Malpractice claims for permanent nerve injuries related to third molar removals

Abstract

On the basis of the register of the Finnish Patient Insurance Association, the aim of this study was to examine malpractice claims for nerve injuries associated with third molar removals and determine whether they are concentrated among specialists, among less experienced dentists, or in certain geographic areas. During 1987-93 there were 139 claims for permanent sensory or motor disturbances related to removal of lower third molars in Finland. The lingual nerve was injured in 54% and the inferior alveolar nerve in 41% of the claims. In 91% of the cases the injury occurred in relation to surgical removal of the tooth and in 6% in relation to simple extraction. The claims were distributed among 123 dentists, of whom 78% were dental surgeons, 15% specialists in oral and maxillofacial surgery, and 7% other specialists. These figures represented 2% of the dental surgeons and 26% of the oral surgeons in Finland (P < 0.01). More than half the claims were associated with dentists with less than 10 years' experience. Claims originated more often from the eastern and northern (rural) areas of Finland than from urban areas (3.8 claims versus 2.4 claims per 100,000 inhabitants, P < 0.05). Compensation was paid to the patients in two-thirds of the cases, indicating that the dentists authorized to decide claims very often considered these injuries avoidable. Therefore, proper diagnosis, treatment planning, surgical techniques, and detailed patient information must be emphasized. In cases where risks are obvious, referral to an oral surgeon is recommended.