Articles Posted in Dental Malpractice

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Dental malpractice can occur during various procedures, but some common dental procedures result in a much higher percentage of dental malpractice claims. The reason for this is probably the complexity of the procedure, the proximity of the procedure to certain anatomical structures in the mouth and tongue and jaw and the severity of the injury when these structures are violated by the dentist performing the procedure. Some of the procedures which tend to cause the most Georgia Dental malpractice claims are:

  • Tooth Extractions in the Lower Jaw: Improper extraction techniques during complex extractions can lead to damage of the jawbone, nerves that run along the jaw and tongue and other parts of the face.  This results in nerve damage and has leads to signs and symptoms such as pain, numbness, (pain and numbness together) and loss of feeling in the lip chin gums, teeth and face.
  • Root Canals Procedures in the Lower Jaw: Not complying with the applicable standard of care when performing root canal therapy (root canals) results in errors during root canal procedures, such as perforations of the root, over-instrumentation of the canals, apllying too much pressure whine filling the canals, using the wrong type of filling material, incomplete cleaning, or overfilling of the canal. These can call cause cause infection, pain, nerve damage and or damage to surrounding tissues and, even at time, damage to the surrounding bone when the malpractice causes and infection and the infection is not treated in a timely manner or is treated ineffectively. This can lead to osteomylitis, a very serious bone infection that is extremely hard to treat due to the lack of blood and oxegynation in the infected bone..
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While three of the top dental injuries are toothache, jaw pain and broken teeth, the most prevalent injuries from dental procedures or dental malpractice in Georgia are quite different. Among the most common injuries from dental procedures are a numb tongue, numb chin, numb lip and teeth, and nerve injuries of the face, jaw and tongue. While this may be stating the obvious, to pursue a dental malpractice claim in Georgia, the plaintiff must prove: (1) that she sustained and injury from a dental procedure; and (2) that the injury was caused by negligence on the part of the dentist during the performance of a dental procedure such as a root canal or dental implant. In other words, it is not enough that there is an injury, but rather the plaintiff must prove that the injury was caused by malpractice.

Basic dental malpractrice law requires that the Plaintiff establish duty, breach and causition. Put another way, tin order to prove her case, the Plaintiff in Georgia must prove that there was a dentist/patient relationship, that the dentist had a duty of care to perfrom the procedure in a competent manner, the dentist breached that duty, and that the breach of the standard of care caused the injuries that the Plaintiff is complaining of in the lawsuit. Some of these necessary requirements are satisfied by expert testimony in the form of an affidavit that is attached to the complaint when it is filed with the court. That is why it is essential to retireve Plaintiff’s records from the defendant, as well as all subsequent treating providers such as dentists, doctors, hospitals and pain doctors.

Elements of damages can include, but are not limited to, past lost earnings, future lost earnings, a decreased ability to labor, disfugrement, physical or mental impairment pain and suffering, past medical bills, future medical bills and other damages. These types of damages are proven with documentary evidence, as well as testimony and opinions from dentists, doctors and lay witnesses in order to fill in the gaps and provide a complete picture to the jury.

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Dental malpractice in Georgia can take many forms. Some of the most common reasons malpractice occurs is a lack of training by the dentist performing certain procedures (such as root canals, dental implants and oral cancer screenings); a lack of communication between two dentists (whether in the same office or in separate dental offices) who are involved in the care and treatment of a patient; a failure to properly document and observe important anatomical landmarks and measurements (thi is especially important when performing root canals and dental implant procedures); failing to review the patient’s chart and medical history prior to using or prescribing drugs that the patient may be alert to or which may interact with medications that the patient is current taking; and carelessly performing a procedure which results in injury to the patient.

The standard of care for dental malpractice in Georgia requires that all of the above situtions be handled in a fashion that a reasonable dentist would do in like or similar circumstances. Many of the standard of care violations that we uncover occur when general dentists perform dental procedures that should be referred out to a specialist. This occurs most often with complicated extractions, root canals and the installation of dental implants. One area that we have seen that results in a lot of dental malpractice claims is large corporate dental chains who advertise as providing affordeable dentures causing severe dental nerve injuries when the attempt an “all on 4” dental implant procedure. This procedure involves extracting all of the patient’s existing teeth (both top and bottom), placing 4 implants on the top and 4 on the bottom, and then attaching the implants to these implants. Unfortunately, the high volume of procedures preformed result in many serious dental nerve injuires that could be avoided with proper training, careful placement and other quality control processes that don’t happen in high volume dental implant offices that sometimes focus on quantity over quality.

Lawsuits in these situations will focus on duty (from the dentist to the patient), breach (of the standard of care, in other words the procedure is not done properly) and the resulting damages (often dental nerve injuries and other types of dental injuries that result from the procedure. These form the basis of the lawsuit and each of the elements are necessary to pursue a dental malpractice case in Georgia.

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Most dental malpractice cases handled by our firm stem from root canals or dental implants that are performed below the standard of care and which result in serious dental nerve injuries. A recent case (that we did not handle) appears to have been filed by a woman who claims that her dentist performed over 30 dental procedures in a single sitting. This is hard to fathom, and, if the allegations are true, it would be hard to imagine how the patient could have stayed numbfor these dental procedures without exceeding the recommended maximum dose of anesthetic numbing agents (but withouth knowing more, I guess it is possible).

8 crowns, 4 root canals, and 20 fillings in a single visit is certainly a lot of dental procedures in one day. Without reviewing the patient’s dental records, it’s hard to comment further, other than to follow the case and learn more as facts develop in the case. According to news reports, the expert who reviewed the records noted that almost every tooth in the plaintiff’s mouth had some form of decay on it, but that the care provided was nonetheless, “wrong.” One of the specific acts of negligence cited in the news report was that the amount of anesthesia administered to the patient exceeded what the expert considered to be safe under the circumstances. It is not clear, what specific injuries this alleged violation of the standard of care caused. However, it is an interesting case to follow for a nunber of dental reasons and I am curios to see how the litigation develops.

Most dental malpractice cases in Georgia are reviewed by an expert dentist, endodontist, oral surgeon or similar expert prior to the lawsuit being filed. If there is malpractice identified by the expert and the malpractice has proximately caused a substaintial permanent injury, an affidavit is prepared to support the lawsuit, the lawsuit is drafted and the complaint is filed in the appropriate court. Most of these cases start out as root canals or dental implants which are not performed to the standard of care and which wind up injuring an adjacent structure in the mouth or jaw such as a dental nerve. This is similar to a medical malpractice case where a doctor or surgeon leaves the surgical field and injures the patient while they are not operating in the area in which they should be. This is usually when the most damage is caused by the dentist.

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The more things change, the more they stay the same. Over the past 25 years, I have seen all types of dental malpractice situations. Most involved a procedure (root canal, dental implants, etc.) which create a dental nerve injury. While the advances in these procedures change over time, the need to perform them within the applicable standard of care does not.

Good, solid dental care certainly does not fit the one-size-fits-all description. Every care situation is different and the facts are what determine the outcome of many cases. The expression: the devil is in the details, certainly rings true in dental malpractice. And the details are often recorded in the patient’s chart so we can determine what took place, at least as far as what the notes say took place.

Unfortunately, many potential clients (and quite a few lawyers who don’t have the depth of experience with dental malpractice cases) conflate sloppy dentistry with dental malpractice. But, sloppy dentistry, while frustrating and while it can certainly cause much harm and frustration cannot support a lawsuit. However, dental malpractice, if committed by the treating dentist and resulting in sufficient injuries due to the malpractice, certainly can. The general standard of care for dental malpractice in Georgia is a national standard and if an expert bases his opinion on a local standard, his opinion can be excluded. Since this is the case, a standard of care expert needs no personal knowledge of the standard of care in the local community in which the malpractice occurred (such as Fulton County, DeKalb County, or Gwinnett County, or the City of Atlanta, for instance) to render an opinion of what the standard of care in the case is; and whether the applicable standard of care was violated by the dentist. What a particular dentist would have done under like and similar circumstances is also not dispostive on the issue of whether the standard of care was violated, although this type of testimony has become common to impeach experts who are being less than transparent when trying to defend a dentist who has clearly committed malpractice. In other words, the dental expert testifies that the way the procedure was performed met the standard of care, but admits under oath that he would not perform the procedure that way. In most cases, that is because performing the procedure the way the defendant did was below the standard of care and that deviation of the standard of care is what caused the injures that the Plaintiff is complaining of in the lawsuit.

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It’s all the rage these days. Clients are asking dentists to pull all of their teeth and install all-on-four dentures. Sometimes called teeth in a day or full mouth implants, these procedures are sometimes performed in the same day. While the billboard advertisements tout shiny smiles and happy patients, this may not always be the case.

All-on-four implants are offered by individual dentists and small dental practice groups. But, the vast majority of these procedures are performed by large dental chains. Some of the large dental chains that offer this type of procedure are ClearChoice, Affordable Dentures, Aspen Dental, Coast Dental, First Dent, DentChoice. This list is certainly not exhaustive and all-on-four dental implant procedures are performed by anyone from a general dentist, periodontist, prosthodontist, all the way up to an oral surgeon.

While the vast majority of these procedures are performed adequately, some complications due to dental malpractice can arise. These procedures require a great deal of expertise, proper planning and implementation, very precise radiographic tests such as the use of a Cone Beam CT Scan (CBCT) and a great deal of skill on the part of the dentist. Lack of proper planning, improper measurements, drilling to deeply when prepare the site for the implant and installing the implants too deeply into the jaw line or just some of the potential problems that can occur when these procedures are not performed correctly. This can happen when the dentist is not properly trained in the procedure, is careless, or lacks the skills to adequately plan and perform the procedure with the applicable standard of care.

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The primary goal of root canal treatment is to eliminate and prevent re-infection of the root canal system anatomy. In necrotic teeth, microorganisms can colonize anatomical complexities, such as isthmuses, ramifications and dentinal tubules and this causes infection and abcesses that are partially the reason why a root canal is performed. Instrumentation (dental files) can reduce the bacterial load by approximately 80%. However, the microorganisms cannot be completely eliminated with dental files alone as the file are very small but not small enought to get into every crevice of the roots of the tooth. sometime, in order to try and achieve this or simply due to inexperience or a lack of skill or knowledge, dentists over-instrument the canals, which is below the standard of care and often leads to catastrophic nerve injury.

After the canals are obturated (or cleaned out) the endodontist (or the general dentist if the patient has not been referred out to a root canal specialist: for the rest of this article we will refer to the practitioner performing the root canal as the “dentist” as both general dentists and endodontists are dentists) places sodium hypochlorite (NaOCl) solution into the canals to clean and disinfect them. This is a strong solution which, due to its antimicrobial/antibiofilm activity, and organic tissue dissolution capacity is able to clean and disinfect the canals. It is placed into the canal by the dentist using a needle coupled to a syringe, a system known as conventional syringe irrigation (CSI). CSI has a rinsing effect, which is an important part of the irrigation process. Once again, due to inexperience, a lack of skill, or nelgigence, too much apical pressure by the dentist can lead to sodium hypochlorite extrusion outside of the tooth roots and, many times, into the dental nerve which lays just beyond the apex of the tooth being treated (if the tooth is a bottom molar).

Root Canal therapy is widely used and is a relatively safe procedure when performed by a properly trained and skilled dentist who complies with the applicable standard of care and performs the procedure taking this into account. However, serious injury can occur if the dentist is negligent and injures the dental nerves below the bottom teeth.  Over instrumentation and extrusion of sodium hypochlorite can lead to serious injury that can be prevented with proper care and treatment.
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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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