When patients see more than one dental provider, keeping everyone on the same page isn't just helpful — it's critical.
Posted in Dental Insights on Thursday, July 9, 2026
Mary Robinson, a 25-year-old receptionist at an assisted living facility, first treated with general dentist Samuel Gough, DDS, in 2016. She mentioned straightening her teeth during Dr. Gough’s evaluation and consultation, so he referred her to Dr. Stevens, an orthodontist.
Dr. Stevens thought Mary was a candidate for orthodontic care despite some bone loss and periodontal issues, but she didn’t return to him for the orthodontia. For unknown reasons, she Mary went to see periodontist Dr. Petrie instead.
At Dr. Petrie’s office, Mary had scaling and root planing done over three visits. Dr. Petrie agreed that Mary’s dental condition might have posed additional risks for orthodontic treatment, but he had no opinion as to whether Mary was a candidate for braces.
Patient Sees More Treaters
In 2018, Mary was still interested in braces, so she went to see Dr. Bream, an orthodontist located near her work. Dr. Bream did an evaluation, took a full-mouth set of films and noted some bone loss Mary was already aware of. Mary agreed to proceed with orthodontic care and signed a general consent form that spelled out the risks. Dr. Bream initially noted that Mary was under the care of the periodontist Dr. Petrie. Mary’s orthodontic treatment with Dr. Bream went as planned, according to his records.
Sometime in 2019, Mary went to yet another provider, general dentist Dr. Roosevelt, because his office was near her home. She came in for her first cleaning with a full set of braces on her teeth and told Dr. Roosevelt her last X-rays had been taken two years prior. The history did not identify any prior dentists, but handwritten records from the first visit indicated that Mary had scaling and root planing performed and her orthodontist was Dr. Bream. Dr. Roosevelt and Dr. Bream did not know each other.
During that first visit, Dr. Roosevelt did spot probings and recorded in the handwritten chart that there was generalized bone loss and some areas of pockets in the 4-6 mm range. He took bite wing films.
Dr. Roosevelt’s records included both electronic and handwritten portions since his office had recently implemented an electronic health record (EHR) system. The EHR system had a template for full-mouth probings, including a detailed periodontal analysis, but Dr. Roosevelt did not use that template.
Dr. Roosevelt put Mary on a regular cleaning schedule, which she attended, but not always at the recommended intervals. At two of these visits, Mary complained of general discomfort and sensitivity; Dr. Roosevelt noted she had some recession. During this time frame, he performed two fillings in addition to the cleanings. However, neither Dr. Roosevelt nor Dr. Bream communicated with each other about Mary’s care – the only updates were provided by Mary.
In November 2021, Dr. Bream removed Mary’s braces, and she never returned for follow-up care with the orthodontist.
At another appointment with Dr. Roosevelt, Mary had another full-mouth set of films taken, which showed significant and generalized bone loss. Dr. Roosevelt’s notes indicated that her periodontal condition should be monitored.
Records Sent to More Periodontists
Around the two-year mark in treatment, Mary requested her records be forwarded to Dr. Paul, a periodontist Dr. Roosevelt didn’t know, and Dr. Roosevelt sent the records. The records thereafter show a scaling and root planing was done. After that visit, Mary requested that Dr. Roosevelt send records to yet another periodontist, Dr. James.
Dr. Roosevelt called Dr. James, who told him Mary was in danger of losing all of her teeth. All had severe bone loss along with severely increased mobility. Mary later lost six teeth due to mobility based on bone loss and received implants placed with grafting.
She filed a lawsuit against Drs. Bream and Roosevelt, contending that neither had referred her to a periodontist or told her she had periodontal problems. In her testimony, Mary said:
- She did not know what scaling and root planing were.
- Dr. Petrie knew she was intent on braces and never discouraged her.
- She decided to go to a periodontist in 2021 only because friends encouraged her to try a periodontist due to teeth sensitivity, not because Dr. Roosevelt referred her.
- She went to all visits as recommended other than having to occasionally reschedule because of work.
Mary said she took care of her teeth as best she could, but relied on the dentist to help clean her teeth because this was difficult with braces. She expected Dr. Roosevelt to do the cleanings since that’s why she went to him in the first place.
Mary denied vehemently that Dr. Roosevelt ever referred her to a periodontist. She also said Dr. Bream never explained the importance of follow-up care with her periodontist or that she was at risk of losing her teeth because of periodontal issues. As for the consent form, Mary said she didn’t really understand it, and Dr. Bream never discussed it with her. She admitted that she had signed the form, but she was nervous about getting braces and was worried the form would scare her, so she didn’t thoroughly read the form or ask questions about it.
Mary contended that if the treaters would have referred her to a periodontist, she would have gone immediately. What’s more, her current periodontist, Dr. James, was very critical of the care from Drs. Bream and Roosevelt. Dr. James had told Mary that if either treater had identified the problem and removed Mary’s braces sooner, he could have treated her periodontal problems and saved her teeth.
Dental Treaters Respond
Dr. Roosevelt testified that he believed Mary understood her periodontal issues because she used the terms “scaling” and “root planing” in discussing her care. As for the recession and bone loss, he said he was aware of these issues when Mary first came in, which is why he recommended regular cleanings.
Dr. Roosevelt further contended that Mary’s cancelation of appointments and lack of good home care contributed to her problems. He insisted that both he and his office staff had clearly told Mary that she should see a periodontist, which is why Mary sought out two different specialists.
In his testimony, Dr. Roosevelt admitted his records were not detailed on the issue of referral. However, he said the entirety of the notes clearly showed that he referred Mary to a periodontist once her braces came off and the full-mouth films were taken.
Dr. Roosevelt had to admit that the office’s computer system included detailed templates for patients with periodontal issues that he didn’t use. If he had used these templates, there would have been a far more detailed picture of the extent and progression of Mary’s dental and periodontal condition. Dr. Roosevelt could not explain why those forms were never used.
Once Dr. Roosevelt learned that Mary had not yet been to a periodontist as recommended, he testified that he had stressed the need for follow-up care. Since Mary returned for visits after the referral and because he thought Dr. Bream would have contacted him if there were issues, Dr. Roosevelt felt he acted appropriately.
Dr. Bream testified that he had a lengthy discussion with Mary about the risks of placing orthodontia on a patient with periodontal issues. He recognized this was a concern at the time the braces were placed, but with regular cleanings, that situation was not so dire that it would cause tooth loss. Dr. Bream said Mary had told him her periodontist was aware of Mary’s planned orthodontia and had expressed no concerns.
Dr. Bream contended that Mary had told him she would continue to follow up with that periodontist, but he never noted the periodontist’s name in the chart or checked on whether the patient actually received follow-up care. He further testified that he assumed Mary treated with a general dentist and periodontist regularly and that those dentists would have contacted him if there were problems. Therefore, Dr. Bream felt he acted appropriately.
Mary’s later treating periodontist, Dr. James, was indeed critical of both Dr. Roosevelt and Dr. Bream. The defendants each retained experts to defend their care. After this testimony, the dentists settled for a confidential amount estimated to be in the low six figures. Costs to defend the dentists were projected to be close to $100,000.
What Can We Learn?
Without question, better communication among the dentists would have provided Dr. Bream and Dr. Roosevelt with a stronger defense. The lack of coordination between the dentists allowed the patient to essentially dictate her care and to misrepresent what she told Dr. Bream. Had Dr. Bream communicated with Drs. Petrie and Roosevelt, he might have learned about and been able to take action about those misrepresentations before the case was litigated.
As for Dr. Roosevelt, if he had spoken to Dr. Bream and documented his referral, the reasons for the referral, and his ongoing discussions with Mary about the increased urgency of seeing a specialist, his defense would have been stronger.
In addition, while not a direct issue in this case, the use of templates may have helped its defense. It would have been far easier to determine the extent of any progression of the periodontal disease over the course of time if the details about the periodontal condition had been thoroughly noted.
Films taken during orthodontic care also would have helped lay this groundwork. While the defense experts relied on the testimony of the defendants, it came down to their word against Mary’s. More thorough documentation, better use of a detailed electronic format, and improved communication and coordination among the providers would have furthered the defense of both Dr. Bream and Dr. Roosevelt – in a defense victory or through reduced settlement amount.
About the Author
Linda J. Hay is a partner in the Chicago office of HeplerBroom, LLC. Ms. Hay has practiced in the professional liability defense arena for more than 25 years and has tried numerous cases to verdict. She is actively involved in a variety of defense bar, professional liability and risk management organizations.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.