Il contenzioso odontoiatrico: la realtà del fenomeno.

OBJECTIVES. In spite of insufficient data, the common opinion is that dental litigations are increasing at rates generating alarm within the profession. The aim of the present research is to give a scientific representation of the dimension of dental litigation, with a view to checking if there is an increasing trend, and to simultaneously analyzing the litigations' most important features (incidence by discipline, average compensations) in the different contexts: private practice, public service; judicial and extra-judicial areas. MATERIALS AND METHODS. Data related to dental litigations have been taken from: 1) private practice and insurance companies, by collecting data coming from ANDI (Associazione Nazionale Dentisti Italiani) and related to professional liability policies specifically dedicated to members between 2002 and 2012 (12,000 active policies in 2012); 2) dental public service, by analyzing data covering the years 2008-2012 from the National Health Service of Desio and Vimercate, which provides 250,000 dental treatments/year to a catchment area of 750,000 people; 3) judicial system, by analyzing the 2007-june 2013 judgements of the Civil section of the Magistrates' Court of the city of Rome. The data were then compared with those reported in a similar study related to the years 2002-2008. RESULTS. The number of disputes treated in the insurance context and related to private practice shows fluctuations from 2.6% (2002) to 4.6% (2012). In the public service, the incidence of litigations ranges from 0.16% in 2008 to 0.40% in 2012, with an higher rate of specious disputes in 2012. As to legal controversies, the court settlements related to dental malpractice over the period 2007-2012 halved (4%) with respect to the period 2001-2008 (9.5%). The dentist was the losing party in 80% of cases (judiciary) and 95% of cases (insurance). Prosthodontics and implantology are the dental specialties most affected by litigation. The breach of informed consent duties accounts for less than the 3% of dispute cases. In comparison with the average sums compensated in the insurance context (from 11,000 euros in 2002 to 4,700 euros in 2012), the amounts awarded by the Magistrates' Court of Rome (> 20,000 euros) are much higher. CONCLUSIONS. Dental litigation shows a very low incidence ratio, ranging from 1:500 and 1:1,250 of all dental patients. The technical error is the main cause of litigation, while disputes related to the breach of information duty are residual (< 3%). Dental treatment generally requires multiple visits, therefore it can be correctly assumed that there is a proper flow of information between the doctor and the patient. The dentist is the losing party in the dispute with the patient in 80-95% of cases, mainly because in civil proceedings the burden of proof bears on dentists and even a simple lack of supporting evidence can lead to an unfavorable outcome. In one third of court trials, dentists are not in possession of an insurance policy. The compensated sums appear on average larger as an outcome of a judicial procedure (mean > 20.000 euros) than as an out of court settlement of the dispute; therefore, when the professional error is evident, a persistent litigation implies higher expenses as well as significant prolongation of time and emotional stress for all parties. The results of the present research indicate no increase in litigations, neither in the judicial nor in the out of court/insurance context, neither in the number of cases nor in the amount of compensations, both in the private practice and in the public service. Scaremongering attitudes towards dental malpractice are not scientifically supported and should be avoided in order to safeguard the clinician's image and to improve his confidence in preventing claims and the ensuing increased risk of defensive dentistry