RCTs and Lawsuits- Fool-proof your Root Canals

Dental lawsuit

A 34-year-old woman from Bangalore sued a dentist and took him to the consumer court after her root canal procedure went awry which caused an infection and swelling of the gum with excruciating pain. Following a court battle which went on for about three years, the woman won a compensation of Rs 60,000 in December 2020.

According to the court the filling after RCT was not done properly and there was incorrect drilling on the right side of the tooth.

Well, we hear such incidences quite often. We may have even come across such cases performed by other dentists or may have made a mistake ourselves. It is a possibility.

How do we make sure that we don’t fall prey to such things and put our practice and future in danger? Here are some tips to reduce the likelihood of court cases especially in a complex procedure like RCT.

  1. Use Rubber Dam: I cannot emphasize enough on this point. Usage of a rubber dam in any endodontic procedure is a must. It is the first point checked in any malpractice involving endodontic procedures.
  2. Create a full plan: don’t just jumpstart to the RC opening (unless in an emergency). Prepare a full plan and go over the plan together with the patient. Capture the plan in detail in patient’s EMR.  Patient consent is a must. This plan should have RCT+Restoration+Prothodontia (crown/bridge, whatever!), Endo without good resto is pointless.
  3. Single visit craze: Be particular in identifying cases that are not fit for single visit and abide by it, even if the patient insists. Doing an RCT that may fail doesn’t put you in a good light. If the patient’s situation is very genuine and he/she needs it to be done in a single sitting, record the change in treatment plan well, take counter signature from the patient.
  4. Don’t delay resto: Microleakages will spoil all of your hardwork and efforts if you give it enough time. Sensitizing the patient about it from the beginning itself improves patient compliance and reduces the time gap.
  5. Don’t try procedures you are not confident of: It is important to relieve the paient of his/her pain more than anything. If you are not confident of a procedure for any reason, do not attempt it, or at least do not attempt it alone. Have someone senior observe you or simply refer the case to someone who is experienced in handling such cases. It is better to share a patient than struggling and finally losing the patient.
  6. Keep a lot of hand files: (and use them) Most of us reuse files, but how many times, that must be watched very carefully. Broek files are hard, both on the patients and on the dentists. Many cases fail due to instrument breakage in the canal, sometimes making retrieval impossible and the patient is made to pay the price by having to lose the tooth.
  7. Glamour of curved canals: Look, it doesn’t matter how curved the canal was and how well you obturated it. For a patient, all that matters is whether the pain got relieved and whether the tooth is now functional or not! As simple as that!
  8. Irrigation is never enough: sodium hypochlorite is your best buddy. Trust it and go on. Irrigate! Irrigate! Irrigate!
  9. RVGs and apex locators are your guides. Literally!
  10. Communicate with your patient, treat him/her like a person. Smile and greet the patient, call them by their name, ask them how they feel. If you do this, they will trust you so much that they would even forgive your mistakes (if you make one). Many research studies conducted on patients who filed lawsuits had one similar story pattern, they all felt unheard. They felt their doctor was cold, and did not treat them well. Communication is your golden armor, embrace it and your patients will love you!
  11. Be unafraid and be confident but also be vigilant and be human!