Articles Posted in Dental Nerve Injuries

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One prominent nerve repair expert explains the need for quick action one a dental nerve injury is diagnosed: Peripheral nerve injuries requiring surgical intervention will have better results the earlier the nerve is repaired after injury. Therefore, repairs with or without grafting done immediately after the injury have better results, with progressively worsening results if done 3, 6, 9, or 12 months or longer after the injury. Wietholter et al reported best results for IAN (Inferior Alveolar Nerve) and LN (Lingual Nerve) repair if reconstruction was done within 3 weeks of the injury. Early repair circumvents major problems encountered with elapsed time such as Wallerian degeneration, atrophy, and fibrosis in the distal portion of the nerve. Atrophy creates a significant size match discrepancy between the nerve graft and either or both stumps. The time factor reflects the rate and extent of degeneration and atrophy of the distal fascicles prior to nerve repair. However, if the injury is primarily a traumatic neuroma without atrophy or degenerative neurologic changes in the distal portion of the nerve, the time factor may not be as important; that is, whether the repair is done at 3 weeks or 2 years may not make a difference in functional outcome.

However, an Atlanta dental malpractice lawyer who almost always has a number of active clients suffering from nerve injuries caused by root canals, dental implants and tooth extractions, I know what most dentists tell patients who have suffered from these injuries: “Your injury is temporary and it will get better. We need to keep an eye on it and wait. It could take up to two years for you to get better. We will monitor you and we simply have to wait, as there is nothing more to do.” Horrible advice that could possible cause you your right to sue if you wait too long.

In most cases, if you are injured by dental malpractice in Georgia, you have two years from the date of the alleged malpractice. Of course, like every rule, there are exceptions, but the are limited and the general rule, as stated above is what you, as a person who has a serious injury from a dental procedure, should proceed under. Also, if you have a serious injury from a dental procedure, you should hire a lawyer today. Why? Well, the first reason is that, in most cases, you should not follow the advice that dentists typically give patients who have suffered a dental nerve injury. Secondly, the deadlines that may apply to your case are quite complex and no one other than an experienced dental malpractice lawyer who regularly handles these types of cases in Georgia should be relied upon to provide you with legal advice. Finally, the sooner a competent lawyer is advising you, the sooner you have another trusted advisor in your camp who can help you make decisions that can save your health and make sure you protect all of your legal rights. In most cases, if you miss the statute of limitations (or the deadline for filing your lawsuit) your right to sue is lost forever.

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A recent article notes that over 60% of people fear going to the dentist. In fact, dentists are feared more than medical professionals such as neurologists and general surgeons. Perhaps the reason for the fear of the dentist arises from the number of dental malpractice cases in Georgia. As dental malpractice attorney in Georgia, I have seen a rise recently in the number of cases of dental malpractice related to the improper placement of dental implants in the lower jaw and improperly performed root canals procedures.

As the article points out, there are a number of ways that you can help alleviate the fear of dentists. The best way I know to eliminate that fear is to choose a dentist carefully. The best way: talk with friends and family and go to a dentist that they have been to before and can highly recommend. The worst way to pick a dentist in my opinion: go to one of the large dental chains such as Coast Dental, Aspen Dental, or Great Expressions. While the care at any of these large dental groups can be excellent, they are extremely large and you may not have the experience or outcome that you desire. The better course is to listen to people you trust and go to a dentist that comes highly recommended.

Another way to lessen the chance of a bad dental experience is to utilize a specialist. For instance, if you need a root canal, you might be better off with an endodontist than a general dentist. That is not to say that all general dentists are not able to perform root canals within the standard of care, it has just been my experience that the level of expertise with general dentists who perform root canals (especially difficult root canals with narrow canals, curved roots or calcified openings) varies greatly. Conversely, most endodontists have the necessary training, experience and tools in their office to competently perform even the most complex root canals.

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Many times, a claim for dental implant malpractice or root canal malpractice involving dental nerve injuries includes a claim for mental pain and anguish. Defendants in these cases typically try to obtain all of plaintiff’s medical and psychiatric records for the previous 10 years, or longer. This type of request was addressed in Brown v. Howard, 778 SE2d. 810 (Ga. App 2015). In holding that the plaintiff’s mental health records were not subject to the defendant “fishing expedition”, the Howard court reasoned as follows:

“Parties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action [.]” OCGA § 9–11–26(b)(1). Georgia law provides several privileges related to mental health, which, collectively, are referred to as the “mental health privilege.” State v. Herendeen,279 Ga. 323, 325, 613 S.E.2d 647 (2005). The components of the mental health privilege include

(5) Communications between psychiatrist and patient;

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I recently took a call from a potential client who suffered what appears to be a lingual nerve injury after she received a dental implant in the lower jaw. While this is unusual, the fact that she received a nerve injury after the placement of a dental implant in the lower jaw is not as uncommon as one might believe. A recent study in the U.K. revealed that about 1% of dental implant procedures performed each year result in nerve injuries.

The number of dental implants installed in the U.S. and around the world is increasing at a rapid rate. Implants can replace lost teeth and are preferred over bridges and other dental devices because implants are permanently screwed into the jawbone and more readily mimic real teeth than a bridge or other device can. This allows the implant to promote a strong bone structure around it and the patient is much less likely to suffer from bone resorption (or bone loss around the area of the missing tooth) after the loss of a tooth when a dental implant is installed rather than a bridge.

However, with this added benefit comes added risk. If the dentist installing the implant does not comply with the standard of care when installing the implant post, dental nerve injury can result. If someone suffers a dental nerve injury from a dental implant, they often suffer from numbness and pain in the jaw, lips, mouth, gums, teeth and chin areas. Although it is less common, someone who suffers a dental implant nerve injury can also suffer from pain that radiates up from the lower jaw and up into the ear and head. While this type of injury is less common, it is almost always a much more serious and debilitating nerve injury and much more difficult to treat due to the transitory (moving) nature of the pain and symptoms. In addition, if the cause of this painful condition is not addressed quickly, the pain can be permanent and result in a significant negative impact in the quality of life. Many of these injured dental implant clients wind up with constant pain and discomfort for the rest of their life.

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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.