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      Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers

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          Abstract

          Introduction

          In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market.

          Material and methods

          The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market.

          Results

          The insurance products analysed are structured on the “claims made” clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy.

          Discussion

          On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess.

          Conclusions

          When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing.

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          Most cited references11

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          Legal liability in bisphosphonate-related osteonecrosis of the jaw

          Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse reaction that may occur in patients administered with bisphosphonates (BP). This condition can cause high morbidity and hinder quality of life. Its treatment is complex and often unsatisfactory, and prevention strategies may have limited effectiveness, if any. Thus, managing patients treated with BP may result in exposure of the practitioner to legal liability or malpractice claims: legal actions pursuant to BRONJ are reported to be underway on three continents. Nonetheless, the attribution of liability, if any, is a complex process requiring, on the basis of current knowledge, a robust and pragmatic approach to the facts, which must be identified from the point of view of the time, place and individuals involved. This means a comprehensive consideration of the sequence of actions from bisphosphonates prescription to BRONJ occurrence (as well as immediately after, and any action potentially related to its causation or worsening) is required in order to determine if a breach in informing, diagnosing, managing or referring the patient took place, as well as determining if the patient was compliant in attending to prescriptions and follow-up programmes.
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            Bisphosphonate-related osteonecrosis of the jaws: legal liability from the perspective of the prescribing physician.

            Recently, it has been reported that patients administered with bisphosphonates (BP), in particular cancer patients receiving intravenous amino-bisphosphonates, as well as patients taking oral BP for prevention/treatment of diseases of altered bone turnover, may be affected by a significant adverse reaction-BP-related osteonecrosis of the jaws (BRONJ). This condition may cause high morbidity and detriment of quality of life. Its treatment is complex and often unsatisfactory, and prevention strategies may have limited effectiveness, if any; thus, BRONJ may become a source of litigation in the near future. Although most cases seem to be triggered by invasive dental procedures and oral health care providers are more exposed to malpractice claims and legal actions pursuant to BRONJ, the attribution of liability requires caution. In fact, types of possible negligence claims against oral health care providers have already been highlighted. However, according to the medico-legal methodology, since BRONJ is an adverse reaction to BP administration, the attribution of liability, if any, requires a comprehensive consideration of the chain of events and figures acting before, and potentially related to BRONJ. The physician prescribing BP at the start of this chain has specific duties which we are going to address, and breaching these duties may set the stage for potential liability claims.
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              Adverse drug reactions in the oral cavity.

              Several drugs may have a number of adverse reactions (ADRs) involving the oro-facial region. The dose of the drug and the time required for the reaction to take place are relevant parameters; nonetheless, ADRs mechanisms are not always known and ADRs are not always predictable since aspects other than drug pharmacodynamics and/or pharmacokinetics, as well as various interacting variables contribute to the final outcome. All tissues and many functions of the oral cavity can be affected. In particular, salivary function is frequently involved and hypo-salivation is the main manifestation; several mucosal lesions with different morphology (ulcerations, vesiculobullous lesions, white lesions, pigmentations, swelling) are also possible. Taste, sensation and trigeminal function alterations have been reported and the recent evidence regarding the occurrence of jawbones osteonecrosis, especially in bisphosphonates treated patients, is increasing. Clinical management may be quite difficult due to the multiplicity of involved classes of drugs and substances (dental materials, foods), the variety of affected tissues and functions, the type of produced lesions and disturbances, the complexity of related pathogenetic mechanisms (if known), the difficulties in assessing causality and managing drug withdrawal and/or dose adjustment, as well as in establishing specific treatments, if any. In this paper the most common and significant oral ADRs, their related aspects and importance (including medico-legal implications) for health care providers will be discussed.
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                Author and article information

                Contributors
                Journal
                Open Med (Wars)
                Open Med (Wars)
                med
                med
                Open Medicine
                De Gruyter Open
                2391-5463
                2016
                2 August 2016
                : 11
                : 1
                : 256-263
                Affiliations
                [1] 1Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via S. Pansini, 5 - 80131 Naples, Italy
                [2] 2Department of Advanced Biomedical Sciences, Naples, Italy, University of Naples “Federico II”, 80131 Naples, Italy
                [3] 3Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, Italy, University of Naples “Federico II”, 80131 Naples, Italy
                Article
                med-2016-0051
                10.1515/med-2016-0051
                5329838
                21d42a69-2b1d-4297-ada5-acd751ca770a
                © 2016 Pierpaolo Di Lorenzo et al.

                This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

                Page count
                Pages: 8
                Categories
                Focus on Medico-Legal and Ethical Topics in Surgery in Italy

                professional liability,malpractice,insurance policy,forensic dentistry

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