The first step in handling a dentist complaint is to speak directly with the person providing your care. If your dental work is being provided at a private office, speak directly with the dentist. If you are being treated at a dental school, speak with both the student and the supervising faculty. It is normal for problems to be addressed at this stage and an amicable solution reached. If the dentist complaint is of a more serious nature (i.e., an osha violation) and/or results in your needing to have a specialized procedure performed (e.g., a dental filling has turned into a root canal), the discussion should take place in the presence of the clinic manager/or clinic facilitator, and any quality assurance personnel if necessary. These individuals are trained to act as the liaison in all dentist complaints as it relates to the clinic. Be certain to take notes of all discussions - you may need them for reference at a later time.

As a clinic manager, I have had my share of complaints to handle. Discussions among fellow clinic managers revealed that the most frequent dentist complaints involved a dental cavity procedure becoming a root canal, post/core and crown procedure. The process for handling this type of dentist complaint is outlined below.

The Problem – Tooth Pain

Sometimes, when performing a filling associated with a dental cavity and tooth pain, the dentist may go too far into the pulp area of the tooth while removing the decay. When this happens, a root canal procedure is needed because the nerves are now exposed. Depending upon the extent of the decay, the dentist may have had no choice but to enter into this area of the tooth. If this information is not explained to the patient, i.e., the deepness of the decay, misunderstandings will often occur. The patient, who was expecting a $125 procedure to be performed, is now faced with dental fees upwards of $1,000-$2,000 (root canal, post/core and crown). Not a very pleasant situation to be faced with. While many dentists will discuss the possibilities with the patient beforehand, some may not. At this point, the tooth will either undergo a pulpotomy (the beginning of a root canal where decay is removed from the dentin and pulp areas of the tooth) or the full root canal procedure, in order to begin the process of saving the tooth.

If care is being provided at a dental school and you were not informed of the possible outcome prior to having the dental cavity filled, speak with the student dentist and faculty in the presence of the Clinic Manager or Clinic Facilitator. If you are being treated at a private facility, the discussion should occur between you and the licensed dentist.

Dentist Complaint – The Initial Discussion

Using the above as an example, the dentist complaint might focus on the lack of information provided to the patient regarding the outcome of the dental cavity procedure. Although you signed a treatment plan (especially at a dental school*), consenting to treatment, you consented to a dental cavity filling, not a root canal.

*I find that, while all dental schools use a treatment plan for their patients, some seasoned dentists in private practice tend not to, especially for "simple procedures". While they may do this to save on time, it is important that each dental procedure you are having be duly noted on a treatment plan with the fees involved, as well as the possible outcomes in order to avoid misunderstandings.

A treatment plan is a contractual agreement which often implies that the care you are receiving is continuous, complete and of the best quality. Referring back to the example, the care provided was incomplete given that the dentist, using both x-rays and the physical examination, should have informed the patient of the possibility of a root canal being needed and/or referring the patient to an endodontist for a consultation prior to starting the filling procedure on the tooth.

Failure to provide this information could be viewed as a violating a dental patient's rights as it relates to their comprehensive care. Given the outcome, some sort of compromise should be considered. Compromise could be in the form of a discount on the root canal and crown procedure. If no agreement can be made during the initial discussion and you are being treated at a dental facility, you may discuss the matter with the clinic director or the individual who supervises both the students and clinic's assigned faculty.

The clinic director is usually a licensed dentist and has both the experience and tact to handle treatment issues, while the clinic manager or facilitator handles the finances. The clinic director is responsible for ensuring that both student dentists and faculty are following strict policies and procedural guidelines when providing patient care.

As a reminder, keep good documentation, remember to get the names and titles of individuals you speak with. Try to get business cards for easy reference as well.

If, after discussing the dentist complaint with all parties of the clinic: dental student, faculty, clinic manager and the director, there is no resolution, you can take your grievance a step further – to the patient advocate. If you are being treated at a private facility, there may be no internal liaison, in which case you may need to proceed directly to external resources in the form of either a peer review established by the dental society or an external legal body to file a small claims suit.

Dentist Complaint – Patient Advocate

The dental school's patient advocate is an individual who usually works in conjunction with the School Deans and outside court systems to handle patient matters as it relates to dental care. The patient advocate works very hard to ensure that standards and guidelines are being followed by everyone – from the students, to faculty, directors and managers, and can help to expedite care in some instances.

It is always a good idea to make an appointment with the patient advocate. This assures that ample time is set aside to discuss your dentist complaint. Review your notes before your meeting, making certain to stick to the facts - outline what you perceive to be the problem and the outcome you would like to see. Make a duplicate copy of your notes for the patient advocate to use during their investigation of the dentist complaint. This is quite helpful - not only does it save time, it may even help to speed up the outcome. According to one advocate, the better prepared patients are with the facts outlining a dentist complaint, the easier it may be to get an amicable resolution. So, document, document, document - and focus on the issues, not the individuals.

At your meeting with the patient advocate, continue to document your discussion. After your meeting, do a follow up email or letter, copying both the clinic director and clinic manager. Be certain to stick to the facts and not get too emotional. I understand how upsetting this situation can be (trust me - I've been there), but it is important to remain calm during this process. The last thing you want is for people to perceive you as being rude, pushy or demanding. Most people will only react in kind, defeating your purpose which is to get a favorable ruling.

Usually, after meeting with the patient advocate, the issue is resolved. If you are satisfied with the outcome, good for you - job well done. If you are not, it is my personal recommendation that all available channels are exhaust. But, also keep in mind, that every discussion that you have had thus far is an opportunity to see the situation from the viewpoint of others. But, if you really believe that a disservice has been done, by all means, use every channel at your disposal to get a fair outcome with a dentist complaint. Again, if you are being treated in a dental school, the next step would involve communicating with the Dean of the dental school.

Dentist Complaint – The Dean

Sometimes, patients may need to the assistance of a dental school Dean to resolve a dentist complaint that could not be resolved at the clinic level. Depending upon the Dean, the issue will either be resolved within a matter of days, or no response may be forthcoming. I am fortunate to have been affiliated with a school that works very hard for patient satisfaction at the clinic level. When a dentist complaint comes to the attention of the Dean, it is usually a sign of bad management or the patient was not aware of the proper chain of command as it relates to the grievance process. In any event, if you have exhausted all of the channels or believe you are not being directed to the proper personnel for assistance, writing the Dean of the school where you are receiving your care is a good way to get the attention of all parties.

In your letter, make certain to stick to the facts, providing the Dean with the information gathered during your discussions. Again, if the Dean is proactive, you will receive a response and the issue will be resolved. If you receive no response, submit a follow-up request with a deadline date. Indicate your willingness to resolve the matter internally, but also indicate your intentions to seek assistance of an external body if no response is received. Hopefully, a response and resolution will follow. If not, you may need to take your dentist complaint to an outside agency.

As you contemplate taking your issue to an outside authority, familiarize yourself with the Dental Patients' Bill of Rights:

Dental Patients’ Bill of Rights You have the right to select your own dentist. This most often applies to having dental work performed in a private facility. But, usually at the dental school level where students are assigned to you, if problems do arise, you can speak with the Clinic Manager or Clinic Facility about transferring you to another student, perhaps even a student who may have practiced in another country and is currently training for US licensure. Advanced dental students are generally individuals who have attended dental school outside the United States. In order to practice dentistry in the US, they must undergo the same educational standards as US born citizens. There are advantages to having an advanced student perform your dental work. They are very familiar with dental procedures and some have had a sufficient amount of patient contact care. I often find that advanced students are more professional, skillful and dedicated than some of the US dental school students. You have the right to hold your dentist accountable for the highest standard of care in the dental community. You have the right to expect your dentist to be of the highest professional, ethical and moral conduct. You have the right to expect your dental health care team to maintain current continuing education. You have the right to be responsive to urgent care and to treat you with courtesy, respect and dignity. You have the right to know in advance the type and anticipated cost of treatment. You have the right to expect prompt appointment scheduling and a right to privacy. You have the right to expect appropriate infection and sterilization protocol for all dental care. You have the right to inquire about treatment alternatives and be advised of the risks, benefits and cost of each option. You have the right to know the education and training of your dental health care team.

Dentist Complaint – External Bodies

In summary, the best first step to resolving a dental complaint is to speak directly with the person providing the care. If you are unsuccessful with reaching a resolution, remember you can also proceed to file a complaint with the state licensing board, the dental society, or an attorney.

Dental Societies (Peer-Review Committees)

Dental societies include local, regional, and state professional organizations controlled by its members. Its primary existence is for promoting the interests of its members, which includes fostering professionalism; promoting and sponsoring continuing education; influencing legislation as it effects the field of dentistry. Dental societies cannot act as a group to control or set dental fees, however they are designed to investigate disputes as they relate to fees and can negotiate reimbursement rates with insurance companies. Because they are familiar with fees and can judge whether a charges are reasonable, they can act in an advisory capacity or offer to arbitrate with both the patient and dentist agreeing in advance to accept the decision.

Local dental societies have established a peer review system as a way to resolve disputes arising from disagreements between patients and providers on dental treatment. Peer review provides an impartial and easily accessible means for resolving misunderstandings regarding the appropriateness or quality of care and, in certain instances, the dental prices charged for treatment. The peer review committee attempts to mediate the problem. In some instances, they may meet to discuss the case, examine clinical records, talk to both the dentist and patient and, if necessary, arrange for a clinical examination. You can contact the dentist association in your state by using this link

The goal of many dental societies is for consumers to be treated fairly. By performing such a valuable public service by acting as a skilled, outside agency, they are striving to keep the image and standards of the dental profession high. They can explain why a particular situation should be approached in a particular way, or why a fee charge is fair and reasonable. Similarly, they can inform a dentist of unreasonable or inappropriate behavior.

If after using a peer review committee without reaching a resolution (i.e., care provided was extremely substandard), a complaint should be filed with the licensing board. While investigating the matter, if the dental society review committee finds evidence of malpractice, the committee can either inform the state licensing board directly or instruct the consumer to do so.

State Licensing Boards

While fee disputes or dentist complaints do not generally fall within the scope of a State licensing board (they are not equipped to handle the large volume of complaints received), they do have peer review committees that can evaluate and mediate some disputes that arise. These committees can look at the facts, including interviewing both parties and make a recommendation towards resolution. In most states, the boards are prohibited from investigating a practitioner unless a written complaint has been received. Many State dental practice acts are posted on the Internet.

When a complaint is made, the board is usually required to open an investigation. The scope of the investigation would depend on the allegations and must be conducted according to the rules specified in the State's dental practice act.

If an investigation results in charges of professional misconduct, there is typically a trial before either a review committee or an administrative law judge. The trial is a formal procedure, with rules of evidence, witnesses, and so on.

If charges against a dentist are sustained, he/she can be sanctioned by the licensing board. Sanctions can include full suspension, temporary suspension, limitation of practice, supervision of practice, and revocation of license. Other sanctions can include restitution of fees, fines, and required additional education.

How to File a Dentist Complaint

Dentist complaints should be clear and concise. Every fact need not be put into the initial letter, and it is best to avoid strong emotion or recommendations. The complaint should:

1. Specify the facts (who, why, when, where, and what)
2. Request an investigation, and where possible
3. Include the specific violation(s) of the State's dental practice act.

Be certain to send the letter certified mail, keeping a copy for your records. Both dental societies and licensing boards receive many complaints over a period of time and must investigate each one received. Therefore, it may take some time before you receive a response.

Important Note: Licensing Boards are not in the business of dispute resolution, and therefore cannot simply help consumers to "get money back." Peer-review committees such as that of a dental society would be the proper forum for assitance with getting fees paid returned to the consumer. Licensing boards exist to enforce regulations, so all they may be able to do in the end is remove a dentist's license to practice or sanction the dentist in other ways.

Malpractice Litigation

If you believe that you suffered significant damage as a result of dental negligence, you may have grounds for a malpractice lawsuit. You should consult with an attorney who specializes in personal liability cases, in particular, dental malpractice. The attorney can evaluate your claim to see whether a valid case against the dentist exists.

LegalZoom one such source which allows you to conveniently file a small claims suit online. Founded by renowned attorney Robert Shapiro, LegalZoom is the premier online legal document service. They provide quality legal documents at up to 85% less than the cost of an attorney. Serving over 350,000 satisfied customers, LegalZoom has been recognized and applauded by Yahoo!, USAToday, Popular Science, NBC, ABC, CBS, PBS, the New York Times, and more. The process is fast and easy, and saves you money in legal costs. With LegalZoom, you can get legal documents for up to 85% less than traditional lawyer fees. If you, or someone you know are looking to file a small claims lawsuit, this is one resource that should not be overlooked.

Because the damages in dental malpractice cases tend to be relatively "small" and the cost of a trial may exceed potential payments from a successful lawsuit, attorneys will often advise settlement or peer review. Some cases, however, do involve substantial damages.

Note that any lawsuit must be brought within a period of time set by state law (referred to as statute of limitation). The statute of limitations can be as little as one year after the procedure is performed. Your attorney can better advise you on the length of these time periods. Therefore, it is important to not delay if you believe a lawsuit may be appropriate, even in cases where you have a case pending with the dental society or licensing board.

Dentist Complaint – Summary

If you have a dentist complaint, use the information I provided to you, as a way to find a resolution. The process may seem a bit overwhelming to you, but it is not impossible. It is important to not give up, but to hold everyone involved in your comprehensive dental care up to the standards which have been set. Some people give up and seek treatment elsewhere in order to correct any damage that has occurred. But others proceed as far as they need to in order to effectuate change in the behaviors and attitudes of some dental clinic settings.

If you had a dentist complaint with a favorable (or unfavorable) outcome, that you would like to share, feel free to Shout Out! and Share It!. Helping others to help themselves is often the way to show some dentists that we are not only smart consumers, but we are active participants with our oral health care needs.