In Denmark and Sweden, the medicolegal system handling complaints is closely related to health legislation. In both countries, complaints are managed by local committees or regional dental complaint boards (DCB) consisting of members from the Dental Association and officials. The committee makes administrative decisions based on best clinical practice and legislation [2, 6, 10]. Following a complaint from the patient and based on the patient file, the DCB gives a written statement, which includes a decision of malpractice or no malpractice. If the decision of the boards is consistent with malpractice, the dentist has to return the fee for the treatment to the patient. In other cases, the DCB may propose a settlement, where the dentist in question accepts to cover the patients’ expenses for re-treatment provided by another practitioner. The dentist or the patient may appeal the decision to a national dental complaint board (NDCB). Besides dentists and laypeople, the NDCB also includes a civil court judge. The NDCB might temper, affirm, intensify, or reject the regional DCB’s decision. If one of the parties still is dissatisfied, the decision can be brought to a civil court.

In Denmark, patient insurance has been a part of health care legislation since 1992. With modification, the law now covers all kinds of treatment independently if the treatment is given in a private or public context. The financial resource for legislation and insurance is primarily founded by the government. However, the dentists pay a premium depending on their revenues.

The insurance in Denmark is a no-fault insurance. This means that it is not a matter of establishing if the practitioner has made a mistake. The important thing is to establish if the treatment per se leaves the patient in a situation where the status of the dentition has deteriorated. Additionally, a re-treatment is not possible to reestablish the patient’s tooth/dentition. Finally, it is important to distinguish between well-known complications to a particular treatment and injuries. To do so, four principles are used:

To describe the content of the four principles, the following should be observed:

In Sweden, a similar no-fault compensation system has been introduced. The purpose has been to provide the patient who suffered a treatment injury with the right to be compensated, regardless of whether the injury had been established by negligence or not [11]. Concomitantly, the system can chase those dentists providing dental care where they were responsible for negligence under tort law.

In cases where the patient cannot accept the decision made in the insurance system, the Danish system has an appeal board. If it is still not acceptable to the patient, the patient can bring the decision to a civil court [12].

In a study of Swedish malpractice cases, less than 1 malpractice case per 1,000 dentists was detected in the period from 1977 to 1983 [2]. In the USA, the number of general malpractice cases per 1,000 dentists increased from 11 to 27 malpractice cases in the period from 1988 to 1992 [3], and more recent statistics from 2007 shows that dentist with at least 1 filed claim increased from 27 per 1,000 dentist to 40 per 1,000 dentist [19].

In Denmark, from 1995 to 2004, the number of malpractice cases increased from 4 to 5 per 1,000 dentists [6]. Dental malpractice claims per 100,000 patients have been relatively constant covering a 10-year period from 1995 to 2004 in Denmark. However, in urban areas the frequency of claims was over the mean of the country (24.7 versus 13.1, respectively) [6]. A similar difference between urban and rural areas was reported in Sweden [2].

In short, medicolegal reports on endodontics are frequently received by the complaint boards and/or insurance systems/companies. As when it comes to the variation in claim frequency, the medicolegal systems vary between countries, and direct comparisons are difficult to make, but in general complaints from patients about dental treatments are internationally rising [7].

Endodontic treatment and prosthodontics have been among the three most frequently listed complaint areas during the past decades (Table 15.2). Notably, oral surgery seems to be lesser involved within recent years, whereas implant placements are a new growing area of malpractice complaints. The latest report has implant as the number one most frequent claim area [9].