Perio: The Most Common Lawsuit in Dentistry?

Perio: The Most Common Lawsuit in Dentistry?

Recently, the dentist I work for casually dropped something in our morning huddle that stopped me in my tracks.

He said, “Perio is the most common lawsuit in dentistry right now.”

Honestly? I was surprised.

I assumed lawsuits would trend toward failed root canals, extracting the wrong tooth, or missed infections. But the more I thought about it, the more I could see why periodontal care might leave us vulnerable when things are missed over time.

And as a hygienist, it made me think about our role in all of this—not from a place of fear, but responsibility.

Because there are things within our control that can help protect our patients, our practices, and ourselves.

Why Perio Makes Sense

Periodontal disease is typically a chronic condition. It doesn’t appear overnight and destroy like wildfire. Most cases progress slowly over years.

That’s part of what makes it risky.

When something progresses slowly, changes can slip under the radar unless we are intentionally looking for them.

Patients who have completed scaling and root planing and are on 3–4 month recare should be receiving regular periodontal evaluations. Patients on a 6-month prophylaxis schedule should also be evaluated at appropriate intervals.

The American Academy of Periodontology (AAP) recommends at least an annual comprehensive periodontal evaluation.

Evaluation isn’t just another box to check.

It’s how we know what is actually happening with the patient sitting in our chair.

How Perio Slips Through the Cracks

From my experience as a practicing hygienist, periodontal disease tends to get missed in one of two ways:

1. A lack of thorough evaluation

• Incomplete or inconsistent periodontal charting

• Not reaching the base of pocketing when probing or scaling

• Relying on “it looks fine” instead of objective measurements

2. A failure to clearly communicate findings

• Avoiding difficult conversations

• Downplaying bleeding or pocketing

• Not clearly documenting disease progression

And I understand how this happens.

Sometimes the schedule is running behind. Sometimes we’re trying to keep an anxious patient comfortable. Sometimes we know the conversation we’re about to have may not be received well.

I’ve felt those pressures too.

But when patients are showing up consistently and we are not objectively evaluating and documenting the periodontium, we can move dangerously close to supervised neglect.

That is where liability can begin to grow.

I Understand Both Sides

I’ve worked with hygienists who can complete a 15–20 minute prophy. I’ve questioned myself because I wasn’t moving that fast. Many of us learn speed as a survival tool.

We’re balancing physical strain, emotional labor, time pressure, late patients, lack of assistance, complex cases—and our lives outside of work.

Some days, just getting through the schedule feels like a win.

I don’t think the answer is pretending those realities don’t exist.

But there are certain parts of our appointments that deserve to remain protected despite them.

Evaluating the periodontium is one of them.

Not because we need another thing to worry about, but because thorough assessment gives us something incredibly valuable:

We know what is actually happening.

And from there, we can decide what needs to happen next.

This Is What We Specialize In

Yes, we clean teeth.

But while we scale, we are also assessing where biofilm is accumulating, where inflammation is present, where home care is breaking down, and where disease may be progressing.

Our role isn’t simply to remove calculus and biofilm.

We gather information. We recognize patterns. We interpret what we see. And we help our patients understand what that information means for their health.

That is a huge part of our specialty.

We aren’t “taking extra time” to evaluate. The evaluation is part of the care.

The Hard Conversations

I know some hygienists hesitate to tell patients where their oral health is falling short.

I used to.

A classmate once told me about a hygienist who tried to educate a patient, and he snapped back:

“If I wanted to be nagged at, I would have stayed home with my wife.”

She was mortified.

Stories like that stick with you. They can make it tempting to soften what we see or tell ourselves we’ll address it next time.

But something that has helped me is remembering:

We are not nagging.
We are evaluating and informing.

Periodontal findings are objective clinical information.

Probing depths.
Bleeding points.
Radiographic bone levels.

We can communicate those findings kindly. We can be thoughtful about our delivery. But we don’t have to make the information disappear because it may be uncomfortable to hear.

Our responsibility is to assess, inform, recommend, and document.

The patient’s responsibility is deciding what they want to do with that information.

The Bottom Line

We have to evaluate.

And we have to communicate what we find.

Those things protect the patient, the practice, and us.

But I don’t want this conversation to make any hygienist more anxious about practicing.

I actually hope it does the opposite.

Because one of the best ways to quiet that little voice that follows us home—Did I miss something? Should I have said something? Did I document enough?—is knowing that we did our part while the patient was in our chair.

And in my experience, the overwhelming majority of patients appreciate thorough care, especially when we explain why we’re doing it.

Give Yourself the Gift of Peace

Periodontal disease doesn’t become a lawsuit overnight.

Problems develop when small moments of inattention compound over time.

But the opposite is also true.

Small moments of intention compound, too.

Every time you probe thoroughly.
Every time you have the slightly uncomfortable conversation.
Every time you document what you saw.

You are caring for your patient—and giving yourself peace of mind.

Because one of the best gifts we can give ourselves as clinicians is being able to leave work knowing:

I did my part.

A patient may decline treatment. They may choose not to change their home care. They may decide they aren’t ready to address their periodontal health.

Those decisions belong to them.

We can care deeply without carrying responsibility for decisions that aren’t ours to make.

So maybe the takeaway from this conversation doesn’t need to be “Be afraid of getting sued.”

I’d rather it be this:

Give yourself the gift of peace.

Assess thoroughly.
Communicate clearly.
Document diligently.

Then go home knowing you did your part. <3