Articles Posted in Dental Malpractice

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The number of multi-practice dental practices (that is dental practices that have a number of locations and that are run by an administrative group rather than a single dentist) is growing nation-wide and in also Georgia. Some of the largest dental practice management companies are, with the approximate number of locations in parenthesis: Aspen Dental (over 240 locations), Great Expression (over 180 locations), Dental One Partners (over 150 locations), Coast Dental (over 100 locations), Clear Choice Dental Implant Centers (over 34 locations) and Mini Implant Centers of America (over 17 locations). Many of these organizations have a large presence in Georgia and the metropolitan Atlanta area. While dentists are professionals who have a code of ethics, many critics of the large, multi-location dental management practices that are sometimes owned by aggressive investment funds, charge that these practice are encouraged to put profit over safety and patient satisfaction in order to meet the bottom line numbers set by the practice. If true, this translates into complaints by patients of sloppy dentistry, the performance of unnecessary procedures, high bills, and low patient satisfaction.

While every case is different, dental patients should make sure that they are comfortable with the dentist who is providing the service to them (not just the practice). Care should also be given to utilizing captive specialists (dental specialists who are in-house with the large dental practice vs. a specialist who is independent of the practice). Dental specialists such as oral surgeons, endodontists, and periodontists are often involved when the care and treatment requires complicated extractions (usually partially and fully impacted wisdom teeth), root canals, and the installation of dental implants. As an Atlanta dental malpractice attorney, these are the specialty areas that I see involved in a great number of dental malpractice cases that my firm handles. Not only that, but these specialties, in my expert opinion, seem to cause the most severe injuries when they commit dental malpractice. This is why it is so important to get all the facts and make an informed decision about who is going to conduct the dental procedure on you, in addition to knowing the reputation of the dental practice. After all, the quality of the treatment you receive is going be directly related to the skills, qualifications and experience of the dental professional rendering the services.

Robert J. Fleming has been handling wrongful death cases, dental malpractice, bus accidents, car accident cases and premises injury cases 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. He practices in and around the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb and other counties and nearby cities 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 discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.

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According to a recent article, a husband and wife told detectives in Florida that they were introduced to a man by a mutual friend and that in later social interactions the man told them he was a dentist and had a dental practice in South Carolina before moving to Florida. The couple said they paid the man cash and that he had offered to do the work from home to keep costs low. However, when he extracted the wife’s tooth and left leaving a tooth fragment (or root tip) behind, causing her medical complications, the couple began their own research and soon discovered that the man was not a dentist. The couple also told detectives about another potential patient they had introduced to the man before knowing he wasn’t a dentist. When detectives met with that patient, they told police that the man had pulled about 10 teeth without anesthetic for him and made him dentures. According to the article, the man accused of posing as a licensed dentist was contacted by a detective, working undercover, and also arranged to meet him for dental work, according to investigators.

While these patients apparently did not use much investigative prowess in selecting their dentist, it is important for you to choose your dentist wisely. The best method is to talk with friends and other people who you trust (such as your attorney, or better yet an attorney such as Robert J. Fleming, who regularly handles dental malpractice claims) and get recommendations for dentists that these people have direct knowledge of. Care should be taken to select a dentist who is competent in the procedure for which you need care. Extractions, root canals, dental implants and other procedures are complex and only a general dentist who is trained in and skilled in the specific procedure should be chosen. Better yet, choose a specialist who has additional training and experience in the area that you need dental work in. For instance, a complex extraction might best be performed by a skilled oral surgeon rather than you general dentist; a complicated root canal with curved roots might best be performed by an Endodontist who has experience with these types of root canals and so on. Why: Because many of the procedures require expertise and can easily end up causing dental injuries due to malpractice if performed by a dentist who does not have the training, experience and skill to perform the procedure according to the standard of care.

Attorney Robert J. Fleming has been handling 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.

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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.

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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.

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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.

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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.   

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If an injured dental patient seeks a lawyer on legal web sites such as avvo.com, 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.

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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:

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Many Atlanta dental malpractice cases result in lingual nerve injuries. It is important to understand the relationship of the lingual nerve to the regions of the third molars (wisdom teeth) on both sides of the jaw.

Over 85% of dental patients have lingual nerves which run a regular course. In other words, over 85% of the patients’ lingual nerves runs in the exact location that the dentist expects it to be and this is usual and normal.

According to most studies, the horizontal distance, or the distance from the lingual nerve to the third molar (wisdom tooth) socket, on average, is 4.4 mm. The vertical distance, or the distance from the lingual nerve to the lingual horizontal rim, on average, is almost 17mm.

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Unlike the medical professional, the dental profession in many states including Georgia, has a lack of oversight over those dental professionals who choose to conduct dental procedures for which they do not have the qualifications and skills to perform. Legally, any dentist can perform any dental procedure. The problem that arises however, is that some general dentists take this liberty too far. As an Atlanta dental malpractice attorney, I have been contacted by victims of dental malpractice who have suffered serious injuries under the following situation:

  • A general dentist attempting to install dental implants in the maxillary (upper jaw) piercing the sinus cavity and leading to serious infections that would not heal;
  • A general dentist attempting to extract a impacted wisdom tooth and damaging the inferior alveolar nerve in the process;