Articles Posted in Dental Malpractice

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Otherwise healthy patients who undergo dental implants are at risk of ending up having heart surgery. As evidenced by the recent situation involving an oral surgeon who performed a number of procedures in his practice including installing implants which became infected, dental implant centers who regularly install “all on 4” dental implants in North Atlanta neighborhoods such as Alpharetta and Roswell, Georgia, must comply with sterilization protocol or risk liability for injures caused by, among other things, non-sterile water.

According to reports, the board of dentistry has  issued a licensure suspension and other penalties to a dentist after one of his patients died and 14 others suffered serious heart infections. At least fifteen patients who were treated at the dental office suffered from bacterial endocarditis. Twelve of the patients required heart surgery and one died, according to the release by the board of dentistry. Interestingly, while it is a dentist that did not follow proper infection protocol, the injuries sustained by the dental patients was not limited to the mouth, but rather, in the most serious of cases, affected the heart.

A continued failure to follow infection protocols exposes patients to a whole host of risks due to infection. This is especially true when dental implant centers install implants upon which dentures are mounted, or as the are commonly referred to in the industry as “all on 4 dentures.” They are called this because the dentures are mounted on 4 dental implants that are installed in the lower jaw for stability. The most serious risk to patients who are treated by dental implant centers of contracting the serious heart infection,” Repeated violations of infection control practices can result in many serious conditions.
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As a lawyer in Atlanta, Georgia who specializes in Dental Malpractice Injuries, I receive lots of calls from Georgia patients who have been severely injured by Atlanta dentists. The calls are many, and at the outset, I must point out, that not every injury in the dental chair is caused by dental malpractice. In other words, some people are injured as a the result of a dental procedures and the injury is something that can happen absent malpractice. It is part of my job, as a lawyer evaluating dental injuries, to identify those types of injuries (dental injuries that occur through no fault of the dentist) and eliminate those cases from consideration. After all, it is the goal of every good lawyer to steadfastly pursue the good cases to trial (if that’s what it takes) and not expend valuable resources and time (from the lawyer, law firm, and potential client who is dragged into litigation when ultimately the case has no merit) on a case that falters due to a lack of provable malpractice.

One such injury that is almost always caused by dental malpractice is something called trigeminal neuralgia (TN), which is sometimes known as “the suicide disease.” It is brought on when the brain’s trigeminal nerve, which carries sensation from the brain to the face, is disrupted, sending unfounded but very powerful pain signals to the brain. The trigeminal nerve breaks off into the lingual nerve and the inferior alveolar nerve and these two nerves are involved in the majority of dental nerve injury trigeminal nerve injuries. Typical dental procedures that cause these types of injuries from malpractice are dental implants placed in the lower jaw, root canals of lower molars and extractions of lower back molars.

Researchers estimate that around five in 100,000 people suffer from trigeminal neuralgia, but it is notoriously difficult to diagnose since the symptoms can overlap with other conditions and accurately describing the pain can be challenging for patients.  One woman suffering from trigeminal neuralgia said that the pain might come on while she brushed her teeth, or sometimes, after a gentle gust of wind blew on her cheek. The result was something like an “electric shock,” she said, with no obvious cause. It later evolved into a “constant and excruciating” sensation. When asked by doctors to rate the pain from one to 10, she said it was a 13. “I was thinking, ‘Was I imagining this pain? Where did it come from? Why is it here?'” This is all quite typical of many of my clients who have suffered this injury at the hands of a negligent dentist or oral surgeon.

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As evidenced by recently filed lawsuit, dental injuries from malpractice that are compensable in a lawsuit can include, in addition to dental nerve injuries, lost wages, pain and suffering and loss of consortium, such injuries as burns inside the mouth caused by fire. Of course, to be recoverable in a court of law, the injuries must be caused by dental malpractice.

As reported previously, a pediatric dentist is being sued for dental malpractice for improperly using a diamond bur to smooth his patient’s teeth while she was under anesthetics. The procedure then caused a spark that ignited the throat pack in the mouth and produced a fire inside the patient’s mouth and resulted in burns that the lawsuit is seeking recovery for.

The case is in suit and is seeking recovery for burns to the epiglottis, throat, tongue, mouth, lips, and surrounding areas. In addition, due to the area of the injury, the lawsuit alleged that some of the injuries may be permanent and disabling.

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Early childhood cavities (ECC) is the single most common chronic childhood dental disease. In the treatment of ECC, children are often sedated under general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. Many of these procedures are not necessary and are performed by “suspect” children’s dental clinics under the auspices of treating the caries aggressively to stay ahead of the game. As we see below, most times, it is not worth the risk of general anesthesia complications to perform restorative work on a child’s baby teeth.

In 2016, the American Academy of Pediatric Dentistry (AAPD)1 announced, “Because restorative care to manage ECC often requires the use of sedation and general anesthesia with its associated high costs and possible health risks, and because there is a high recurrence of lesions following the procedures, there now is more emphasis on prevention and arrestment of the disease processes.” The AAPD’s policy statement goes on to enumerate methods of chronic disease management, active surveillance, and interim therapeutic restorations and states, “Non-surgical interventions should be implemented when possible to postpone or reduce the need for [previously accepted] surgical treatment approaches.”

A common rationale for aggressive surgical treatment with sedation or general anesthesia has been the vastly overstated association between tooth decay in primary teeth and subsequent decay in permanent teeth. In fact, this connection is modest, with the relative risk ratios ranging from 1.4 to 2.6.2,3 One reason the association it not strong is that the shedding of decayed primary teeth eliminates sites for bacterial colonization in the mouth and thus reduces risk of caries in the permanent dentition. The loss of primary teeth with replacement by permanent teeth is a normal developmental process that requires no professional intervention.

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Georgia patients are injured every day from dental procedures. Common dental procedures are not always as safe, effective, or durable as we are meant to believe. As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the the ADA committee on evidence-based dentistry. “We’re kind of behind the times, but increasingly we are trying to move the needle forward.”

According to a recent article in the Atlantic Magazine, “excessive diagnosis and treatment are endemic,” says Jeffrey H. Camm, a dentist of more than 35 years who wryly described his peers’ penchant “creative diagnosis” in a 2013 commentary published by the American Dental Association. “I don’t want to be damning. I think the majority of dentists are pretty good.” But many have “this attitude of ‘Oh, here’s a spot, I’ve got to do something.’ I’ve been contacted by all kinds of practitioners who are upset because patients come in and they already have three crowns, or 12 fillings, or another dentist told them that their 2-year-old child has several cavities and needs to be sedated for the procedure.”

The article also cites Trish Walraven, who worked in a dental office for 25 years and now manages a dental-software company with her husband, and recalls many troubling cases: “We would see patients seeking a second opinion, and they had treatment plans telling them they need eight fillings in virgin teeth. We would look at X-rays and say, ‘You’ve got to be kidding me.’ It was blatantly overtreatment—drilling into teeth that did not need it whatsoever.”

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The dean of a major university dental school has filed a lawsuit after being terminated as dean and in his complaint alleges, among other things, the stealing of gold crowns from the dental school and accusing officials of retaliating against him for reporting problems at the College of Dentistry. As an Atlanta lawyer who specializes in dental malpractice, this is an interesting development since many of the experts that we use in our cases in Georgia are deans of colleges of dentistry in other states. In Georgia, with limited exceptions, a dental malpractice lawsuit must contain an affidavit by an expert alleging at least one count of malpractice against the dentist being sued in the lawsuit. In most cases, the affiant will be the dean or former dean of a dental school and have extensive experience performing the procedure at issue in the malpractice lawsuit.

The Dean’s lawsuit cites numerous other problems that the dean allegedly uncovered. They include:

  • A departmental deficit of almost $2 million because clinical faculty (dentists) at the dental school were being paid salary supplements based on gross revenue from clinical services, not net revenue. The lawsuit alleges that officials did nothing to address the dean’s concerns;
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An Improperly Installed Dental Implant Is The Result of Dental Error

Dental implants must be placed carefully to ensure that they will heal properly and be able to bear the stress of biting and chewing. Common errors made by dentists, oral surgeons and periodontists who incorrectly install implants include placing the implant in areas without sufficient bone density or placing the implant too deep in the jaw so that it impinges on the nerves in the lower jaw or the sinus cavity in the upper jaw. In both instances, this is a result of dental malpractice. These mistakes can be avoided by using an experienced dentist who utilizes 3D CT scans and mapping to plan the placement of the implants prior to installing them.

Not All Dentists Are Created Equal

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Root Canals Are Common Procedures In Georgia

Root canals are a common dental procedure performed in Georgia by general dentists and endodontists. If the root canal is not performed correctly, the plaintiff in a lawsuit will allege that the defendant dentist was negligent in performing a root canal and the malpractice resulted in the plaintiff suffering permanent nerve damage. In most cases, the permanent nerve damage causes the plaintiff to endure constant pain in addition to the numbness and, in some instances, intermittent spiking sharp pain. While this may sound odd: i.e., numbness and pain at the same time, it is relatively common for dental nerve injuries such as a lingual nerve injury or inferior alveolar nerve injury from a root canal. Not only is this a common result of dental malpractice, often the numbness and pain are permanent.

Most Complications Involve Root Canals on Back Teeth and Women

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As a lawyer in Georgia who regularly handles dental injuries, I come across a lot of situations which result in dental injuries. Some injuries are sustained prior to the patient going to the dentists, while others are caused by the dental treatment itself. Some of the most common situations which result in dental injuries outside of the dental office are:

Car Accidents. The most common situation that I encounter that results in a non-dentist induced dental injury is in accident cases and most commonly in car wrecks. Probably the most common scenario that results in dental injuries is a car accident victim who smashes their mouth into the steering wheel when they are hit from behind while stopped.

Sports Injuries. There’s a reason most sports require you to sign paperwork and waivers before you can play. While fun to participate in, sports put your body in danger. With balls, bats, sticks, and even other players moving quickly around on the field or court, it doesn’t take a lot to cause an injury. Protect yourself while playing any sport by wearing the right protective gear, and be prepared for the unexpected. Unfortunately, most sports injuries occur to children, who do not yet have the self-awareness to appreciate some of the dangers inherent in all sports. A hard tackle in football, a foul ball at a baseball of softball game, or even an elbow in basketball can knock a tooth out or even fracture a jaw.

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As a recent article related to sub-standard dental care makes clear, the practice of dentistry is only as good as the dentist who is performing the dental care and treatment. Why on earth a dentist in a large dental practice would subject his patients to potential disease and infection by re-using dental instruments which were designed and sold for single-use is anyone’s guess. What is important to know though, is that the dental care and treatment must comply with the applicable standard of care, regardless of the circumstances.

Dental implants are especially susceptible to infection because they are, by definition, a foreign body placed in the mouth with the intent on it staying there for the life of the implant.

As a lawyer who regularly handles dental malpractice cases in Georgia, I have reviewed many malpractice cases that stem from the negligent installation of dental implants. Most of these cases are very fact intensive and require a thorough review to determine if there was malpractice and if the malpractice caused the injury which the patient is complaining of. In most cases, all of the dental and medical records must be obtained and a competent expert must be retained to review the records to determine this. This is a complex process that, in many cases, takes many months to complete. That is why time is of the essence if you have been injured by a dental procedure.

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