Published on:

Changes in the American Heart Association Guidelines may impact the use of antibiotics by dentists during tooth extractions and root canal treatment. The impetus for the new guidelines appears to be concern for prophylactic use of antibiotics when the are not indicated, which can lead to treatment resistant infections down the road. However, the standard of care, i.e., what a reasonably prudent dentist would do under like or similar circumstances, does require the use of antibiotics by dentists in a number of important situations in order to avoid catastrophic results. One such use involves protection of the heart from infection due to tooth extraction or root canal therapy. Infective endocarditis is a bacterial infection of the heart lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause serious injury or even death if untreated. A common group of bacteria that cause this infection is Viridans Group Streptococci  or VGS. Importantly, dental patients with existing heart conditions, including those with prosthetic heart valves, are more susceptible to the infection, while dental patients with normal heart valves develop the infection less often.
In 2007, the American Heart Association changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with heart defects. However, the guidelines were careful to note that the giving of preventative antibiotic treatment should be limited when not indicated, as noted above. Dental patients should ask their primary care doctor or cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on the new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure. Similarly, if they are aware of a condition that they have that requires the use of antibiotics prior to dental treatment, they should be careful to note that on the dental office intake forms and to bring this to the attention of their dentist or oral surgeon.

They should also be aware that overuse of antibiotics when they are not indicated, can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been an increase in the number of antibiotic resistant bacteria. When this happens, new and much more complex antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.

Published on:

There are many incidents of dental malpractice. According to a recent article, a lack of protocol to ensure sterilization has lead to numerous cases of bacterial heart infections and one death. The dental board investigated three initial reports of bacterial endocarditis, a type of heart infection, after a physician at the local Medical Center noticed that two patients had contracted the unusual disease and had one thing in common — both had been treated by the same dentist. The dental board did not suspend the dentist, but rather it ordered him to improve his infection prevention protocols.  Apparently, the dental board is continuing its investigation of the matter and further action could be taken against the negligent dentist. This is highly likely considering there are a total of 15 people who have suffered greatly due to the lack of proper standards and protocols at this dental practice.

According to the article, an inspection of the dentist’s office revealed clear violations of the dental standard of case such as the use of a single use vial of Propofol for more than one use; pre-filled syringes of medication; expired vials and multi-dose vials of medication; non-sterile preparation of instruments and poor documentation of medication units. These types of infractions are apparent from the records kept by the practice and were probably uncovered after a thorough investigation and multiple interviews with the dentist and his staff.

Bacterial endocarditis is extremely rare and can be fatal. Often, the victim must undergo heart surgery and/or lengthy medication protocol to recover from the condition. In this particular case, the dentist who committed the malpractice would be liable to all of the patients who sustained injuries and damages. In order to recover for dental malpractice in Georgia, the Plaintiff must show that the dentist committed malpractice; that the malpractice caused the plaintiff’s injuries and the amount of damages, which usually consists of past and future medical bills, lost wages and pain and suffering. In order to file dental malpractice lawsuit, the plaintiff’s attorney must attach an affidavit from a dental expert who regularly practices in the filed of dentistry in questions and which lists at least one act of dental malpractice which caused or substantially contributed to the injuries that the plaintiff is complaining of in the lawsuit.

Published on:

Many asbestos-related lawsuits involve the deadly condition called mesothelioma, which is a particularly aggressive form or cancer that: (1) is almost always fatal; and (2) has a very long latency period (sometimes as long as 30 years). The latency period is the amount of time between exposure to the toxic materials (in this case, asbestos) and the onset of the disease. In Deggs v. Asbestos Corp., the family of a deceased worker tried to bring a wrongful death suit after the worker had previously brought an asbestos-related lawsuit against nearly 40 asbestos defendants 15 years earlier. In the earlier lawsuit, the injured worked settled with a number of the defendants and obtained a $1.5M verdict at trial against the the sole remaining defendant which refused to settle. Unlike other cases that involve mesothelioma, the injuries in this particular case were lymphoma, pleural disease and asbestosis, as a result of many years of exposure to asbestos while the Plaintiff served in the Navy during World War II.

In denying the attempting wrongful death lawsuit, the Court found that “[a] wrongful death action accrues at the time of death as long as there is a subsisting cause of action in the deceased at the time of death subject to exceptions not present here.”  Therefore, the Court found that the suit was time-barred.

Malignant mesothelioma is a type of cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium). Mesothelioma is an aggressive and deadly form of cancer. Mesothelioma treatments are available, but for many people with mesothelioma, a cure is not possible.

Published on:

According to a recent BBC News and Health article, which analyzed a study in the British Dental Journal, approximately 1% of dental implant procedures performed each year result in nerve injuries. Dentists should improve care before and after implant surgery, the study says. A dental implant is an artificial tooth root, which is screw or cylinder-shaped, that is placed into the jaw to hold a replacement tooth or bridge. Dental implants are generally used if someone has lost a tooth or teeth due to disease or injury. The type of nerve injury which can be caused by implant surgery has increased in recent years alongside a rise in implant surgery. Approximately 10,000 lower jaw implant procedures are performed each year in the UK and in 2007, 30% of all nerve injuries cause by dental work were associated with implants. This contrasts with 10% in 1997. This is almost certainly due to the increased acceptance and usage of dental implants after extractions.  The King’s College London research team found that these injuries could have a significant impact on people’s quality of life with more than half of the 30 patients participating in the research suffering from constant pain or discomfort after surgery and 40% complaining of numbness. 30% of the implant injury patients reported psychological problems, including four who were diagnosed with depression. Most of the injuries revolved around the trigeminal nerves such as the inferior alveolar nerve, the mental nerve and the lingual nerve.

70% of the 30 patients were referred to a nerve specialist more than 6 months after surgery, despite evidence showing that removing implants soon after surgery reduces the risk of permanent damage. In addition, a referral after 6 months reduces the likelihood that the nerve specialist will be able to properly diagnose and surgically repair the injured nerve, if that is the course of treatment that is warranted. If the micro-neurosurgeon determines that the best course of treatment is surgical repair, the surgery must be performed as soon as possible. In other words, the longer the injury goes untreated, the less likely that the surgical repair will be successful. Many times, the dentist who caused the nerve injury is reluctant to refer the injured patient to a specialist and this is below the standard of care to not timely refer a patient with a dental nerve injury to a nerve specialist. However, the proper course of treatment is to refer the patient out in a timely manner and to have continuity of treatment.

Attorney Robert J. Fleming has been handling wrongful death cases, automobile accident cases, personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.

Published on:

According to the American Association of Endodontists, root canal treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep tooth decay, repeated dental procedures on the same tooth which are not successful, or a crack or chip in the tooth which widens and/or deepens over time to the point that the pulp of the tooth is affected. A traumatic injury to a tooth may also cause pulp damage even if the tooth looks fine on the outside. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

Endodontic treatment typically consists of the following steps:

1. The dentist who is performing the root canal therapy examines and x-rays the tooth, then administers local anesthetic to numb the area and tooth that is to be worked on. After the tooth is numb, the dentist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.   

Published on:

If an injured dental patient seeks a lawyer on legal web sites such as, dental malpractice usually falls under a sub-heading of medical malpractice. This is certainly the case, and there are a number of dental procedures that commonly lead to dental malpractice claims, among them are: Root canal therapy, dental implants and puncturing the sinus cavity during a number of procedures in the upper jaw.

In order to pursue a dental malpractice case, and affidavit of an expert is required to be filed with the lawsuit in most jurisdictions. This is the same requirement as medical malpractice cases. The filing of the affidavit with the complaint necessitates that an expert in the field review the case and provide and opinion in the form of an affidavit that the treatment rendered in the case was below the standard of care. The standard of care for dentists and doctors is that they must exercise such reasonable care and skill for their patients as, under similar conditions and like surrounding circumstances, is ordinarily employed by the dental or medical profession generally. This is investigated by reviewing the treaters records, radiographs and other related information in order to determine the level of care provided by the potential defendant. The reviewing expert must have been regularly engaged in practice or teaching three of the past five years in the same area of practice or specialty, with sufficient frequency to establish an appropriate level of knowledge, as determined by the trial judge, in performing the same procedure, diagnosing the condition or rendering the treatment which is alleged to have been performed or rendered negligently by the defendant. In most cases, there is no grace period for filing the expert affidavit after the suit is filed. If there is no malpractice affidavit, the suit will be dismissed.

As discussed above, the standard of care must be violated during the procedures and care in order for there to be a case to pursue. In other words, simply because an injury occurred, does not mean there is malpractice. However, in most instance, the expert review will determine if there was malpractice and whether the malpractice caused he injury. Since dental malpractice is a form a medical malpractice, it follows that in order to pursue such claims, the injuries complained of must be extensive and permanent.

Published on:

According to a recent webmd article, dogs attack and bite over 4 million Americans every year, half of these attacks are on children between ages 5 and 9. One out of every five of those bites causes an injury that requires medical attention, according to the Centers for Disease Control. Children are also more likely than adults to be injured by a dog bite and the severity of the injuries that children sustain are often much more severe than those that adult dog attack victims suffer because children are, in many cases, unaware of the dangers of the dogs and helpless against an attack.

Although strays or other strange dogs can bite, most of the time people are actually bitten by a dog they know, which could be a friend’s dog or even the family pet. Other times, a loose dog in the neighborhood comes up upon a child and attacks.

In order to prevent dog bites and attacks:

Published on:

With the holiday season approaching, we once again have detected an increase in the number of slip and falls and trip and falls in the Atlanta Hartsfield Airport and its parking lots and approaches. This is not new and it’s hardly surprising. When the number of travelers through the airport increases, the number of accidents and injuries rises exponentially. Why? There are a number of reasons for this, but probably the biggest reason is that the airport and airline employees are overworked and stretched too thin. When this happens, safety invariably suffers. Floors are mopped without “Wet Floor” warning signs being placed to warn travelers of wet floors, airplane exit ramps are extended but not fully fastened which leads to trip hazards, dropped food and spilled drinks and water are not removed quickly and are left on the floor as hazards, airline personal are too busy to safely navigate the busy terminal in machinery, extension cords and other equipment are left on the terminal floor as trip hazards, broken seats in the terminals go un-repaired and lead to injuries; restaurants and fast food establishments in the terminals leave food and other hazards on the floor, safety checks are not performed as often as usual, elevators and escalators receive heavier than normal traffic which leads to malfunctions and safety hazards, terminal trains are often late to stops and overcrowded leading to trip and falls and other accidents, and traffic in and around the airport is at an all-time high which leads to more accidents and injuries in the parking lot and approaches to the terminals.

To have a valid premises liability claim, an injured person at the airport generally must be able to prove the following:

  • The airport (which includes the terminals, the approaches to the terminals and the surrounding parking lots and property) contained a dangerous condition;
Published on:

According to a recent article in the a respected medical journal, there is an increase in the number of dental nerve injuries following the placement of dental implants. More importantly, the genesis of the article is that this rise in the number of injuries can be avoided. Most dental nerve injuries occur after the incorrect placement of a dental implant in the lower jaw (or mandible). When the dentist does not correctly measure the available bone height between the top of the jawbone and the top of the inferior alveolar nerve, an avoidable dental nerve injury is likely to occur.

With the advent of numerous technological advancements that are not available to measure and map the jaw prior to placement of implants, these types of inferior alveolar nerve injuries are almost always due to malpractice on the part of the dentist. In my experience, most of these injuries are caused by general dentists, who are not aware of the standard of care for placing implants, and try to place implants in their office instead of referring the patient out to a specialist such as an oral surgeon, to complete the implants. Most times, the oral surgeon will plan and place the implants and then refer the patient back to the general dentist to place the crown on the implant.

Symptoms commonly experienced after a dental patient sustains an inferior alveolar nerve injury are:

Published on:

As evidenced by the recent newspaper account, victims of dog bites not only suffer physical injuries, but often suffer long-lasting emotional trauma from the attack. In the article, the writer wrote how, for health reasons, he had been walking during lunch breaks from work. One day while he was walking, someone unleashed his dog between his car and his house. Instead of running into the yard and house, the dog turned and charged the pedestrian on the sidewalk. The dog attacked, jumped on the pedestrian and bit the walker. Once she realized that she was being attacked by a dog, the pedestrian put her arm up and fortunately she was bitten on the arm (as opposed to the dog attacking her buttocks, stomach or crotch, which are common areas that dogs bite during brutal dog attacks) and the bite wound was not catastrophic. However, the trauma and resulting emotional distress, anxiety and fear of being attacked again by a dog is what has caused the most damage to this dog bite victim. This is common. In other words, many times the emotional and psychological damages sustained by a dog bite victim are more serious than the physical injury. If anyone has ever been attacked by a dog, it is easy for them to understand how debilitating this type of attack can be. Now, a pleasant walk in the neighborhood is no longer enjoyable due to the stress and fear that a dog may appear out of no where and attack.

In the case discussed above, the dog owner would be liable for all damages caused by the dog under all of the Atlanta metro county leash laws. If a dog owner allows his dog to run off leash and the dog attacks someone, the dog owner is negligent per se (a legal term meaning that the person is negligent due to the fact that they violated a state, code or law) and is liable for all damages that flow from the dog’s behavior. In fact, it is not necessary for the dog to bite someone for the owner to be liable. We have handled cases in the past where the dog has run up on people and the startled person was injured, without the dog biting anyone. This is still covered under the numerous leash laws. In essence, you must have complete control over your dog so that it cannot cause any damage to those around you. If you fail to due this, you are liable for all damages sustained due to the dog’s behavior.

Attorney Robert J. Fleming has been handling dog attacks, as well as wrongful death cases, automobile accident cases, personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.