Atlanta Injury Lawyers Blog

Dental Implants are an effective treatment for missing teeth. In fact, they are the preferred treatment because they integrate into the jaw just like you natural teeth. Unfortunately, with the rise of dental implant procedures, there has been a rise in dental malpractice claims caused by these implants procedures. The following are the most common types of malpractice-related injuries:

(1) Tissue or nerve injury– Dental implants are an invasive procedure. When the implants are screwed into place, common problems include abnormal swelling of the tissue surrounding the implant. If proper care is not taken by the dentist, this tissue can become infected and lead to other complications. Another problem caused by dental implant malpractice is nerve damage. Nerve damage occurs when the implant is placed too close to the nerve, or in extreme cases of malpractice, when the implant is screwed through the nerve canal and into the nerve itself. If this happens, the implant must be “backed out” as soon as possible, but in most cases, if the implant is in the nerve, the resulting nerve damage is irreparable. Explicit recommendations for pre-operative radiographic evaluation prior to placement of implants can help prevent nerve injuries. Cone beam CT scanning, can provide improved imaging for planning implant treatment.  Many dentists also use software to assist in the planning of implants and for the identification of the inferior alveolar nerve “IAN” canal position.  Most cases of paresthesia can be prevented but not remedied. However, when this problem occurs, follow-up must be initiated quickly, since the first few months may determine the degree of nerve healing. Many dentists fail to timely treat or refer injured patients to a nerve specialist in order to try to cover up their mistake, however, this is rarely successful and amounts to nothing more that an additional count of negligence against the defendant dentist in the dental malpractice lawsuit.

(2) Sinus Complications — these occur when the patient receives a maxillary implant (to replace an upper tooth) and the implant “communicates” with the sinus and causes infections and other unpleasant side effects. In many cases, this happens because the dentist failed to do a pre-implant sinus lift which can alleviate these possible sinus problems.

This happens all too often here in Atlanta and in other parts of the country but I rarely take the time to write about it. However, I feel compelled to share what happened recently to help other victims of dental malpractice. I received a call from a very nice woman who clearly had a very serious dental nerve injury from a dental procedure. She was frustrated and troubled because she has had intense pain and paresthesia (numbness) in her lower lip, the corner of her mouth and her facial skin, since a general dentist installed implants in replace of teeth #30 and 31. These are the two last mandibular molars on the right side (assuming that the wisdom tooth and that side has been extracted). The reason for the pain and numbness? The general dentist placed the implants into the nerve canal when installing them. Then he backed them out to weeks later. In other words, the dentist crushed her mental nerve by screwing the implants through the nerve canal and into the nerve itself. Apparently, the dentist did not perform the pre-implant procedure testing and planning that is required by the standard of care for dentists under similar circumstances. This is an implant procedure complication that is almost always caused by malpractice and is easily avoidable.
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As a Georgia trial lawyer who specializes in Dental Malpractice, I represent clients who have suffered lingual and inferior alveolar nerve injuries and other maxillofacial nerve injuries caused by Oral Surgeon dental malpractice. Today, I read that an oral surgeon in Oklahoma who has “voluntarily” closed his offices after health officials began investigating his dental practice.

Despite his office’s “spiffy” facade, this oral surgeon is being investigated for contributing to the spread of hepatitis and the HIV to his patients. State and County inspectors raided the Oral Surgeon’s office and found evidence of employees using dirty equipment, re-using syringes, and administering drugs without a license.

This lack of quality assurance and proper medical protocol is appalling and I must say that it is not the norm. The injuries that I see most often result from dental errors during a number of dental procedures as follows:

DENTAL IMPLANTS

Nerve injuries related to dental implant treatment is becoming an increasing problem. The incidence rate of implant-related inferior alveolar nerve (IAN) nerve injuries varies greatly but can approach 40% of some patients. 25% of edentulous patients (those without any of their natural teeth left) present with a degree of altered IAN function, thus reinforcing the need to follow guidelines and the standard of care on the necessity of pre-operative neurosensory evaluation. 3-D scanning now available in many specialist practices and dental hospitals provides improved imaging for planning implant placement with little radiation exposure.

ROOT CANAL PROCEDURES

Any tooth requiring endodontic treatment that is in close proximity to the IAN canal should be given special attention by the dentist. If the canal is over prepare’ or the apex opened, chemical nerve injuries from irrigation of root canal materials is often the result.

WISDOM TOOTH EXTRACTIONS

Third molar surgery or extraction-related inferior alveolar nerve injury is reported to occur in up to 10 % of all extraction cases. Factors associated with IAN injury are age, difficulty of surgery and proximity to the IAN canal. If the tooth is closely associated with the IAN canal radiographically, i.e., it is superimposed on the IAN canal, darkening of roots, loss of lamina dura of canal, or deviation of canal  which is probably due to interference of the root with the inferior alveolar nerve canal, then the risk of nerve injury doubles according to some reports in the dental literature.
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Injury to a nerve is the most common problem I encounter as an Atlanta Dental Malpractice Attorney. This type of injury is caused by the implant being too long for the application or being screwed too far into the bone and compromising the inferior alveolar nerve canal.

Unfortunately, this type of dental nerve damage is almost always permanent. While damage to skin tissue or bone often heals, the same cannot be said for nerve injuries. This underscores the need to avoid the malpractice that causes these injuries in the first place by, for instance, not relying solely on x-rays (which sometimes lack the clarity needed to know the exact distance to the nerve canal). There are a number of more advanced and more accurate tests that can be performed prior to conducting dental procedures that place the inferior alveolar nerve, mental nerve and lingual nerve in danger. Often, the dental malpractice standard of care requires that these tests be performed prior to the procedure to protect against damaging these nerves. In addition, the standard of care requires a number of procedures to be performed after the dental procedure to ensure, despite the dentist’s best efforts and proper pre-procedure planning and testing, that the nerve has not been injured.

In addition the resulting numbness, many patients suffer from debilitating pain. Many find this hard to comprehend (i.e., how can I be numb and have severe pain at the same time in the same area). Suffice to say that the interaction between the central nervous system and sensory nerves are extremely complicated and that there is a very complicated medical explanation, but we can leave it at: it is possible and it does happen to many of my clients who are the victims of dental malpractice while undergoing dental implant procedures.
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With the new year upon us, many people contemplate dental work as a way to have a new beginning or to get ready for the new year. As an Atlanta Dental Malpractice lawyer, I am far too aware of injuries that can result from botched dental work.

Dental implants, root canals, and wisdom 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 bother to take pre-procedure x-rays or CBCT scans to make sure there is sufficient room between the tooth roots and the nerve or nerve canal.

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 dental nerve injuries after the dental implant was placed too deep into the jaw. Many doctors who treat these nerve injuries, refer to them as trigeminal neuralgia or trigeminal nerve injuries. While this is a rather imprecise diagnosis in my opinion, it is widely used by neurologists and other medical professionals who do not treat dental nerve injuries on a regular basis because the trigeminal nerve supplies the face, eyes, mouth and scalp with  sensations such as touch, pain, and temperature.

According to the Trigeminal Foundation, trigeminal nerve injuries can cause episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the trigeminal nerve are distributed: the lips, eyes, nose, scalp, forehead, upper jaw and lower jaw. Sometimes you may notice pain with touch or when a cold breeze hits your face. This is a common complaint of clients who have suffered this type of dental injury.

Eating, speaking, drinking, brushing your teeth, shaving or applying makeup may all be difficult because of the changes in feeling. Examples of some patients with these nerve injuries.
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