Articles Posted in Dental Nerve Injuries

Published on:

The need for a root canals typically arises when the patient has a cavity that is too deep to be filled congenitally. The cavity extends down into and close to the roots of the teeth. When this happens, the dentist will either refer the patient to and Endodontist or perform the root canal herself. Either is fine, but the root canal must be peformed properly to comply with the applicable standard of care for dental malpractice in Georgia.

X-rays or CT scans (“imaging”) are taken of the tooth to determine the extent of the decay and to determine how many canals must be accessed to perform the root canal. In order to comply with the legal standard of care for dentistry, imaging should be performed before, during and after the root canal is completed. In addition to imaging, there are many test that the dentist must perform to make sure she is performing the root canal on the correct tooth; that the tooth is not cracked (most cracked teeth cannot be cured by a root canal); and to make sure a root canal is indicated.

Most times, after a root canal, the tooth is scheduled for the placement of a crown, but if the area is not too large, a crown is not always necessary (just a filling). If all goes well, the pain from the original need for the root canal and from the drilling and pressure associated with the procedure itself should subside within a few days, at most. Similarly, the numbness from the anesthesia necessary to perform the root canal should wear off the same day.

Published on:

Robert J. Fleming handles medical malpractice and dental malpractice cases in the Atlanta area and throughout Georgia. He is a skilled trial lawyer who has delivered verdicts that far exceeded the last offer from any insurance company or defendant. He is well versed in all aspects of medical/dental malpractice litigation and continues to exceed expectations. Helping clients get back on their feet, pay outstanding medical bills, and funding trusts for the victim and their family are some of the remedies that Robert J. Fleming has fashioned when representing clients who have been injured due to negligence and dental/medical malpractice.

With almost 30 years of experience in the law, Fleming was, again, recognized by Super Lawyers Magazine as one of the best medical malpractice lawyers in Georgia. Within the area of medical malpractice, he regularly handles dental malpractice cases that involve dental nerve injuries. Some of the procedures that commonly lead to dental malpractice litigation include root canals, dental implants and complicated extractions. Dentists in Georgia must comply with the standard of care when rendering care and treatment to their patients. Just like many other types of professionals, dentists must provide care that a reasonable dentist would provide under like and similar circumstances. Some examples of dental malpractice are quite clear, such as extracting the wrong tooth, drilling into areas that are not in the surgical area and failing to order a biopsy when the patient clearly has signs or symptoms of cancer (and must be ruled out or risk them dying from undiagnosed cancer). Others examples or malpractice are less obvious (but just as culpable) and the case must be reviewed by a dental expert such as an endodontist or oral surgeon who can review the facts of the case, the treatment rendered and the resulting injuires to render an opinion of whether there was malpractice or not.

The resulting damages from dental malpractice certainly can run the gamut. Some malpractice results in relatively minor damages (and hence do not result in a lawsuit), while others can result in permanent life altering injuries or even death. In addition, there is not always a direct relationship between the level of malpractice and the severity of the injury. That is why a potential dental malpractice client would be well advised to seek a lawyer who has substantial experience evaluating and pursuing dental cases in court. The dental malpractice lawyer should be able to evaluate the case from a medical-legal perspective to determine (1) if the case should be reviewed by a dental expert; and if so, which expert would be best qualified to review the case. Experts need to have complete copies of files in order to propery evaluate a case and render an opinion.

Published on:

When a dental procedure is performed in Georgia, serious injuries can often result. However, one type of injury is completely preventable — swallowing  (either whole or pieces that have broken off) dental instruments such as drill bits, root canal files, and teeth. Since the patient is most often lying prone in the dental chair and not cognizant of what is going on around them, it is encumbent upon the dentist to protect the airway so that nothing gets dropped down the patient’s throat, which could lead to dental instruments either being entrapped in the lungs, stomache or intestines.

“I was at the dentist getting a root canal, and the next thing I know I was told I swallowed a tool,” is a comment that I have heard in the past. “I didn’t really even feel it going down. All I felt was a slight cough. When they did the xray they realized, I swallowed it, and it is in my stomach,” is another sentiment that has been relayed to our office by dental patients who have swallowed dental instruments, sometimes without their knowledge. Often, once the dental instrument has made its way past the throat, it continues to work its way down the intestinal tract, or worse, can wind up deep in a lung.

Dental instruments are sharp and can wind up lodged in the back of the throat, the trachea, bronchial passages, stomach and intestines. Sharp edges can cause all types of complications in the body such as coughing up blood, stomach ulcers and rectal bleeding. Once lodged in these areas of the body, the dental instruments must be removed as soon as possible to prevent further harm, especially in the case of foreign objects in the lung, which sometimes require surgery to remove part of the lung along with the stuck dental instrument or foreign object. If immediate sugery is not performed to remove the dental instrument (and often some of the lung if it is lodged in the lung), infection could set in and infections in the lungs are very hard to treat. The dental instruments (such as a drill bit or root canal file that has broken off during a root canal procedure are a foreign body that was in the mouth and bacteria in the mouth is some of the most virulent and aggressive types of bacteria. If it remains in the lung (or other parts of the body), and if it’s sitting there any length of time, the risk is that it will create an abscess. Once an abcess develops, it is hard to control the infection, as antibiotics, while normally very affective in treating infections, have a difficult time traveling to some parts of the body such as the lungs due to a lack of sufficient blood flow.
Published on:

With the post COVID-19 shelter at home situation nearing an end, many people contemplate getting dental work that they may have needed before all of this started, but have not been able to complete. This could be because of shelter in place and business laws that have been enacted to combat the spread of the corona virus, or it may be due to a personal decision to not receive non-emergency dental or medical care until the pandemic has subsided.  This pent up demand may be seen as a way to have a new beginning or to get ready for the post COVID-19 lifestyle. As an Atlanta Dental Malpractice lawyer, I am far too aware of injuries that can result from botched dental work. While I hope that it happens to none of you, chances are some of you will receive dental treatment which is below the standard of care and this may result in a dental malpractice lawsuit to recover for injuries.

Dental implants, root canals, and tooth extractions are just three of the many dental procedures that result in serious nerve injuries to the lingual and inferior alveolar nerves. It’s a simple (not simplistic) error that dentists make that cause these injuries. Most times, the injury occurs because the dentist does not take into account the distance between the tooth root and the nerves, or worse yet, doesn’t even take pre-procedure x-rays to make sure there is sufficient room between the tooth roots and the nerves. Other times, the injuries are the direct result of sloppy dentistry or the dentist simply not caring enough about his patient to ensure that the procedure is done correctly and the nerve is not placed in danger.

Dental implant procedures are “in” these days and they are effective, if performed within the standard of care. Unfortunately, we are seeing a lot more clients coming into our office complaining of nerve injuries after the dental implant was placed too deep into the jaw and resulting  in a damaged nerve. There are many ways for the dentist to measure the amount of bone height that is available for the implant prior to drilling the hole for the implant and placing the implant in the jaw. While some of these measurements have a margin of error, most methods today do not.

Published on:

Dental implants are becoming more common in Georgia. Along with the increased use of implants comes a not so welcomed increase in the number of dental nerve injuries caused by implants being installed improperly by general dentists.

Sensory alteration resulting from the injury results in serious injuries that can be life altering. In some cases, the injuries become much more serious due to the general dentist (who quite possibly negligently installed the implants and caused the nerve injury) is not trained  or otherwise qualified to diagnose and treat the nerve injury. Once this is the case, what was otherwise a potentially temporary injury can morph into a permanent and debilitating injury that can affect almost every life function of the injured dental patient.

Effective management of potentially serious nerve injuries caused by implants is based on providing a timely diagnosis and then treatment such as steroids or anti-inflammatories or corrective surgical intervention as soon as possible after diagnosis of the nerve injury, for best results in properly treating the nerve injury. In other words, the general dentist should timely refer the injured dental implant patient to a nerve specialist. The nerve specialist, in turn, can provide an early diagnosis and recommend the correct course of action for successful treatment. As these injuries become more prevalent, it is more and more apparent that nerve injuries are more likely to be persistent or even permanent when there is an increased period of time between injury and a diagnosis by a competent dental nerve specialist of the patient. If the diagnosis is delayed, there can be irreversible damage to the patient. Unfortunately, as a dental malpractice lawyer who specializes in dental implant injuries, I often see clients who sustained a dental nerve injury, report the symptoms of this injury to the dentist who installed the dental implants, and then these clients are not referred out to a nerve specialist. Rather, they are told that the injury is “normal” and that it will heal on its own over time. Many times, this advice is harmful to the patient and, in some but not all cases, negligent.

Published on:

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.

Published on:

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.

Published on:

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;

Published on:

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.

Published on:

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.

Awards
Contact Information