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Prevalence and Causes of Patient Complaints Against Dentists in Golestan Province (2012-2022)
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Behina Banifatemi1    , Azizeh Karimian2 , Amir Reza Ahmadinia *3 |
1- General Dentist, School of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran.
2- M.Sc in Biostatistics, Dental Research Center, School of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran.
3- Associate Professor, Department of Periodontics, School of Dentistry, Golestan University of Medical Sciences, Gorgan, Iran. , ar.ahmadinia@gmail.com |
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Keywords: Dentists [MeSH], Forensic Medicine [MeSH], Forensic Dentistry [MeSH]
Article ID: Vol27-27 |
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Full-Text [PDF 947 kb]
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Type of Study: Original Articles |
Subject:
Forensic Medicine
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Abstract: (6 Views) |
Extended Abstract
Introduction
An individual’s teeth significantly impact their health, communication, aesthetics, and self-confidence. Consequently, it is natural for people to pay close attention to and be sensitive about their oral and dental health.
Medical malpractice refers to treatment that deviates from the approved standards of medical science, resulting in harm to the patient, primarily due to the practitioner's lack of skill, such that other competent physicians would have been capable of performing the treatment correctly. Dental malpractice encompasses errors in the diagnosis, treatment, or management of a disease.
The prevalence of dental complaints varies from one location to another and from time to time; however, generally, the number of dental complaints is increasing globally over time. The most significant factors influencing dental complaints include behavioral factors, failure to inform the patient about treatment complications, high treatment costs, and incomplete diagnostic examination for proper disease identification.
The analysis of dental complaints is significant, both for elevating the standard of patient health through improving the quality of dental education programs and services, and for raising the awareness of practitioners and reducing the costs of the healthcare system.
Given the importance of being aware of complaints made in the field of dental treatments for their prevention, the enhancement of the quality of dental education and services, and the avoidance of costs associated with dental complaints, and considering that the results of previous studies on the distribution of the causes of patient complaints are inconsistent, and in light of the absence of a similar study conducted in Golestan Province, this research was undertaken to determine the frequency and causes of patient complaints against dentists in Golestan Province.
Methods
This descriptive, retrospective study was conducted on 96 complaint files against dentists in Golestan Province using a census method during 2012-2022.
The registered files that resulted in a verdict were reviewed through in-person attendance at the Golestan Province Medical Council Organization.
The observation technique and recording data on an information form was utilized for data collection. Incomplete files, complaints against dental technicians, and dentists without a medical council number were excluded from the study.
For each file, an information form was designated, which included the complainant’s age and gender, the dentist's age, gender, work experience, academic degree, the location of treatment or service provision, the reason for the complaint, the dental service provided, the year of complaint registration, and the outcome of the issued verdict. The available data were extracted from the files, and the prepared form was recorded by the researcher. The data were then entered into the statistical software SPSS-27, and the frequency of variables was reported using descriptive statistics indices.
Results
Of the 704 licensed dentists, 96 patient complaints against dentists in Golestan Province were registered during 2012-2022.
The highest number of complaints was filed in 2019, followed by 2020. Subsequently, the trend was decreasing. Of the total complaints filed against dentists, 87 cases (90.6%) were against general dentists and 9 (9.4%) were against specialists. In the frequency distribution analysis, the majority of complaints concerned prosthetic treatments (29.2%), surgery (26%), and endodontic treatment (18.8%).
In the field of prosthetic treatments, one case was related to prosthodontists, and 27 cases were related to general dentists. Regarding the causes of complaints concerning prosthetic treatments, 9 cases (33.3%) were due to the patient's dissatisfaction with the form and color of dental crowns, 8 cases (29.6%) were related to anterior dental laminate due to laminate fractures and tooth sensitivity, 6 cases (22.2%) were related to composite veneers due to composite discoloration and gingival tissue problems, and 4 cases (14.8%) were related to removable prostheses due to oral mucosal ulceration and poor retention.
A total of 25 recorded files were related to patient complaints regarding surgical treatments. One file pertained to a periodontist regarding the loosening and lack of osseointegration of fixtures after implant surgery. Three files related to oral and maxillofacial surgeons, 2 of which concerned the loosening and lack of osseointegration of fixtures after implant surgery, and one involved a patient experiencing pain, swelling, and reduced sensation in the lip and tongue following wisdom tooth extraction. Of the 21 complaint files against general dentists, 13 cases (61.9%) were related to implant surgery, 9 cases were due to infection at the surgical site, loosening, and removal of the implant, and 4 cases were due to improper implant placement in the esthetic zones of the mouth, 5 cases (23.8%) involved numbness of the lip and tongue following wisdom tooth surgery, and 3 cases (14.2%) were related to severe pain and infection after tooth extraction.
Of the 87 complaint files against general dentists, the highest number of complaints, in descending order, concerned prosthodontic treatments (n = 27, 31%), surgeries (n = 21, 24.1%), restorative treatments (n = 15, 17.2%), and endodontic treatments (file separation, root perforation, and crown fracture) (n = 15, 17.2%), inappropriate dentist behavior (n = 6, 6.9%), and pediatric dentistry (n = 3, 3.4%). Complaints against specialists included surgeries (n = 4, 44.4%), endodontic treatments (n = 3, 33.3%), inappropriate behavior (n = 1, 11.1%), and prosthodontics (n = 1, 11.1%). Out of the total number of complaints, 72 cases (75%) were against male dentists and 24 cases (25%) were against female dentists.
Out of all the complaints, dentists were acquitted in 42 cases (43.38%), convicted in 33 cases (34.37%), and the plaintiffs reached a settlement in 21 cases (21.09%). In the cases where the dentists were convicted, 13 cases (39.3%) resulted in a verbal reprimand and compensation, and 20 cases (59.7%) resulted in a written reprimand, compensation, and inclusion in the file. In none of the registered complaints against specialists was the practitioner found guilty. The highest frequency of complaints was recorded during 2019, amounting to 21.9%.
Conclusion
Based on the results of the current study, the highest number of complaints belonged to dental prosthetics, surgeries, and endodontic treatments, respectively.
Considering that pain in dentistry constitutes an emergency and primarily arises from advanced dental caries, which subsequently increases the probability of requiring root canal treatment, the likelihood of a complaint in this area is higher.
Of all the complaints examined in this study, a higher percentage (90.6%) was against general dentists. This issue may be due to the greater variety of dental treatments provided by general practitioners.
In our study, a high percentage of complaints (75%) were against male dentists. This observation may be attributed to the lower employment rate among female dentists, their potentially greater caution during treatment procedures, and the nature of their emotional-psychological relationship with patients.
In the present study, the highest number of complaints was reported duing 2019, followed by 2020, after which the trend was decreasing. Certain factors, such as the improvement in the quantity and quality of the curriculum in the field of dentistry, the introduction of new and modern technology and tools, and the scientific updating of dentists through attending practical workshops can be considered the most important reasons for this.
In the current study, the majority of complaints (83.3%) originated from private offices. A significant factor in this regard is the higher cost of treatment in private offices compared to private and public clinics, which subsequently raises the patient's level of expectation and anticipation from the treatment. Furthermore, the greater number of private offices compared to clinics throughout the city may also be a contributing factor.
The high percentage of complaints in this study that resulted in the acquittal of the dentist signifies that no professional malpractice occurred in those cases. It appears that other factors, such as the dentist's inappropriate behavior and interaction with the patient, inadequate patient information regarding the treatment plan, inaccurate estimation of treatment costs, and failure to obtain informed consent—may have prompted the patient's complaint. Each of these factors is contrary to the principles of medical ethics and will ultimately be detrimental to both the medical community and the patient.
It is noteworthy that in none of the complaints registered against specialists in this research was the practitioner found guilty. It seems that the lack of negligence among the specialists in our study is due to their greater scientific knowledge, expertise in treatment, and perhaps a better awareness of regulations and a higher ability to resolve disputes with patients.
One of the most significant limitations of this study was the lack of computerized record-keeping, the absence of a suitable procedure for filing records at the Golestan Province Medical Council Organization, and the incompleteness of the files.
Ethical Statement
This study was approved by the Research Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1402.252). To adhere to the principles of medical ethics, particularly concerning the confidentiality of the patient records, the records were reviewed at the location of the Golestan Province Medical Council Organization and in the presence of a respected representative from the organization.
Funding
This article has been extracted from the DDS dissertation of Ms. Behina Banifatemi in Dentistry at Golestan University of Medical Sciences. The study was funded by the Vice-Chancellor of Research and Technology at Golestan University of Medical Sciences (approval no. 113369).
Conflicts of Interest
No conflict of interest.
Acknowledgments
The authors of this article sincerely thank the presidency and staff of the Golestan Province Medical Council Organization for their valuable support in conducting this study.
Authors' Contributions
Behina Banifatemi (DDS): Project execution, Data collection, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Azizeh Karimian (M.Sc): Data analysis, Interpretation of the results, Approval of the final manuscript.
Amir Reza Ahmadinia (DDS, MSc): Project administration and design, Project execution, Interpretation of the results, Drafting of the initial manuscript, Approval of the final manuscript.
Key Message: The majority of patient complaints, primarily concerning prosthodontics, surgeries, and endodontics, were against general practitioners, predominantly male, and one-third of these complaints resulted in the dentist's conviction.
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