Lightning Dental Charts publishes this recurring series based on real dental board complaints and disciplinary actions nationwide. Each post is designed to help general dentists reduce malpractice risk, strengthen their documentation practices, and understand what dental boards really look for when they open a case file.

Case One: A Missed Oral Cancer Screen Turns Into an $11.5M Verdict

In one of the most sobering malpractice cases of the past year, a Pennsylvania appellate court upheld an $11.5 million judgment against a general dentist for failing to detect oral cancer.

The dentist, who carried the typical $1 million malpractice policy, is personally responsible for the remaining $10.5 million.

The facts were simple and unfortunately familiar. The dentist provided routine care to a patient for several years but never documented an oral cancer screening in the patient’s record. The plaintiff’s attorneys argued that had an early lesion been noted and referred, the cancer might have been caught at a treatable stage.

Without a dental note documenting that the screening occurred, the defense had little ground to stand on.

“Oral cancer screens — every patient, every visit, no exceptions.”
— Jeff Tonner, JD, Co-Founder, Lightning Dental Charts

This case underscores the importance of clearly charting even routine procedures. Many dentists perform oral cancer screens out of habit but fail to record them clearly. In the eyes of the court — and the board — if it’s not in the chart, it didn’t happen.

Charting takeaway:
Make “OCE” (Oral Cancer Exam) part of your permanent dental note template. Document findings, patient education, and any referrals. Even a two-sentence entry can make the difference between a defensible chart and an indefensible claim.

Case Two: Billing Confusion Leads to Board Complaints — and Charting Scrutiny

In two separate Arizona cases involving AHCCS (Medicaid) patients, billing misunderstandings triggered dental board complaints. Both patients believed that pre-authorization meant full coverage. When asked to pay their portions, they filed grievances.

While the board eventually dismissed the financial allegations, both cases revealed charting deficiencies.

In one instance, the board noted missing treatment rationale and unsigned progress notes. In another, the patient’s file lacked documentation of financial counseling, a detail outside the original complaint but enough for the board to issue a letter of concern.

These cases highlight a crucial reality: a dental board complaint opens the door to a full audit of your records, not just the specific issue raised. Dental Boards often review every chart entry — clinical or otherwise — for compliance with dental record keeping guidelines.

Charting takeaway:
Your dental notes should always present a coherent story: Observation → Diagnosis → Treatment → Follow-up → Financial discussion (if relevant).
A well-structured dental note template helps ensure that nothing is omitted, even under pressure or time constraints.

Case Three: Cracked Crowns and Sequencing Errors

A third case involved a patient presenting with no bilateral occlusion. The treating dentist developed a plan to restore the anterior and bicuspid regions first, intending to address the posterior teeth later.

Several new crowns fractured soon after placement due to excessive occlusal forces. Upon review, the board determined that the treatment sequence was inappropriate — posterior support should have been established before anterior restorations.

The dentist received a letter of concern for poor sequencing and inadequate clinical justification.

In its findings, the board noted that the chart lacked any discussion of occlusal stability, provisional restorations, or patient counseling. The absence of narrative reasoning made it impossible to demonstrate that the treatment plan was well considered.

Charting takeaway:
Boards expect documentation to reflect sound clinical reasoning. Your notes should explain why a chosen sequence or procedure was performed — not just what was done.

Lightning’s guided charting system prompts users to include these details automatically, reducing the risk of vague or incomplete documentation.

Case Four: Implant Failures in Smokers and the Missing Consent Clause

An increasing number of board cases now involve implant failures in patients who smoke. In many of these instances, the board concludes that informed consent was inadequate because the record failed to mention smoking risks or cessation recommendations.

One practical addition can help prevent this:

“For patients who smoke, a Smoking Cessation Course is highly recommended before implants are placed.”

Including this statement in your implant consent form — and confirming that it’s discussed and signed — adds a layer of protection that’s difficult to dispute.

Even when clinical technique is flawless, incomplete documentation can make a case indefensible.

Charting takeaway:
Integrate risk-specific clauses into your dental note templates and consent forms. Update them regularly to align with evolving dental board expectations.

Broader Implications: Charting as Risk Management

Across these cases, one theme emerges: charting quality determines defensibility.

Boards and courts alike judge the dentist’s actions primarily through what’s written in the record. A missing note, outdated template, or absent rationale can transform a defensible case into a disciplinary action.

That’s why defensible dental charting has become a foundational risk management strategy. Beyond compliance, it demonstrates professional judgment, patient communication, and adherence to the standard of care.

Dentists who treat documentation as a legal instrument — not just a clinical habit — dramatically reduce their exposure to dental board complaints and malpractice claims.

How To Strengthen Your Documentation Today

1. Use legally informed templates
Most EHRs were built for billing, not legal defensibility. Lightning Dental Charts includes templates reviewed by a leading dental malpractice attorney to ensure compliance with dental record keeping guidelines and charting best practices.

2. Customize dental note templates by procedure
Scaling and root planing, implant placement, sedation, or restorative work — each requires different documentation triggers. Preloaded templates make it easy to capture key metrics every time.

3. Prioritize clinical narrative
Include diagnostic reasoning and patient communication. Replace checkbox charting with concise clinical storytelling.

4. Review your informed consent language annually
Update it for new risks (e.g., vaping, new implant materials, sedation protocols) and keep signed copies in the patient record.

The Takeaway

Whether it’s a missing oral cancer screening note, a poorly sequenced treatment plan, or an incomplete consent form, documentation failures remain the most common and preventable cause of dental board action.

Every dental note you create is more than a clinical record — it’s your legal safeguard.

Lightning Dental Charts makes defensible documentation faster, easier, and more consistent — because protecting your license should never come at the expense of your time.

FAQ Section 

1. What makes a dental note legally defensible?

A legally defensible dental note includes clear, chronological documentation of the dentist’s observations, diagnosis, treatment rationale, and patient communication. Each note should reflect sound clinical reasoning and adhere to current dental record keeping guidelines. Consistency across all dental note templates helps ensure your documentation holds up under a dental board or legal review.

2. How often should I update my dental note templates?

Dental note templates should be reviewed and updated at least once per year—or sooner if there are changes to ADA standards, state board regulations, or your clinical protocols. Outdated templates are one of the most common causes of documentation deficiencies cited in dental board complaints.

3. What are the most common dental charting mistakes that trigger board action?

Common charting mistakes include missing clinical justification, incomplete periodontal charting, lack of informed consent documentation, and template notes that don’t support the treatment provided. These gaps often lead to sanctions even when patient care was clinically appropriate.

4. How can defensible dental charting reduce malpractice risk?

Defensible dental charting provides a written record that demonstrates professional judgment, patient communication, and adherence to the standard of care. In the event of a dental board complaint or lawsuit, well-documented notes serve as your strongest evidence that care was appropriate and informed.

5. What tools can help dentists improve documentation quality?

Modern charting systems like Lightning Dental Charts help dentists save time while improving legal defensibility. By using pre-built, attorney-designed dental note templates, you can automatically capture the key details boards and courts expect—reducing risk and ensuring consistent documentation across your practice.

🦷 Start your free trial of Lightning now!
Click here to see how Lightning’s AI-powered, legally informed dental note templates can help you prevent the next complaint before it starts.