Articles Posted in Dental Malpractice

According to a recent BBC News and Health article, which analyzed a study in the British Dental Journal, approximately 1% of dental implant procedures performed each year result in nerve injuries. Dentists should improve care before and after implant surgery, the study says. A dental implant is an artificial tooth root, which is screw or cylinder-shaped, that is placed into the jaw to hold a replacement tooth or bridge. Dental implants are generally used if someone has lost a tooth or teeth due to disease or injury. The type of nerve injury which can be caused by implant surgery has increased in recent years alongside a rise in implant surgery. Approximately 10,000 lower jaw implant procedures are performed each year in the UK and in 2007, 30% of all nerve injuries cause by dental work were associated with implants. This contrasts with 10% in 1997. This is almost certainly due to the increased acceptance and usage of dental implants after extractions.  The King’s College London research team found that these injuries could have a significant impact on people’s quality of life with more than half of the 30 patients participating in the research suffering from constant pain or discomfort after surgery and 40% complaining of numbness. 30% of the implant injury patients reported psychological problems, including four who were diagnosed with depression. Most of the injuries revolved around the trigeminal nerves such as the inferior alveolar nerve, the mental nerve and the lingual nerve.

70% of the 30 patients were referred to a nerve specialist more than 6 months after surgery, despite evidence showing that removing implants soon after surgery reduces the risk of permanent damage. In addition, a referral after 6 months reduces the likelihood that the nerve specialist will be able to properly diagnose and surgically repair the injured nerve, if that is the course of treatment that is warranted. If the micro-neurosurgeon determines that the best course of treatment is surgical repair, the surgery must be performed as soon as possible. In other words, the longer the injury goes untreated, the less likely that the surgical repair will be successful. Many times, the dentist who caused the nerve injury is reluctant to refer the injured patient to a specialist and this is below the standard of care to not timely refer a patient with a dental nerve injury to a nerve specialist. However, the proper course of treatment is to refer the patient out in a timely manner and to have continuity of treatment.

Attorney Robert J. Fleming has been handling wrongful death cases, automobile accident cases, personal injury cases, 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.

According to the American Association of Endodontists, root canal treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep tooth decay, repeated dental procedures on the same tooth which are not successful, or a crack or chip in the tooth which widens and/or deepens over time to the point that the pulp of the tooth is affected. A traumatic injury to a tooth may also cause pulp damage even if the tooth looks fine on the outside. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

Endodontic treatment typically consists of the following steps:

1. The dentist who is performing the root canal therapy examines and x-rays the tooth, then administers local anesthetic to numb the area and tooth that is to be worked on. After the tooth is numb, the dentist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.   

If an injured dental patient seeks a lawyer on legal web sites such as avvo.com, dental malpractice usually falls under a sub-heading of medical malpractice. This is certainly the case, and there are a number of dental procedures that commonly lead to dental malpractice claims, among them are: Root canal therapy, dental implants and puncturing the sinus cavity during a number of procedures in the upper jaw.

In order to pursue a dental malpractice case, and affidavit of an expert is required to be filed with the lawsuit in most jurisdictions. This is the same requirement as medical malpractice cases. The filing of the affidavit with the complaint necessitates that an expert in the field review the case and provide and opinion in the form of an affidavit that the treatment rendered in the case was below the standard of care. The standard of care for dentists and doctors is that they must exercise such reasonable care and skill for their patients as, under similar conditions and like surrounding circumstances, is ordinarily employed by the dental or medical profession generally. This is investigated by reviewing the treaters records, radiographs and other related information in order to determine the level of care provided by the potential defendant. The reviewing expert must have been regularly engaged in practice or teaching three of the past five years in the same area of practice or specialty, with sufficient frequency to establish an appropriate level of knowledge, as determined by the trial judge, in performing the same procedure, diagnosing the condition or rendering the treatment which is alleged to have been performed or rendered negligently by the defendant. In most cases, there is no grace period for filing the expert affidavit after the suit is filed. If there is no malpractice affidavit, the suit will be dismissed.

As discussed above, the standard of care must be violated during the procedures and care in order for there to be a case to pursue. In other words, simply because an injury occurred, does not mean there is malpractice. However, in most instance, the expert review will determine if there was malpractice and whether the malpractice caused he injury. Since dental malpractice is a form a medical malpractice, it follows that in order to pursue such claims, the injuries complained of must be extensive and permanent.

According to a recent article in the a respected medical journal, there is an increase in the number of dental nerve injuries following the placement of dental implants. More importantly, the genesis of the article is that this rise in the number of injuries can be avoided. Most dental nerve injuries occur after the incorrect placement of a dental implant in the lower jaw (or mandible). When the dentist does not correctly measure the available bone height between the top of the jawbone and the top of the inferior alveolar nerve, an avoidable dental nerve injury is likely to occur.

With the advent of numerous technological advancements that are not available to measure and map the jaw prior to placement of implants, these types of inferior alveolar nerve injuries are almost always due to malpractice on the part of the dentist. In my experience, most of these injuries are caused by general dentists, who are not aware of the standard of care for placing implants, and try to place implants in their office instead of referring the patient out to a specialist such as an oral surgeon, to complete the implants. Most times, the oral surgeon will plan and place the implants and then refer the patient back to the general dentist to place the crown on the implant.

Symptoms commonly experienced after a dental patient sustains an inferior alveolar nerve injury are:

Unlike the medical professional, the dental profession in many states including Georgia, has a lack of oversight over those dental professionals who choose to conduct dental procedures for which they do not have the qualifications and skills to perform. Legally, any dentist can perform any dental procedure. The problem that arises however, is that some general dentists take this liberty too far. As an Atlanta dental malpractice attorney, I have been contacted by victims of dental malpractice who have suffered serious injuries under the following situation:

• A general dentist attempting to install dental implants in the maxillary (upper jaw) piercing the sinus cavity and leading to serious infections that would not heal;
• A general dentist attempting to extract a impacted wisdom tooth and damaging the inferior alveolar nerve in the process;

As an Atlanta dental malpractice lawyer, I am well aware of a number of dental injuries that clients suffer due to improperly performed root canals, as well as from other dental procedures that are performed below the standard of care. Some of the leading dental injuries related to root canals are abscesses, infections, perforation of the sinuses, and facial nerve injuries.

I recently read an article which discusses a possible link between root canals and cancer. Interestingly, the article discusses how, even if the root canal is done correctly and all of the FDA approved materials are used, there could be a link between having the root canal and contracting cancer. While this makes for interesting reading, I have not seen any credible evidence to support this conclusion, and the American Dental Association (“ADA”) and other dental organizations have not, to my knowledge found this type of causal link.

However, with this being said, I still believe in being careful and only undergoing a root canal if it is absolutely necessary to save your tooth. The reason? The many dental injuries that occur when a root canal is not performed properly. As discussed above, many clients suffer from injuries that are caused by improper root canals. Some injuries occur when the dentist drills past the end of the root canal when cleaning the roots before filling them. In the upper maxillary teeth, this often results in a perforation of the sinus, communication between the mouth and the sinus, and infection. In the lower mandibular teeth, this can result in an injury to the mandibular nerves that run below the lower teeth and which run especially close to the roots of the molars. This type of injury is often very serious, as the resulting nerve damage causes loss of sensation and innervation to the chin, lip and jaw area. Sometimes, this numbness is combined with pain, which can be especially debilitating.

The role of Dental Assistants is governed by the Official Code of Georgia. It has expanded over time and, now, dental assistants can do all of the following while they are actively assisting dentists in a dental office:

1. Apply desensitizing agents to root surfaces of teeth and prepared the surfaces of teeth prior to cementation of temporary restorations and crowns, bridges, or inlays.
2. Place cavity liner, base or varnish over unexposed pulp.