Articles Posted in Dental Malpractice

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Dental nerve damage can often be caused by dental treatment. Many kinds of treatment have reportedly caused dental nerve damage such as root canals and placement of dental implants in the lower jaw. Despite many types of proposed treatment and many claims of success, many victims of dental malpractice in Georgia have exhibited poor recovery after surgery is attempted to correct dental nerve damage.

After undergoing microneurosurgery, an injured dental patient’s quality of daily life activities may improve because of the resolution of numbness or pain in the tongue, lip, chip or face during movement.  Other areas of sensory perception which may improve after this type of corrective surgery are thermal perception (ability to feel hot or cold) and taste sensation.  Improvements in taste can include recoveries of sweet and salty tastes or recovery of the injured patient’s ability to taste sour things again. It is interesting to note, that even when some semblance of taste is recovered, the taste buds on the side of the tongue that the nerve was injured on are sometimes smaller and less prominent, and this  almost always permanent. It is also common that the subjective taste perception does not mimic an apparent regeneration of the nerve under some of the radiographic tests that are available for this purpose, such as a cone beam CT scan (3D CT), x-rays, MRI or MRN.

I regularly handle cases that involved nerve injuries that were caused by dental procedures. It has been my experience that most of these injuries are traumatic and severe. Due to the nature of the injury, the effects on the injured patient are certainly seen in pain and numbness in the area of the injury. However, many times the patient has far more reaching pain and numbness that cannot be adequately addressed by corrective surgery, pain drugs or therapy. In these cases, the patient’s injuries become debilitating and permanent. In these cases, the injury become much more than simply a physical pain or numbness and it can affect almost every aspect of the patient’s daily life. This can include, but is certainly not limited to, pain while brushing teeth; pain while eating; drooling; unbearable pain in the jaw, face and ear; tremendous anxiety; difficulty sleeping; not being able to work; sexual dysfunction; fear of getting future dental work done; and many other types of problems.

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To the surprise of many, a child can be put to sleep for a dental procedure by a dentist who does not have a medical degree. While this should not be a concern in and of itself, when you couple this with the fact that according to the American Dental Association, educational and training requirements to administer sedation and dental anesthesia in Georgia is governed by the Georgia Board of Dentistry, this creates an alarming and dangerous situation. As a Georgia lawyer who specializes in dental malpractice, including injuries caused by improper administration of anesthesia, I am concerned for the safety and well-being of our children in Georgia (as well as adults who receive general anesthesia when they undergo complicated dental procedures) and would hope someone other than the Georgia Board of Dentistry would oversee this area of dentistry.

While the anesthesia is reportedly administered by dentists with anesthesia training, in almost all cases involving complicated dental procedures such as root canals, dental implants or complicated extractions, the anesthesia is not administered by a medically trained (i.e., and M.D.) anesthesiologist. To make matters worse, dentist can perform sedation and anesthesia themselves without having a physician (anesthesiologist) or dental anesthesiologist present.

This is all concerning for adults, but the problem is exasperated when it comes to parents who bring their children to the dentist and are left in the dark as to what is happening in the exam room. Sedating children is much more complicate and potentially dangerous than sedating adults. There is a much smaller room for error with kids. While state dental boards require the dentist to qualify for a special anesthesia permit, there is no assurance that these dentists who are sedating our children are specially trained and qualified to sedate children — and parents need to know this.  There are no national standards for what the dental anesthesia permit requires, and some states do not require it at all.   And, the standards are determined by the American Dental Association, not by the ABA or by medical boards or even the two national boards for dental anesthesiology. Why this is so, is not immediately clear, but a national standard administered by the medical community seems to make sense.

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General dentists must comply with the standard of care for dentists under like or similar circumstances in Georgia and nationwide. When a dentist fails to comply with this standard of care and a serious injury or death results, a lawsuit for dental malpractice can be filed. A national dental practice, which touts itself as general dentistry for kids has been sued by a mother of a child-patient who died as a result of complications from a dental procedure, and an infection which was alleged to have not been treated properly. According to reports, the infection spread after a follow-up visit to the dentist and sadly took the fear year-old girl’s life.

Infections secondary to dental procedures, while not uncommon, rarely cause death. This is because most patients report back to the dentist and receive the proper treatment to get the infection under control and to make sure that the patient does not become toxic and the infection does not spread. Ludwig’s Angina is one type of dental infection that can cause death if not properly diagnosed and treated by dentists.The majority of cases of Ludwig’s angina are odontogenic in etiology, primarily resulting from infections of the second and third molars (wisdom teeth). In this scenario, the dental infection spreads to the throat and compromises the patient’s ability to breath and can, if not treated cause severe suffering, lack of oxygen to the brain, and even death. With progressive swelling of the soft tissues and elevation and posterior displacement of the tongue, the most life-threatening complication of Ludwig’s angina is airway obstruction. Prior to the development of antibiotics, mortality for Ludwig’s angina exceeded 50%

Even if the original dental procedure that caused the infection was performed within the standard of care, the dentist and the dental practice may be liable for failing to timely diagnose and treat Ludwig’s Angina and/or failing to refer the patient to a specialist in a timely manner.

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The placement of dental implants is a surgical procedure that comes with many potential complications. Dental implants are designed to be a permanent replacement for teeth and as such are anchored into the jaw. However, with an increased rate of the placement of dental implants comes more injuries and complications from these procedures.  The following are common bad outcomes from dental implants, and in many cases, are the direct result of dental malpractice committed by the dentist who installed the dental implant:

  1. Facial nerve damage from the implant being placed into the nerve under the tooth. Common signs and symptoms include numbness, loss of sensation, and pain in the jaw, lips, chin and tongue. It is common to have pain and numbness at the same time or alternating pain and numbness.
  2. failure of the implant to anchor into the jaw, this is known as failed osseointegration. The most common sign of this is that the implant is very loose or falls out.
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I have been practicing law since 1994. Over the years I have had, what I consider, some great trial victories in areas such as medical malpractice, civil litigation and personal injury. But, there is one area of law that I have gravitated to over the years and which has become somewhat of a specialty for me: dental malpractice. While I could not fully explain in this article all of the reasons why I have gravitated to specializing in dental malpractice, I can say that I am drawn to this area of law because it allows me to help clients who have been seriously hurt seemingly out of the blue. In other words, many of my clients went to the dentist of have a simple dental procedure performed (such as getting a dental implant or root canal) and within days they have suffered a lief-changing injury. This is very unsettling and I understand what these clients are going through. Consequently, I get a deep sense of satisfaction in being able to walk them through the legal and dental process, and ultimately I do everything I can to help them recover from the dental injury and move on with their life.

I consider myself to by very good at identifying dental negligence and being able to quickly and accurately identify which dental injuries are caused by malpractice and which cases have merit. This seemingly simple step goes a long way in helping those injured in the dental chair have a clearer understanding of how and why they were hurt and what their prospects of being adequately compensated for their dental injuries are.

While my dental malpractice clients vary in every respect (i.e, age, gender, income level, political affiliation, etc.), they all have one thing in common: they were seriously injured by no fault of their own, and many times this happens when they are under general anesthesia and not even cognizant of what is taking place. I understand how troubling this is and I do all I can to address this with my clients. Many of these injuries are debilitating and permanent such as trigeminal nerve injuries, mental nerve injuries, inferior alveolar nerve injuries, and lingual nerve injuries. Due to the nature of facial nerve injuries, there is a great deal of pain, numbness, and quite frankly disbelief. All of these reactions are real and normal and I do my best to address them with each client that I represent in this area of law.

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This is the question many potential clients call to ask. And it’s a reasonable inquiry, to say the least. Whether one can sue for dental malpractice related to the placement of a dental implant depends on a number of factors including but not limited to: Whether the pre-implant planning process was properly followed; whether an implant surgical guide was used; whether the pre-implant planning measurements were followed in placing the implants; and whether the skills and technical proficiency of the dentist placing the implants meet the standard of care.

Of course, whether one can sue for dental malpractice related to the placement of dental implants will depend on the answers to the above questions. But, the result of the negligence must be a substantial injury from the dental implant placement. In other words, it is not enough that the dental implant procedure did not go well (or you are not happy with the procedure for one reason or another), in order for there to be the basis for a lawsuit, you must have suffered an injury from the dental procedure.

We have seen a proliferation of injuries to the facial nerves after the negligent placement of dental implants. Most of these are from implants placed in the lower jaw (or mandible) which are placed too deep into the jaw and affect the inferior alveolar nerve or the mental nerve, if the implant is placed closer to the front of the mouth. However, there are instances of nerve injuries after the negligent placement of dental implants in the maxillary (upper jaw) although these are much rarer and do not have a classical presentation. From the cases that I have evaluated, the trigeminal nerve most often injured by improperly placed maxillary dental implants is the infra-orbital nerve. This nerve runs out of the foramen (small opening in the skull) just below the eye and runs a course which stays well above the upper teeth. Of course, the improper placement of the dental implant must result in damages in order to support a dental malpractice lawsuit, which in many cases of dental negligence, are substantial. Whether the injury is to the nerves in the lower jaw (much more common) or upper jaw, timely action is needed in order to properly evaluate the cause of the injury and whether a malpractice lawsuit is justified.

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As an Atlanta lawyer who specializes in the handling of dental malpractice cases, I have noticed a rise in the number of dental malpractice claims caused by negligent dental treatment during certain dental procedures. Many of the injuries that we have been seeing are catastrophic and permanent. The cases on the rise that I have seen involve dental nerve injuries sustained after the patient has undergone dental implant placement, root canal therapy and extraction of wisdom teeth and other molars.

Dental malpractice in this area often leads to serious injury due to the proximity of the nerves in the jaw and face to the tooth and mouth structures that are being worked on. For instance, dental implants can cause injury to the nerves in the mouth due to placement of the implant in the wrong position. This often leads to the implant crushing the nerve and the patient is often left with insurmountable pain and numbness. Similarly, if a root canal is not performed according to the applicable standard of care, this too, can lead to a serious dental nerve injury that, in many cases, is permanent and debilitating.

As a dentist licensed in the State of Georgia, a dentist and the acts performed in the dental  practice are governed by and subject to the Georgia Dental Practice Act, O.C.G.A. §§ 43-11-1, et seq. (the “Dental Act”) Under the Dental Act, “dentistry” means the evaluation, diagnosis, prevention, or treatment, or any combination thereof, whether using surgical or nonsurgical procedures, of diseases, disorders, or conditions, or any combination thereof, of the oral cavity, maxillofacial area, or the adjacent and associated structures, or any combination thereof, and their impact on the human body provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law, including, but not limited to, the acts specified in Code Section 43-11-17. When a dentist performs any of the procedures mentioned in the Dental Act, the procedures must be performed within the standard of care or liability attaches to the malpractice.

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Recent studies confirm that almost 1/4 of Americans have been negatively impacted by medical errors. While this appears alarming on its face, the scary part, is that the actual number of Americans who have been victimized by medical negligence could be much higher due to unreported medical errors or situations in which medical errors have occurred and are the subject of a coverup by the doctor or hospital.

The recent survey which was conducted by the NORC at the University of Chicago, found that almost 25% of Americans reported having personally experienced a medical error and was careful to note that, when medical errors do occur, they “have a lasting impact on the patient’s physical health, emotional health, financial well-being, or family errors.

In addition to the 25% of Americans that the study uncovered as having personally experienced the results of medical malpractice, 31%, almost 1/3 of Americans, reported that someone who they knew well and whose medical care they were personally involved with experienced the ill-effects of medical malpractice.

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As an Atlanta dental malpractice attorney, I receive calls every day from dental patients who have been injured due to dental procedures. Almost all of the dental nerve injuries that are actionable dental malpractice claims involved the trigeminal nerves of the face, mouth, neck and jaw.

The trigeminal nerve is the largest of the cranial nerves and has three major divisions: the opthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve or inferior alveolar nerve (hereafter referred to as the “mandibular nerve” for simplicity and consistency) (V3). A nerve outside of the central nervous system is called a peripheral nerve. The mandibular nerve is a peripheral nerve which is the largest of the trigeminal nerves and is the most common branch injured following dental implant surgery. While the mandibular nerve is technically outside of the central nervous system, most of my clients report debilitating pain in parts of their face and head served by the mandibular nerve. This nerve carries sensory information from the lower lip, chin, lower teeth, gums, the lower jaw, and, at times, can extend up and into the ear on the side of the face affected by a dental implant injury, for example.

The mandibular nerve also contains motor fibers for supply of the muscles for eating (mastication), muscles of the ear and muscles of the soft palate. However, these motor branches and many of the sensory fibers to the external ear are rarely injured during implant surgery because these motor fibers are separated from the V3 branch of the trigeminal nerve prior to its exit from the foramen ovale of the skull and many of the sensory fibers enter the nerve above the lingula of the ramus. A V3 injury in dental implant surgery usually occurs after the nerve enters the lingula of the mandibular ramus and anywhere along its pathway in the jaw and/or its exit from the mental foramen in the chin area of the jaw.

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Molar tooth anatomy sometimes includes auxiliary root canals, loops, curved roots and fins which are difficult to detect, clean and obturate (fill). Many times, general dentists try to perform root canals on multi-rooted molars with these conditions and it could be below the standard of care for dentists under like or similar circumstances for them to do so. Other situations that may require referral by a general dentist to an endodontist to perform the root canal are narrow canals, abnormally large canals, internal resorption, broken files in a canal, canals requiring a post, and canals that are in the inferior alveolar nerve canal or in the sinus for maxillary molars and pre-molars.

Improper technique by a general dentist performing a complex root canal can lead to apical and coronal leakage of the root canal, root canal failure and, in the worst case scenario, injury to the nerves and other anatomic structures around the tooth. Improper technique can be in the form of over instrumentation of the root, not getting accurate working lengths, using excessive force while condensing with instruments to compact the gutta-percha, not properly sealing the core prior to obturation, not creating an apical stop, or over filling the canal by applying too much gutta-percha too quickly or placing too much volume in the canal to the fill with canal without exuding out of the end of the canal.

In addition to improper technique, a general dentist can commit dental malpractice while performing a complex root canal therapy treatment by: failing to perform an adequate and sufficient implant placement work-up and evaluation, including measurements to determine the depth of the available bone into which the implant can be safely placed without injury to the nerve; failing to sufficiently determine the location within the bone of the nerve bundle (the bundle that carries the nerve, the artery and the related anatomy through the jaw) to allow for the safe placement of the implant without injury to the nerve; placing the implant into the nerve canal and injuring the inferior alveolar nerve; failing to timely treat and/or remove the implant after becoming aware of complaints of numbness or pain or pain and numbness together; failing to adequately monitor and mitigate the consequences of paresthesia after negligent placement of the implants into the nerve canal; failing to timely refer the injured patient to a nerve specialist after the implant was placed in the nerve canal and the patient sustained a nerve injury, as indicated by the signs and symptoms of number, pain and/or pain accompanied by numbness relayed by the injured patient; and failing to gain informed consent for the implant procedure. All of these are actions or inactions on the part of the general dentist that can result in a dental malpractice claim, if the malpractice has resulted in injury sufficient in nature to warrant the filing of a malpractice claim.