In recent years, there has been an important debate related to the issue of litigation in the dental field. Guidelines on how to deal with the issue have existed for several years (since 2003). These, in addition to considering the trend in comparison with other medical disciplines, observe from the outset how the origin of litigation is frequently the perception of a right denied or a sudden error – an error that, of course, is often present – but which is then emphasised, even by judgements expressed by other dentists. On the other hand, in an interesting article published by Prof. Radice on the Modern Dentist, he adds that as well as diagnostic-therapeutic errors there are frequently those of a management and behavioural nature.
One of the medical branches of greatest impact in the legal field is that of anaesthesiology. From this point of view it should be noted that daily dental practice normally involves local anaesthesia. It is accompanied by the systemic approach in the forms of general anaesthesia, which is mainly used in large oral surgery in a dedicated facility and in some cases in treating paediatric patients, and sedation, in which there is an increased interest in an outpatient setting.
Professional associations are pursuing important efforts to provide professionals with reliable and evidence-based management protocols. One of these, the American Association of Oral and Maxillofacial Surgeons, recently published interesting research by Ji and Dodson in its reference journal. The investigation included cases of anaesthesia-dental dispute reported on Thomson Reuters Westlaw Next Database and involving a professional oral or maxillofacial surgeon. The episodes were classified by the patient’s details (age, gender), clinical environment (hospital and outpatient), level of anaesthesia (simple local anaesthesia, intravenous sedation, general anaesthesia), administrator (dentist or anaesthesiologist), mortality and morbidity and legal outcome. Of the 112 episodes investigated, 61 were excluded because they did not fall within the scope of oral/maxillofacial surgery, 29 in the anaesthetic one, as well as 5 “duplicates” and another 4 for other reasons. There are therefore 13 cases remaining. We will analyse the most interesting data related to this, albeit it from a limited sample.
First of all, 9 cases of litigation, equal to 69.2%, involved interventions performed in the outpatient setting.
Local anaesthesia was found to be the safest method among the 3 investigated, but this does not mean that it was free from problems, since it is involved in 2 of the 13 cases investigated.
As regards systemic procedures, it should be noted that 4 of the episodes (30.7%) included the presence of an anaesthetist alongside the surgeon. Differences in legislative terms should be taken into account regarding the skills of a single dentist/anaesthesiologist. This means that the presence of the specialist does not constitute protection in the absolute sense from the advent of complications, as is perfectly normal.