Articles Posted in Dental 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.

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Dental offices in Georgia, and dental practitioners are governed by the Georgia Drugs and Narcotics Agency, as well as medical facilities.

The following are tips shared by the Georgia Drugs and Narcotics Agency for dentists and physicians who must prescribe drugs.

1. Stamped signatures are not valid for any prescription issued in the State of Georgia. (Georgia Pharmacy Practice Act O.C.G.A 26-4-80(i)).

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Recent reports indicate that Georgia is about to pass legislation to allow dental hygienists to work on patients without dentists present. Dental Association officials said in the past that they were concerned about the safety of patients, but they agreed to support the measure this year.

Under the legislation, dental hygienists would be allowed to do basic cleaning and preventive care in so-called “safety-net settings,” which would be qualified health centers, school-based health clinics and dental offices without a dentist present. While there certainly is a need for more access to dental care, the counter balancing concern is safety for these patients who will not be seen by board certified dentists. Since only about 25% of dentists who practice in Georgia accept Medicaid, this law may provide a low-cost way for the elderly and poor to find affordable preventative dental care in Georgia. However, which dental procedures will these hygienists be performing without supervision and what is the expected protocol if the patient is in need of emergency dental care. Or, more importantly, who will perform dental screenings to rule out serious and/or potential life-threatening conditions such as serious abscesses, oral cancer or tumors in the head, neck, gums or tongue.

As a practical matter, the work that hygienists perform now in dental offices is not actively overseen by dentists anyway. The hygienist performs the cleaning and then the dentist comes into the treatment room to inspect the results of the cleaning and perform and oral exam. Many times, the oral exam is the most important part of the process, especially with poor or elderly patients who may, due to a number of reasons, have a higher risk of cancer or other conditions that could be spotted by a thorough oral exam conducted by a board-certified dentist in Georgia.

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Many of the dental nerve injuries which our Georgia clients suffer from are permanent. At trial, Plaintiff is qualified to testify that she does not foresee her pain and impairment ever resolving. In other words, that she does believes that her injury is permanent and is asking the jury to award damages to compensate her for the permanent injury caused by the dental malpractice.

Legal support for this is found in many prior Georgia cases., such as the following Georgia appellate court decision: Stephen W. Brown Radiology Associates v. Gowers, 278 S.E.2d 653, 157 Ga.App. 770 (Ga. App., 1981). 

The court did not err in charging on pain and suffering, future medical expenses, and elements of pain and suffering such as “deformity or unnatural condition.” Nor did the court err in charging the age-old expression that the jury was authorized to accept plaintiff’s own testimony regarding his injuries and suffering in preference to the evidence of a whole college of physicians.” See Great A. & P. Tea Co. v. Dupee, 71 Ga.App. 148(2), 153, 30 S.E.2d 365; Southern R. Co. v. Petway, 7 Ga.App. 659(1), 67 S.E. 886; Southern R. Co. v. Tankersley, 3 Ga.App. 548, 60 S.E. 297; Wolfson v. Rumble, 121 Ga.App. 549(2), 174 S.E.2d 469.

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In 2005, the Republicans in Georgia, lead by the Republican Governor tried to rob the Georgia citizens of its right to a fair and impartial jury trial by, among other things, placing a limit on the amount of non-economic damages that can be awarded in medical malpractice cases. The thinly veiled reason: to stop frivolous medical malpractice lawsuit. Can anyone reading this really argue that placing a limit on damages when someone is severely injured by medical negligence is a recipe to stop frivolous lawsuits? No. The real reason and the real effect of this type of proposed tort reform is just another governmental grab to take away our freedom as jurors and for the government elitists to tell us what a catastrophic injury is worth. Why? For the Republicans, to help out the powerful insurance companies by limiting their exposure to large verdicts when, for instance someone is rendered a quadriplegic from malpractice or when a little boy loses his legs when the medical providers fail to detect a fast growing tumor despite his parents bringing him to the doctors because or clear sign and symptoms of this type of tumor. Thankfully, the Georgia Supreme Court overturned the limits on damages in these situations because it was clearly unconstitutional. Undeterred, the Republicans are trying to help out the big insurance companies by seeking to pass similar legislation on the federal level. In addition to being discriminatory and based on nothing more than “talking points” which don’t stand up when examined closely, the proposed federal tort reform violates one of the GOP’s stated basic tenets of minimal federal government intervention on state’s rights. Of course, when they see an opportunity to, once again, bail out the powerful insurance companies, the Republicans who are pushing this ill-advised legislation simply ignore state’s rights.

Paul Bland writes the following article which is compelling and points out the hypocrisy of the latest “tort reform” by Republican legislatures, this time on the federal level. Paul Bland is executive director of Public Justice, a national public interest law firm that pursues high-impact lawsuits to combat social and economic injustice, protect the Earth’s sustainability and challenge predatory corporate conduct and government abuses.

The GOP has long had the brand of being the party of states’ rights and minimalist federal government — it’s no wonder that Paul Ryan has been thinking about sending Medicaid back to the states since he was in college. Indeed, one of the reasons cited by House Republican leadership in the battle over the American Health Care Act for why Medicaid funding should be distributed to states in block grants with fewer federal requirements is that it empowers states to design Medicaid programs that meet each particular state’s needs.

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I am looking at a case for a woman who has tongue cancer which appears to have not been treated appropriately by her general dentist, either prior to the diagnosis or after it. The standard of care for dentistry mandates that a general dentist properly screen every patient for oral cancer, especially during a “routine cleaning.” 

Who gets oral cancer?:

Short answer, men are twice as likely than women to contract oral cancer. Men who use snuff of chewing tobacco are 50 times more likely to contact oral cancer. Heavy users of alcohol are also more likely to contact oral cancer during their lifetime, However, this is not the end of the inquiry, as it should be noted that 25% of those who get oral cancer are not men and drink alcohol only occasionally. This is why dentists must screen all patients for oral cancer.

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The number of multi-practice dental practices (that is dental practices that have a number of locations and that are run by an administrative group rather than a single dentist) is growing nation-wide and in also Georgia. Some of the largest dental practice management companies are, with the approximate number of locations in parenthesis: Aspen Dental (over 240 locations), Great Expression (over 180 locations), Dental One Partners (over 150 locations), Coast Dental (over 100 locations), Clear Choice Dental Implant Centers (over 34 locations) and Mini Implant Centers of America (over 17 locations). Many of these organizations have a large presence in Georgia and the metropolitan Atlanta area. While dentists are professionals who have a code of ethics, many critics of the large, multi-location dental management practices that are sometimes owned by aggressive investment funds, charge that these practice are encouraged to put profit over safety and patient satisfaction in order to meet the bottom line numbers set by the practice. If true, this translates into complaints by patients of sloppy dentistry, the performance of unnecessary procedures, high bills, and low patient satisfaction.

While every case is different, dental patients should make sure that they are comfortable with the dentist who is providing the service to them (not just the practice). Care should also be given to utilizing captive specialists (dental specialists who are in-house with the large dental practice vs. a specialist who is independent of the practice). Dental specialists such as oral surgeons, endodontists, and periodontists are often involved when the care and treatment requires complicated extractions (usually partially and fully impacted wisdom teeth), root canals, and the installation of dental implants. As an Atlanta dental malpractice attorney, these are the specialty areas that I see involved in a great number of dental malpractice cases that my firm handles. Not only that, but these specialties, in my expert opinion, seem to cause the most severe injuries when they commit dental malpractice. This is why it is so important to get all the facts and make an informed decision about who is going to conduct the dental procedure on you, in addition to knowing the reputation of the dental practice. After all, the quality of the treatment you receive is going be directly related to the skills, qualifications and experience of the dental professional rendering the services.

Robert J. Fleming has been handling wrongful death cases, dental malpractice, bus accidents, car accident cases and premises injury cases for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years. He practices in and around the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb and other counties and nearby cities including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.

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According to a recent article, a husband and wife told detectives in Florida that they were introduced to a man by a mutual friend and that in later social interactions the man told them he was a dentist and had a dental practice in South Carolina before moving to Florida. The couple said they paid the man cash and that he had offered to do the work from home to keep costs low. However, when he extracted the wife’s tooth and left leaving a tooth fragment (or root tip) behind, causing her medical complications, the couple began their own research and soon discovered that the man was not a dentist. The couple also told detectives about another potential patient they had introduced to the man before knowing he wasn’t a dentist. When detectives met with that patient, they told police that the man had pulled about 10 teeth without anesthetic for him and made him dentures. According to the article, the man accused of posing as a licensed dentist was contacted by a detective, working undercover, and also arranged to meet him for dental work, according to investigators.

While these patients apparently did not use much investigative prowess in selecting their dentist, it is important for you to choose your dentist wisely. The best method is to talk with friends and other people who you trust (such as your attorney, or better yet an attorney such as Robert J. Fleming, who regularly handles dental malpractice claims) and get recommendations for dentists that these people have direct knowledge of. Care should be taken to select a dentist who is competent in the procedure for which you need care. Extractions, root canals, dental implants and other procedures are complex and only a general dentist who is trained in and skilled in the specific procedure should be chosen. Better yet, choose a specialist who has additional training and experience in the area that you need dental work in. For instance, a complex extraction might best be performed by a skilled oral surgeon rather than you general dentist; a complicated root canal with curved roots might best be performed by an Endodontist who has experience with these types of root canals and so on. Why: Because many of the procedures require expertise and can easily end up causing dental injuries due to malpractice if performed by a dentist who does not have the training, experience and skill to perform the procedure according to the standard of care.

Attorney Robert J. Fleming has been handling dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.

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Changes in the American Heart Association Guidelines may impact the use of antibiotics by dentists during tooth extractions and root canal treatment. The impetus for the new guidelines appears to be concern for prophylactic use of antibiotics when the are not indicated, which can lead to treatment resistant infections down the road. However, the standard of care, i.e., what a reasonably prudent dentist would do under like or similar circumstances, does require the use of antibiotics by dentists in a number of important situations in order to avoid catastrophic results. One such use involves protection of the heart from infection due to tooth extraction or root canal therapy. Infective endocarditis is a bacterial infection of the heart lining, heart valve or blood vessel. Although rare, it can occur when bacteria enter the bloodstream through breaks in the gums during invasive dental procedures or oral surgery. It can cause serious injury or even death if untreated. A common group of bacteria that cause this infection is Viridans Group Streptococci  or VGS. Importantly, dental patients with existing heart conditions, including those with prosthetic heart valves, are more susceptible to the infection, while dental patients with normal heart valves develop the infection less often.
In 2007, the American Heart Association changed its guidelines, recommending patients take antibiotics before invasive dental procedures only if they are at risk of complications from infective endocarditis. This includes patients with artificial heart valves, transplanted hearts with abnormal heart valve function, previous infective endocarditis and people born with heart defects. However, the guidelines were careful to note that the giving of preventative antibiotic treatment should be limited when not indicated, as noted above. Dental patients should ask their primary care doctor or cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on the new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure. Similarly, if they are aware of a condition that they have that requires the use of antibiotics prior to dental treatment, they should be careful to note that on the dental office intake forms and to bring this to the attention of their dentist or oral surgeon.

They should also be aware that overuse of antibiotics when they are not indicated, can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been an increase in the number of antibiotic resistant bacteria. When this happens, new and much more complex antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.