Key Takeaways
- Legal risk in dentistry is rarely tied to a single mistake; it often builds through small breakdowns in communication and follow-through
- Patients getting lost to follow-up is one of the most common and preventable sources of exposure
- Clear, thorough documentation becomes critical when cases are reviewed months or years later
- Communication outside of standard systems (texts, emails) can create gaps and increase risk
- Transitions, such as referrals, weekends, and handoffs between team members, are where issues are most likely to occur
- Taking time to evaluate your processes can help uncover blind spots before they turn into larger problems
Most dentists don’t spend much time thinking about legal risk, and that’s understandable. The focus is on patient care, running the practice, and keeping everything moving. But as Dr. Jordan Romano shared on a recent episode of Beyond Bitewings, the issues that lead to legal exposure rarely come from one major mistake. They tend to build quietly over time, often in ways that feel routine in the moment.
Dr. Romano, an internal medicine physician and medical expert witness, has spent more than a decade reviewing cases where something went wrong. His role is to evaluate whether the “standard of care” was met, essentially, whether a reasonably trained provider would have acted the same way under similar circumstances. What stands out from that work is how often these situations come down not to clinical skill, but to communication, documentation, and follow-through.
It’s Not Just About What Happens in the Chair
One of the most overlooked areas of risk happens after the patient leaves the office. A treatment plan may be clearly explained, a referral made, or follow-up care recommended, but what happens next is where things can start to break down.
Patients don’t always follow through. Messages get missed. Appointments are scheduled and then canceled. From a clinical perspective, it may feel like the responsibility ends once instructions are given. From a legal perspective, it’s not always that simple.
As Dr. Romano explained, cases often hinge on whether the provider ensured that the plan actually moved forward. A recommendation alone isn’t always enough. Practices that build systems to confirm follow-through, rather than assume it, are far less likely to find themselves dealing with preventable issues later.
Communication Is Where Things Go Sideways
If there’s one consistent theme across malpractice cases, it’s communication. Not just with patients, but within the practice and across providers.
Dentistry is increasingly a team-based environment. Hygienists, assistants, front office staff, and specialists all play a role in the patient experience. The more people involved, the more opportunities there are for details to get lost or misunderstood.
That risk increases even more when communication happens outside of standard systems. Text messages, personal emails, or quick side conversations may feel efficient, but they create gaps. They’re often not visible to the rest of the team, and in many cases, they’re still legally discoverable if something goes wrong.
The safest and most effective approach is also the simplest: keep communication clear, consistent, and centralized so that everyone involved in the patient’s care is working from the same information.
Documentation Tells the Story Later
When a case is reviewed, it doesn’t happen the next day or even the next month. It can be years later. By then, the only reliable record of what happened is what was documented at the time.
That’s where many providers find themselves at a disadvantage. Notes that felt sufficient in the moment can come across as vague or incomplete later. Copy-and-paste documentation, while efficient, may not fully reflect the specifics of a patient’s situation or the provider’s clinical reasoning.
Strong documentation isn’t just about compliance; it’s about clarity. It captures what was discussed, what decisions were made, and why. It also allows anyone else involved in the patient’s care to quickly understand what’s going on, which becomes critical in a team-based environment.
Risk Often Lives in the Transitions
Interestingly, many issues don’t occur during treatment itself, but during the transitions around it. End-of-day decisions, weekend coverage, referrals to outside specialists, and after-hours communication are all moments where things can slip.
Dr. Romano shared that even timing, such as procedures performed late on a Friday, can introduce additional risk if follow-up plans aren’t clearly defined and executed. When practices are busy or understaffed, it becomes easier for something small to be missed, and those small gaps can compound over time.
This is also where systems matter most. Clear processes for handoffs, follow-ups, and after-hours communication can significantly reduce the likelihood of something being overlooked.
Taking a Step Back to Move Forward
One of the more practical takeaways from the conversation is something many practices rarely make time for: stepping back and evaluating how things actually work.
Most teams are focused on keeping up with the day-to-day demands of patient care. But without occasionally looking “under the hood,” it’s difficult to see where inefficiencies or risks may be hiding.
Dr. Romano suggested something simple but effective: asking a trusted colleague to observe your practice or discuss how they handle similar situations. Whether through study clubs, peer conversations, or informal reviews, those outside perspectives often highlight issues that are easy to miss when you’re in the middle of it every day.
The goal isn’t to practice defensively or to overcomplicate your workflows. It’s to be intentional about how your practice communicates, documents, and follows through. The dentists who take the time to refine those areas aren’t just protecting themselves legally; they’re improving the overall quality and consistency of care for their patients. And in the long run, that’s what matters most.