Articles Posted in Dental Malpractice

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The news is shocking. A 4 year-old boy went to the dentist for what appears to be a fairly routine procedure and winds up dying. Obviously, his family and their lawyer want answers. This appears to be a senseless death and  a lawsuit will be filed shortly, according to the malpractice attorney representing the deceased child and his family.

As an experienced dental malpractice attorney in Georgia, I am at a loss to explain this tragic result. While I do not have any information or reason to believe that these types of actions were involved in the above tragedy,  I receive many calls from parents who complain that they are strong-armed into getting, what they later consider to be unnecessary dental treatment on their very young children. Often, they relay to me after the fact that they took their baby to a dentist ‘s office that specializes in children’s dentistry and are told that their child needs multiple fillings on baby teeth, that the child must be put under anesthesia to perform the fillings, AND that the procedure has already been started. Every parents worst nightmare. This is an atrocity that should not be tolerated, yet this is apparently standard operating procedure at some pediatric dental offices that specialize in children’s dental care and who prey on the poor and uninformed. To be sure, this is not done at every office, and some children’s dental offices practice in an ethical and professional manner, but, once again, others do not.

According to a preliminary report from the medical and dental records the child may have had inadequate oxygen during a dental procedure and, in turn, the lack of oxygen caused an irregular heart rhythm which led to no pulse. The pediatric dental office that was providing the dental care to the child performed CPR until EMT’s arrived and the child was transported to the hospital where he died later that evening. While this certainly addresses the immediate causes of death, other inquiries should be: (1) what was the overall health of the child; (2) did he actually need the procedures that were performed on him on the day that he died. Considering that these were baby teeth, was it really required that he have major dental procedure at this age?; (3) did the procedure in question, if they were medically necessary, require general anesthesia or could local anesthesia have been used?; (4) what protocols were in place at the dental office to make sure the proper anesthesia was used, the proper monitoring during anesthesia was performed and what was to be done if complications, such as those that occurred in this case, were encountered and were they followed in this case?.

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As a dental malpractice attorney in Atlanta, I see many types of claims for damages resulting from dental malpractice. Sometimes, the injury sustained due to the malpractice is discreet and not ongoing, but still debilitating. Other times, the injury is ongoing, permanent and renders the client unable to perform her normal duties at work. Still others are more unique, in that the client has a special talent of career which is impacted by a dental injury (such as a dental nerve injury that affects the ability to use the tongue or lips) and this ruins a promising career or talent. As an example, a musician who must use her mouth to play her instrument can purse claims for the loss of her career following an allegedly botched procedure by a dentist. This is the situation in a closely followed case that is just entering litigation. The musician, who has performed in orchestras in areas outside of Atlanta, claims in her lawsuit that her face could prematurely age because of irreversible bone loss as a result of negligent work performed by the defendant dentist. According to the suit, in an attempt to avoid jaw surgery after lifelong dental and breathing problems, the plaintiff sought an alternative. The dentist defendant, treated her unsuccessfully for years before placing an anterior growth device and controlled arch braces, in the musician’s mouth.

According to the plaintiff’s account, the device was supposed to be a substitute for jaw surgery by stimulating new bone growth, helping to move teeth and the the jaw forward and improve her airway. Instead, the plaintiff claims in pleadings that the device worsened the condition and that the use of the device was below the standard of care of what a reasonably prudent dentist would do under like or similar circumstances (what is known as the standard of care in Georgia) because it is unproven and not supported by medical knowledge or science. Due to the alleged malpractice, the plaintiff fears that she could lose four to six front teeth, and, over time vertical height in her front jaw leading to the early aging of her face.

The above is an interesting example of the what the law calls an “egg shell plaintiff.” In other words, if one commits dental malpractice and, due to some unique factors that apply only to the injured plaintiff, the damages are exponentially increased (such as the loss of a music career due to a dental injury), the defendant is liable for all of those damages so long as the remaining elements of the claim are proven by the Plaintiff. Another example would be a professional athlete who can no longer play professional sports due to an injury sustained from dental malpractice. As is true with every case, even with damages, the plaintiff must prove duty, breach and causation to prevail in a dental malpractice claim in Georgia.

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If you are a dental patient in Georgia and you suspect that your dentist may be recommending treatments you don’t actually need or if you sustain and injury from a dental procedure and suspect that the injury was caused by dental malpractice, you can complain to the dental board. However, the odds are pretty good that nothing will happen and to add insult to injury, many times the dental board will drag out the proceedings until after the statute of limitations has run, effectively precluding you from filing a lawsuit and suing the dentist for the malpractice.

As is true for other medical professions, state dental boards are typically made up of dentists overseeing dentists, leaving the profession to police itself. This is certainly true of the Georgia Board of Dentistry, which, as of last count, is compromised of almost all dentists. While this is the norm, and certainly not illegal, it does cause suspicion as to just how objective the board will be when looking into your situation.

Nationwide, dentists rarely have their licenses pulled by their dental boards. In 2018, according to the Department of Health and Human Services, state boards revoked or suspended only 225 licenses – 0.1% of all dentists. Ten states didn’t suspend a single dentist.

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In Georgia, when a patients suspects that they are the victim of dental malpractice and request their file, the dentist must give the patient a complete copy of their file, including all radiographic materials such as x-rays and cone beam CT scans. As a Georgia lawyer who regularly handles dental malpractice cases, I receive calls from irate patients who have properly requested a copy of their file but are being stonewalled by the dentist. In most cases, the dentist feels safe in refusing to provide the patient file, and in doing so, feels as if this will convince the injured patient to not seek legal action. Rarely does this work and, in more cases than not, it spurs the injured patient to hire an experienced dental malpractice lawyer to obtain a copy of the file, evaluate the case, and file a lawsuit if the case has merit.

When a dentist refuses to give the patient a copy of her records after they have been properly requested pursuant to statute and appropriate notice to the dentist via certified mail, the statute of limitations (or the amount of time within which the injured patient must file a lawsuit) could be tolled for the period of time during which the dentist refuses to comply with the statutory request for the records. See O.C.G.A. Section 9-3-97.1. 

O.C.G.A. Section 31-33-2 provides, in pertinent part:

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As a lawyer in Atlanta who handles dental malpractice on a regular basis, I can gauge by the number of potential new clients the amount of dental procedures that take place in Atlanta. Since we only handle new cases that involve injuries caused by a dental procedure, and the number of dental procedures performed in Atlanta was down to almost zero in April and May of 2020, we have seen the number of dental malpractice calls go down by almost 75% in April and 90% in May. Although the numbers are not in yet for June, as of this writing, I imagine the calls related to new dental malpractice claims are down by about 90%.

While dentist offices tend to be stable businesses that do not fluctuate much in the number of procedures performed, dentists have been especially hard hit by the corona virus pandemic.  For the most part, any dental procedures that are not emergencies have been put off. This includes cavities, cleanings and a whole host of other dental procedures.

Atlanta dentists stopped all non-emergent care on March 16, when the CDC and the American Dental Association issued protocols against elective care. Some dentists say they closed even earlier as protective equipment became in short supply. By mid-April, half of dentists in Atlanta had either laid off their entire staffs or instituted staggered work weeks with a skeleton staff. While there are reports of some dentists not closing in some other parts of the county, I have not heard of any here in Atlanta. As Atlanta dentists ramp back up and head back to work, it’s unclear whether patients will follow. While Georgia has given dentist offices the go-ahead to reopen, patient volumes remain half of what they were before the pandemic.

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Many clients are getting dental implants in the upper jaw. The sinuses are located right above your upper teeth, which poses a potential problem when pulling teeth and installing dental implants such as sinus perforation when having one of your upper teeth extracted?

The anatomy of the sinus floor and its relationship to the upper teeth varies from person to person. In some people, the sinus floor is well above the roots of their teeth with bone separating the roots from the sinuses. While in other people the floor follows the roots more closely. In essence, wrapping around the roots with minimal bone between the sinus and tip of the roots. Still others actually have the roots of the teeth up into the sinus, which seems to work fine, so long as they are not disturbed (i.e., extracted forcefully). For those whose sinuses are very close to or even touching their tooth roots, there is a risk that the sinuses will be perforated when their tooth is extracted. This risk is greater if the tooth being extracted is infected or has an abscess at the tip of the root. This situation calls for extreme caution and if the dentist does not comply with the standard of care, a communication between the mouth and sinus can occur and this is often a very serious complication which could have been avoided which can take months and even years to resolve. 

When considering an extraction of an upper tooth, if  x-rays show that the tooth’s roots are near the sinus floor or actually in the sinus cavity; or if there is an infection or abscess, the dentist should take a cone beam CT scan (“CBCT”) of that area prior to extracting the teeth and certainly before placing the implant in that area.  A CBCT can assess the proximity of the roots to the sinus or assess the degree of existing defects that may lead to a sinus perforation following an extraction. Since CT scans are imperative in planning and placing implants, it is considered below the standard of care for dentists to not perform a CBCT before extraction and implant in this area. In fact, due to the complicated anatomy, it may be necessary to perform a pre-extraction CBCT and a pre-implant CBCT. This is so because the extraction may cause significant changes to the bone structure that would affect the available bone in which to place the implant. If there is enough bone height, the implant will fail, or worse, the implant will be screwed into the sinus where it will invariably lead to communication between the mouth and sinus and repeated infections. Sinus perforations, if not diagnosed and left untreated, can persist, leading to an oral-antral fistula—an opening between the sinus and the mouth. Oral-antral fistulas can result in sinus infections as well as fluid drainage from the mouth to the nose. They can also lead to drinks being leaked into the sinus, whistling noises when breathing, and a whole host of unpleasant problems caused by the opening between the mouth and sinus.  It is important to manage sinus perforation at the time it occurs to prevent it from progressing to a chronic oral-antral fistula. Proper care and treatment after a communication is caused often requires that an oral surgeon consult with an ENT and/or the two of them working together to resolve the issue.

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All dentists and dental offices must use best practices and follow the standard of care to protect patients and provide the safest office environment possible. This has always been the law in Georgia, but now, in the face of the COVID-19 pandemic, these dental providers must do much more.

To reduce the risk that patients and staff will be exposed to COVID-19, the American Dental Association has provided various guidelines to dental offices. The guidelines echo the recommendations of the U.S. Centers for Disease Control.

These are among the highlights of the new guidelines and should be instituted by general dentists, oral surgeons, endodontists, periodontists, and all other dental specialists:

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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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