How to Avoid a Board Complaint or Lawsuit on an Ortho Patient with Periodontal Disease

I. Introduction
● Dr. Amanda from StraightSmile Solutions continues her liability series, focusing on orthoperio cases.
● Periodontal disease is the #1 reason for orthodontic lawsuits and board complaints.
● There is zero excuse for a primary care dentist to get sued over perio—especially if you stick with Phase One interceptive (where perio is virtually nonexistent).

II. The Golden Rule: Get Perio Clearance in Writing
● For adult patients, obtain a signed perio clearance from their periodontist BEFORE starting ortho.
● If you are the patient’s periodontist (doing inhouse perio treatment), document all probing, bone levels, and treatment plans.
● The clearance must state that orthodontic treatment is safe. If the periodontist says no, you do not start. Period.

III. Maintenance During Ortho Treatment
● Patients with perio history require periodontal maintenance (PMT) every 34 months throughout ortho.
● If they refuse PMT or fail to keep appointments, you may dismiss them—without a refund if outlined in your contract.
● Progress Xrays (or CBCT) should be taken regularly, more often than the standard yearly interval.

IV. Documentation Is Everything
● Every perio patient needs a complete record: medical/dental history, chief complaint, Xrays, diagnosis, treatment plan, informed consent (general + supplemental perio consent), and documented discussion of risks, benefits, alternatives, and questions (P.A.R.?).
● Use HIPAAcompliant software; never put patient data into public AI tools like ChatGPT.
● If you refer to a specialist, keep written proof. You are the “paperwork collector.”

V. Map Out Potential Problems Ahead of Time
● Before starting, anticipate every way a perio case could go south (bone loss, recession, grafting needs before/after).
● Put all expectations in writing, including consequences for noncompliance.
● If you don’t know how a specific tooth movement will affect the perio status, phone a friend (periodontist) and get documented advice.

VI. The Bottom Line
● Perio risk is almost entirely avoidable by doing Phase One interceptive ortho on children.
● For adults, be ruthless about clearance, maintenance, and documentation.
● A patient who is scared off by these requirements is not a patient you want.
● Don’t let a perio case become a lawsuit. Protect yourself upfront.