Dental Professional Liability Claim Report

3RD EDITION

For decades, The Dentist’s Advantage Program and CNA have remained steadfast in their commitment to supporting dental professionals through education, risk mitigation, and comprehensive insurance solutions. As the landscape of dental care continues to evolve, so do the challenges and responsibilities encountered by practitioners across all practice settings.

The Dental Professional Liability Claim Report: 3rd Edition reflects our ongoing dedication to helping dentists understand the circumstances that may lead to professional liability claims. By analyzing closed claims and identifying patterns in patient outcomes, we aim to provide actionable insights that can inform clinical decision-making and enhance patient safety.

The Academy of General Dentistry (AGD) is honored to have provided input and suggestions on this important initiative. AGD’s commitment to lifelong learning and excellence in general dentistry aligns with our shared goal of empowering dental professionals to deliver safe, effective, and compassionate care. Together, we recognize that understanding risk is a critical component of professional growth and patient advocacy.

As partners in this endeavor, we extend our sincere appreciation to the dental community for its resilience, professionalism, and unwavering support to patients. It is our hope that this report serves as a valuable resource for dentists in solo, group, academic, and institutional settings, helping them to navigate the complexities of modern dental practice with confidence and clarity.

Key Findings of the Dental Professional Liability Claim Report

Since the prior report, the average total incurred for professional liability closed claims increased 10.5 percent, from $134,497 to $148,655.
Although failure to diagnose is associated with various conditions, the severity primarily results from claims associated with cancer or other tumorous growths of bone or soft tissue. Such claims represented 41.0 percent of failure to diagnose claims, with an average total incurred of $403,614.
Swallowed/aspirated object – a dental never event – now represents a larger proportion of dental claims (7.5 percent) and has increased in severity (24.1 percent) since the 2nd Edition report.
The average total incurred for all claims in which procedural sedation was administered is $248,821. For claims in which the sedation caused an injury or death, the average total incurred is $437,116.
Professional conduct complaints increased by 3.4 percent, and the average defense / expense payment rose substantially by 77.5 percent.

Terms

Average Total Incurred

Also referred to as “claim severity” within the report, refers to total paid indemnity and expense payments (total incurred), divided by the total number of closed claims.

Distribution

Refers to a specific group of closed claims with categories expressed as a percentage of the total.

2nd Edition

A reference to the prior report, entitled ‘Dental Professional Liability Claim Report: 2nd Edition,’ which includes claims that closed from 2015-2019.

Introduction

CNA and the Dentist’s Advantage program strive to educate our insureds, and the healthcare industry at large, on risks associated with patient care in dental practice. This 3rd Edition of the report provides a prioritized analysis of key claim types, interspersed with case study summaries. Future Spotlights will be produced to delve deeper into selected topics of interest. Our goal is to help dentists enhance their practice and minimize professional liability exposures by identifying loss patterns and trends.

Dataset and Methodology

There were 836 professional liability closed claims and 1,719 closed license protection matters attributed to insured dentists from January 1, 2020, through December 31, 2024. Dataset inclusion criteria are as follows:
  1. an insured dentist or dental practice with
  2. professional liability closed claims resulting in an indemnity payment ranging from $10,000 to $1,000,000; or
  3. license protection matters that resulted in claim expenses of $1 or more.
Since elements of the inclusion criteria in this report may differ from that of previous CNA/Dentist’s Advantage claim analysis and claim reports issued by other organizations, we suggest readers exercise caution when comparing these findings with other reviews. Similarly, due to the fundamental uniqueness of individual claims, the average total incurred amounts referenced within this report may not be indicative of the total incurred amounts attributed to any single claim. Furthermore, due to the limited number of claims in some claim categories, the presence or absence of one or two high-severity claims may cause a substantial increase or decrease in the average total incurred from the 2nd Edition to the 3rd Edition. This may not be indicative of any significant risk trend.

Professional Liability Claims Analysis

This report presents an analysis of the top professional liability closed claims by dental procedure, allegation, and injury type, followed by a section describing the impact of procedural sedation exposures.
Since the prior report, the average total incurred for professional liability closed claims increased 10.5 percent, from $134,497 to $148,655. Overall, this is consistent with national trends in medical malpractice and social (tort) inflation where settlements and judgments continue to trend upward, with periodic “nuclear verdicts” now affecting the dental industry.
The rise in the average total incurred is primarily influenced by a 9.8% increase in the severity of claims associated with General Practitioners (GPs), from $129,457 to $142,185. Approximately 90 percent of the claims in the dataset are associated with GP dentists. However, it should be noted that, while they are a smaller portion of the dataset, claim costs associated with non-GPs increased 17.2 percent from $170,347 to $199,721. For reference, outside of GPs, the three specialties with the highest claim costs on average include oral maxillofacial surgeons, prosthodontists, and periodontists.

…settlements and judgments continue to trend upward, with periodic “nuclear verdicts” now affecting the dental industry.

Dental Procedures

Collectively, the top three dental procedures remained the same as the prior report with an increase from 41.5 percent to 44.4 percent of the total claim distribution as seen in Figure 1. Although two of the top three procedures reflected a decrease in the average total incurred (Figure 2), their combined severity increased 1.6 percent from $148,876 to $151,300. More signifi- cant was the rise of 17.9 percent, from $124,294 to $146,544, for claims outside of the top three procedures. Among the top three dental procedures, the only increase in average total incurred was for implant surgery/placement which was up 15.9 percent to $153,246.
Historically, incurred costs for claims associated with implant surgery/placement are significantly impacted by cases of nerve injury. In this dataset, nerve injury represents the top injury- related cost driver for implant placement. Other issues also may lead to severe claims with implant surgery/placement, as discussed in Case Study 1.
An example of a less frequent procedure with a notable increase are claims associated with clinical oral examinations, with an average total incurred of $261,381 up 29.6 percent as compared to the prior report. This is primarily due to cases of failure to diagnose oral cancer or other destructive lesions (Case study 2). Review the Allegations section for more informa- tion on claims related to failure to diagnose. Severe outcomes may result from clinical oral examination procedures due to other allegations/injuries. Case Study 3 presents an example.

1

Distribution of Dental Procedures

Closed Claims with Paid Indemnity of ≥ $10,000
Top Procedures
Surgical extraction
12.3%
16.6%
Implant surgery/placement
15.9%
16.3%
Root canal therapy
13.3%
11.5%
Other Notable Procedure
Clinical oral examinations
3.7%
5.3%
2020
2025

2

Average Total Incurred of Dental Procedures

Closed Claims with Paid Indemnity of ≥ $10,000
Top Procedures
Surgical extraction
$193,871
$173,982
Implant surgery/placement
$153,246
$132,246
Root canal therapy
$115,702
$127,136
Other Notable Procedure
Clinical oral examinations
$201,631
$261,381
2020
2025

3

Distribution of Allegations
Closed Claims with Paid Indemnity of ≥ $10,000
Top Allegations
Inadequate precautions to prevent injury
20.5%
26.3%
Procedure performed improperly
18.5%
20.5%
Treatment failure
19.6%
17.0%
Failure to diagnose
7.0%
7.3%
Failed implants
5.1%
5.7%
Other Notable Procedure
Failure to refer
1.7%
1.3%
2020
2025

4

Average Total Incurred of Allegations

Closed Claims with Paid Indemnity of ≥ $10,000
Top Allegations
Inadequate precautions to prevent injury
$141,426
$135,989
Procedure performed improperly
$119,259
$142,916
Treatment failure
$102,362
$107,019
Failure to diagnose
$170,027
$250,151
Failed implants
$116,410
$135,056
Other Notable Allegation
Failure to refer
$148,087
$193,640
2020
2025

Analysis by Allegation

The top five allegations by distribution accounted for 76.8 percent of all claims, as shown in Figure 3. Although all but one of the top five experienced an increase in average total incurred since the 2nd Edition report, as seen in Figure 4, the change for one allegation stands out (failure to diagnose).
Severity for failure to diagnose increased by 47.1 percent to $250,151, which is now 68.3 percent higher than the overall average total incurred.
Although failure to diagnose is associated with various conditions, the main contributor for the increase in severity is from claims associated with cancer or other tumorous growths of bone or soft tissue. Such claims represented 41.0 percent of failure to diagnose claims, with an average total incurred of $403,614.
Outside of the top five allegations, a similar alleged lapse in dentists’ duty to the patient is failure to refer. The average severity for claims associated with this allegation increased by 30.8 percent. For purposes of this claim report, all cancer/tumor related claims are captured under failure to diagnose, whereas failure to refer is primarily comprised of claims associated with periodontal disease, nerve injuries, RCT and infection.
Case studies 4 and 5 present examples of failure to diagnose/refer.

Analysis by Injury

Similar to other areas of this report, the change in the distribution of the three most common injuries has remained relatively flat compared to the prior report. While the order of the three most common injuries remains unchanged, they now account for just over 50 percent of the total claims. The following points highlight several notable changes relevant to clinical safety and the incurred severity of loss.
Swallowed/aspirated object – a dental never event – now represents a larger proportion of dental claims (7.5 percent) and has increased in severity (24.1 percent) since the 2nd Edition report, as represented in Figure 5. Case studies 7 and 8 present examples.
Despite a decrease in severity of 10.3 percent, nerve injury (Case Study 6) remains a frequent and severe dental patient injury, with an average total incurred of $188,938. This is 27.1 percent greater than the overall average severity of $148,655.
Although it dropped out of the top five injuries due to a relative decrease of 5.6 percent, the average total incurred for corrective surgical treatment increased 70.3 percent (Figure 6). A review of these claims indicates that issues associated with complex implant-supported restorative care are primarily responsible for the increase.

5

Distribution of Injuries

Closed Claims with Paid Indemnity of ≥ $10,000
Top Injuries
Corrective dental treatment required
25.5%
26.2%
Injury to nerve/paresthesia
14.9%
17.1%
Swallowed/aspirated object
5.2%
7.5%
Other Notable Injury
Corrective surgical treatment required
9.8%
4.2%
2020
2025

6

Average Total Incurred of Injuries

Closed Claims with Paid Indemnity of ≥ $10,000
Top Injuries
Corrective dental treatment required
$102,204
$105,124
Injury to nerve/paresthesia
$210,568
$188,938
Swallowed/aspirated object
$71,980
$89,358
Other Notable Injury
Corrective surgical treatment required
$112,486
$191,525
2020
2025

Dental Nerve Injuries

Severe Claims Primarily Associated with:

• Mandibular third molar and other surgical extractions (IAN*, lingual nerve)
• Mandibular posterior dental implant placement (IAN, mental nerve)
• Mandibular posterior RCT (IAN)
Common Outcomes
• Paresthesia, dysesthesia, hyperesthesia, anesthesia
• Functional deficits (e.g., drooling, impaired speech, difficult chewing / swallowing)
• Accidental self-inflicted trauma
Essential Management Steps
• Anticipate/recognize adverse or unexpected outcomes
• Evaluate immediately or as soon as possible
• Prompt specialist referral
• Timely treatment for severe and/or persistent injuries
• Frequent/effective communication with patients and specialists
• Maintain detailed records

7

Distribution of Claims Associated with Sedation Resulting in Sedation-Related Injuries
Closed Claims with Paid Indemnity of ≥ $10,000
Level of Anesthesia
Percent of Sedation Cases with Sedation-Related Injury
Minimal sedation
0.0%
Moderate sedation
31.3%
Deep sedation / General anesthesia
21.4%

8

Average Total Incurred for Claims Associated with Sedation-Related Injuries
Closed Claims with Paid Indemnity of ≥ $10,000
Level of Anesthesia
Average Total Incurred with Sedation-Related Injury
Minimal sedation
$0
Moderate sedation
$428,155
Deep sedation / General anesthesia
$481,924

Focus on Procedural Sedation

Procedural sedation represents a new area of analysis in the 3rd Edition report. Although procedural sedation is only associated with 8.1 percent of claims included in this analysis, the injuries and costs associated with these claims are often severe. The average total incurred for all claims in which procedural sedation was administered is $248,821. For claims in which the sedation caused an injury or death, the average total incurred is $437,116.
For claims associated with moderate sedation, 31.3 percent resulted in a sedation-related injury or death, while 21.4 percent of deep sedation/general anesthesia cases resulted in a sedation-related injury or death as noted in Figure 7.
Although there were no sedation injuries associated with minimal sedation, it is important to note that when minimal sedation was intended by the provider, 45.5 percent of cases resulted in moderate sedation by definition, according current ADA Sedation Guidelines.* This set of cases represents one third of the moderate sedation cases associated with sedation injuries
Of note, multiple claims associated with sedation injuries were cases in which the practitioner did not possess a valid sedation permit as required by state law, or whose permit did not apply to the administered sedation level.
* Review the ADA 2016 Guidelines, page 2 for situations in which intended minimal sedation is categorized as moderate sedation (moderate sedation recommendations apply). All sedation cases were categorized as minimal, moderate, or deep sedation by one reviewer, consistent with ADA and other applicable clinical practice guidelines.

Analysis of License Protection Matters

In this analysis, there were 1,719 closed license protection (LP) matters in the 3rd Edition dataset. License protection matters involve the defense of the insured dentist before a regulatory agency or state dental board. License protection matters include the cost of providing legal representation to defend the dentist during the investigation, whereas professional liability claims may include an indemnity and/or settlement payment. A Spotlight on License Protection Matters will expand upon this overview.

9

Distribution of License Protection Matters by Top Allegations
Closed License Protection Matters with Paid Expense ≥ $1
Improper treatment/care
58.7%
59.9%
Professional conduct
7.7%
11.1%
Billing / insurance / financial dispute
6.5%
7.4%
Examination / evaluation / diagnosis
10.9%
7.3%
2020
2025
The average defense payment increased 9.5 percent since the 2nd Edition report from $4,428 to $4,847.
The top four license protection allegations by distribution in the 3rd Edition dataset are represented in Figure 9, highlighting limited variation from the 2nd Edition. By far, the most frequent license protection complaints involve improper treatment/care. The top examples of this allegation include improper or negligent restorative treatments or surgical techniques.
Dental crowns represent the procedure most often associated with improper treatment/care allegations, at 31.0 percent of restoration complaints. For complaints involving surgical treatment/care, implant placement surgery is the most frequent procedure cited, at 30.7 percent.
Professional conduct complaints increased by 3.4 percent, and the average defense/expense payment rose substantially by 77.5 percent from $3,328 to $5,906. Professional/personal misconduct and other regulatory/legal noncompliance (e.g., failure to release patient records) comprised the majority of these complaints. Only complaints associated with clinical oral examination and diagnosis experienced a greater increase in the average defense/expense payment from $3,684 to $7,527 (104.3 percent). The top complaints related to examination / evaluation/diagnosis include wrong diagnosis, failure to diagnose and failure to complete a proper patient assessment.

10

Distribution of Licensing Board Outcomes
Closed License Protection Matters with Paid Expense ≥ $1
Closed – no action
74.6%
80.0%
Fine
6.4%
7.7%
Letter of warning / reprimand
5.4%
4.2%
Continuing education (CE)
6.4%
3.9%
Probation
2.4%
1.9%
Revocation
0.0%
0.6%
Surrendered license
0.6%
0.6%
Suspension
1.0%
0.6%
Other
3.2%
0.5%
2020
2025

Licensing Board Actions/Outcomes

The Licensing Board outcomes by distribution are displayed in Figure 10. There was an increase in the outcomes of closed – no action as well as fines in the 3rd Edition of the report.
  • The proportion of LP matters that closed with board disciplinary action decreased from 25.4 percent to 20.0 percent.
  • Although the percentage of LP matters that closed with no action increased by 5.4 percent by distribution, the average defense payment for those matters increased by 22.1 percent, from $3,180 to $3,882.