Articles Posted in Dental Malpractice

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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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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.