Damian Panchal lists some of the things to consider to avoid litigation when undertaking endodontic treatment.
Involving your patient
With a growing fear of litigation among young dentists, it is important that you take all the necessary steps to avoid a complaint in this increasingly litigious society.
During your undergraduate training, if the clinical situation dictated, root canal treatment was often the procedure of choice. There was little conversation about the risks and complications that can arise, as quite often specialists were on hand to provide assistance. However, the answer is not always root canal treatment.
When your head says, ‘taking the nerve out will solve the problem’, you need to stop, sit down and have a lengthy discussion with your patient about what they would like to do next. You will be surprised at how many people are not prepared to undergo multiple lengthy appointments for a procedure that does not have a 100% guarantee of success.
Whilst you may be thinking, why would you rather have the tooth out when we can at least try and save it, ultimately it is not your decision to make. You are there to advise in your patient’s best interests, however it is their tooth and therefore their choice.
Risks and complications
Root canal treatment comes with its own extensive list of risks and complications. A written consent form can be a useful aid to gaining informed consent.
Sometimes a patient’s only knowledge of root canal treatment is ‘I have heard it hurts’. It is your job to alleviate their concerns whilst ensuring they understand what the procedure involves. To ensure their consent is valid, it needs to be voluntary, informed and the person must have capacity to make that decision. Capacity is assessed by an individual’s ability to understand and retain the information, use or weigh up that information and communicate their decision back to you.
Your consent form should highlight who will be undertaking the procedure and on what tooth it will be completed on. You should always offer the option of a referral to a specialist endodontist for an improved prognosis. This is part of offering all of the treatment options, whilst ensuring you are covering yourself medico legally if anything unfortunately does go wrong.
There are at least seven risks that should be explained to each patient for all root treatment procedures. These need to be explained in terminology they can understand and can be supplemented with visual aids and radiographs where appropriate.
- Failure of canal location and negotiation
- Failure to remove existing root filling material
- Blockage of the root canal
- Fracture of an endodontic file within the root canal
- Tooth fracture
- Root perforation
- Hypochlorite accident.
Using your professional experience and judgement you should then highlight which of these risks are particularly relevant for their tooth. Ensure a thorough assessment has been completed and consideration paid to factors that complicate the procedure. The AAE Endodontic Case Difficulty Assessment Form and Guidelines (www.aae.org, 2010) can be a useful document to aid your discussion with the patient and give a realistic expectation of the prognosis.
Whilst many patients will sign where they are told without reading the risks, all material risks and complications should be explained to the patient to ensure you are gaining informed consent. A signature on a consent form is not evidence that consent has been gained and is of secondary importance to the quality of your communication and information you have provided.
The best means of avoiding litigation is to involve your patients, give them time to think and ask questions, and provide treatment that is within your experience and comfort. Complications do happen, it’s the nature of root canal treatment, but your patient needs to understand these risks before it happens, not once it has happened.
www.aae.org/specialty/wp-content/uploads/sites/2/2017/10/2006casedifficultyassessmentformb_edited2010.pdf (2010) accessed 21 April 2019