect the patient's right to make independent decisions. Ethics requires that a physician disclose his or her errors to the patient if those errors affect the patient's health.

Openly admitting and analyzing mistakes benefits the patient, the dentist, and the entire practice.

CASE ONE
A dentist examines a new patient who comes in complaining of severe toothache. Although the patient has several teeth that require treatment, the doctor is able to detect which tooth is the source of pain at the moment. This is tooth number 31 with a large filling. The filling cracked and pulp damage began. An x-ray shows bone loss at the site of separation of the tooth roots and inflammation of the peri-apical region. The tooth is mobile and the dentist decides that it will no longer be possible to save it. He explains the diagnosis to the patient and suggests removing the tooth. The patient agrees.

The doctor injects the patient with an anesthetic and leaves the operating room for a while to see another patient who has come for a follow-up examination. After the examination, the dentist returns to the operating room, checks the anesthesia, and begins the tooth extraction procedure. The operation goes without complications, but suddenly, while curettaging the hole, the dentist notices that he removed tooth No. 30, and not No. 31. Tooth No. 30 was also affected by caries and was mobile, but it was not the cause of pain and even without treatment could still be preserved a few months.

The dentist, fearful for his reputation, tells the patient that the infection has spread to a nearby tooth and advises that it be removed so that the pain will stop. The patient agrees, feeling grateful to the dentist, who noticed the “additional problem” in time and eliminated it. The dentist removes tooth No. 31.

CASE TWO
The dentist conducts a follow-up examination of a patient who has been treated by him for several years. The patient reports that he has noticed soreness and increased sensitivity at tooth No. 12. The dentist takes an x-ray of this area and sees secondary carious lesions under the gingival margin of the filling. This lesion has already extended into the pulp and the periapical region has expanded. The dentist is surprised, because the patient always carefully underwent examinations and preventive procedures. The doctor does not understand how such a lesion could develop in such a short period of time - six months between visits. He carefully examines the previous x-ray of the same tooth (taken a year ago) and notices that the lesion was already present then, but for some reason went unnoticed. The dentist regrets his mistake, but does not want the patient to be disappointed in him. Therefore, he tells the patient that a new carious cavity has appeared under the filling and the tooth now requires endodontic treatment followed by the installation of a crown. A patient who believes his doctor and even recommends him to friends accepts this explanation and agrees to treatment.

DISCUSSION
Providing health care is a complex endeavor that requires talent and knowledge of how to deal with biological elements that can be unpredictable. This combination of human and technological aspects increases the likelihood of errors for several reasons. The doctor's actions are inevitably influenced by such human factors as subjective judgment, fatigue, lack of time, mistakes of other people, etc. The devices and equipment with which the dentist works are also not flawless. Of course, patients want to believe that their doctor always makes an absolutely accurate diagnosis and never makes mistakes in treatment, but this is simply impossible.

Yes, doctors make mistakes, and it is very important to think about how best to admit your mistake to the patient. What should a dentist do when he sees that his mistake has seriously harmed the patient? How to deal with your emotions? What is the doctor's benefit from admitting his mistake? How to report an error to a patient? Is there an ethical justification for a dentist hiding a mistake from a patient?

ETHICAL AND LEGAL VIEWS ON DOCTORS' MISTAKES
From an ethical point of view, the dentist is obliged to inform the patient about his mistake, respecting the patient's right to make independent decisions. Knowing about the doctor’s mistake, the patient will be able to decide what further treatment to choose and, importantly, who to entrust this treatment to. Perhaps he will prefer to see another specialist, no matter how unpleasant it may be for the attending physician.

From a legal point of view, the doctor-patient relationship is based primarily on trust. And there are circumstances in which a doctor is legally obligated to tell a patient the truth. The court insists that the doctor comply with this duty and considers cases where the doctor deliberately deceives the patient to conceal negligence in his work as a violation of the law.

It’s a paradox, but sometimes doctors hide their mistakes precisely for fear of litigation. However, it turned out that patients are much more likely to forgive a doctor for a mistake than for a deception. Moreover, in court, the attitude towards the actions of a doctor is the same: the punishment for deception is usually heavier than for professional negligence.

In the situations described above, dentists have probably managed to deceive their patients, and they will never know the truth. But doesn't the dentist have a moral obligation to respect the patient's right to make independent decisions? No. No matter how unpleasant a mistake may be, it does not in itself indicate unethical behavior or incompetent actions by the dentist. An error in the treatment of a patient does not automatically entail legal liability for the doctor.

THE IMPACT OF ERRORS ON DENTISTS AND THEIR PRACTICES
Dentists, like doctors of other specialties, arrogantly believe that there can be no mistakes in their work. Unfortunately, many of them, consciously or not, never associate errors with the operation of technology and do not recognize them as an integral part of dental practice. Therefore, awareness of a mistake leads many doctors to a state of emotional stress. This stress is compounded by thinking about possible consequences and the fear of having to report the error to the patient. Additionally, if the error is related to technique, the dentist's reluctance to acknowledge and analyze it may result in similar errors being repeated. Therefore, open discussion of the error may benefit more than one patient. Such a discussion relieves emotional stress and allows you to draw the right conclusions from what happened.

HOW TO REPORT AN ERROR TO A PATIENT?
In both cases described at the beginning of the article, as a result of a dentist’s error, the patient’s oral condition changed and, accordingly, the need for treatment changed. In the first case, the consequences are not too serious, since the condition of the mistakenly removed tooth was far from satisfactory. It is safe to predict that the tooth would still have been lost, only it would have happened later. But in the second case, the ill-fated tooth might never have required endodontic treatment and installation of a crown. However, the patient in the first case has no less right to a truthful explanation of what happened than in the second.

It is difficult to avoid admitting your mistake to someone whose mistakes are obvious. Many dentists have at one time or another felt the desire to evade explanations with a patient, especially if their mistake significantly affected the prognosis or further course of treatment. It is even more difficult to make excuses to a patient if you tried to hide your mistake.

It is very difficult to start such a delicate conversation with a patient. In this case, the best way out is sincerity and simplicity of explanation. You can start it with simple words: “I made a mistake.” For example, in the first case we described, you could say: “I made a mistake and removed the tooth adjacent to the one that is causing you pain. Now I will remove the affected tooth, and we will talk about what can be done.”

Similarly, the patient in the second case should have been told that the carious lesion could have been seen on an earlier image, but the doctor did not see it, and this error led to the progression of the lesion. If the dentist conceals this error from the patient, he thereby violates his right to “informed consent” and risks being exposed by another doctor to whom the patient may consult in the future.

In addition, many patients themselves ask doctors questions about the causes of the disease. If the patient asked such a question in situation number two, the doctor would have to either admit his mistake or lie to the patient. Of course, there are circumstances in which not telling the truth is ethically justifiable, but the justification should be for the benefit of the patient, not the dentist.

However, despite all of the above, it is not necessary to admit a mistake immediately in all cases. For example, if a dentist is not sure that he has made a mistake, it is better for him to seek advice from colleagues and check everything again before discussing the problem with the patient. But if a doctor postpones a conversation with a patient without a good reason, then it will be much more difficult for him to admit his mistake.

The patient has a right to know the truth, and the doctor has an ethical obligation to the patient. Moreover, the doctor has obligations to his colleagues. Remember, the patient may find out about the deception by visiting another doctor. And then he may lose all respect and trust in the dental profession in general.