Medicolegal issues of peri-anaesthetic dental injuries: A 21-years review of liability lawsuits in France

Abstract

Background/aim: Peri-anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico-legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico-legal issues of PDI-related liability lawsuits in France.

Material and methods: A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri-operative care, dental injuries, and convictions were collected when available for analysis.

Results: Twenty-four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation-adjusted Euros) excluding legal fees.

Conclusions: The analysis of PDI-related liability lawsuits shows that medico-legal issues differ from those of PDI-related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI-risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia-related damages.

Keywords: anaesthetic risk; dental injury; endotracheal intubation; liability lawsuit; mouthguards.