Articles Posted in Dental Malpractice

As an Atlanta Dental Malpractice Lawyer, I encounter many clients who have had asymptomatic wisdom teeth extracted. Not only is this a form of dental malpractice (because it constitutes over-treatment) but many of these procedures result in permanent nerve injuries to the lingual nerve and/or the inferior alveolar nerve. Many times clients have gone to the dentist for a check up and are told that they should have all four wisdom teeth extracted, even though there are no problems associated with these teeth. To be sure, there are times when wisdom teeth should be extracted, but this is not always the case.

Simply put, a wisdom tooth that is not causing any problems, should not be removed. Even “impacted” wisdom teeth should not be removed, unless they are infected or causing another serious dental problem.

Unfortunately, over ten million wisdom teeth (also known as third molars) are extracted from almost 5 million people in the United States every year. This results in hundreds of permanent nerve injuries when the lingual nerve or the inferior alveolar nerve is damaged due to a needle severing the nerve during nerve blocks injections, a root tip ripping the nerve during extraction or a number of other complications related to the drug use to numb the patient or the extraction. I have seen cases in which both of these nerves have been damaged by one extraction.
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A group of 10 families in New York has filed a lawsuit against Small Smiles/Access Dentistry, a nationwide network of dental clinics that also has a presence in Georgia. The lawsuit alleges that dentists at Small Smiles in Schenectady performed unnecessary procedures on young children. The lawsuit also alleges that the children were physically restrained during these procedures. The company has been charged with fraud, dental malpractice, negligence, breach of fiduciary duty and battery.

Some of the children mentioned in the lawsuit include

An eight-year-old girl who had six root canal surgeries and crowns, four dental extractions and three fillings during a single visit. During all these procedures, the girl was physically restrained in a chair.
A one-year-old boy who had four root canal surgeries and four dental extractions while being restrained in the chair.
A four-year-old girl who had a total of eight fillings, four dental extractions and two root canal surgeries during a single visit.
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The mouth is an important part of our ability to function as humans in society. We use it to eat, drink, and communicate with each other. We take the mouth largely for granted, until there is a problem. We then trust a dentist or an orthodontist to fix that problem. But sometimes dental professionals fail to perform adequately. In that case, the patient should look into their legal options.
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The Food And Drug Administration has found that the maker of the popular Invisalign invisible braces failed to inform the agency about allergic reactions to the product. Some of these allergic reactions were serious enough to be life-threatening.

According to the Food and Drug Administration, it first learned about these allergic reactions this year. The agency has sent the company that manufactures Invisalign, Align Technology, a warning letter, alleging that the company failed to inform the agency about how it was going to enhance its reporting procedures. Align Technology has issued a news release saying that it did, in fact report, these incidences of allergic reactions to the FDA.

The FDA letter describes certain serious symptoms that patients who used the braces suffered:
On November 2, 2007, one patient reported severe gum and lip irritability. The lips and gums became swollen, red, sore and irritable. There were several other such reports that were made to the FDA, and some of these cases were serious enough to require hospitalization of the patient.

As recently as May 11, 2010, there was another report of allergic reactions from using the braces. This patient suffered a burning tongue sensation. The patient also reported soreness in the throat, mouth ulcers as well as swollen lymph nodes.
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As an Atlanta dental malpractice lawyer, the risks from the widespread use of dental fillings containing mercury have been a particular subject of interest to me. This week, the Food and Drug Administration (“FDA”) announced that it would be revisiting this safety issue. An FDA advisory panel has convened a professional review to analyze the risks from mercury amalgam dental fillings.

The announcement of this review comes just about 18 months after the FDA declared that the fillings were safe. Over the past couple of decades, the FDA has found that dental amalgam fillings containing mercury are safe to use.

Dental fillings containing mercury have been used for decades now. The American Dental Association has always held that the fillings are completely safe. However, the fact that these fillings contain mercury, a known toxin, has always been a source of concern especially to Atlanta dental malpractice attorneys.

The FDA in 2009 released new evidence that states that dental fillings containing mercury are safe for people aged six and above. However, the FDA also cautioned that very young children and developing fetuses may have health risks from the mercury in their fillings. However, there have always been critics of amalgam fillings who believe that the FDA has purposely chosen to misread evidence pointing to the risks of mercury-containing amalgam fillings.
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As an Atlanta Dental Malpractice Attorney, I receive many calls from dental patients who have been injured in the dentist’s chair. Some are injured during wisdom tooth extraction, others are injured from nerve block injections and still others suffer their nerve injury after receiving toot canal therapy or a new dental implant. Most ask some form of the same question: “Will my dental nerve injury get better.” The answer, unfortunately is, “it depends.”

The most common dental nerve injuries are to the lingual nerve (with the most likely symptom being a numb tongue, pain in the tongue, or a decreased ability to talk comfortably), the mental nerve (most likely accompanied by a numb lip and/or chin) and the inferior alveolar nerve (most commonly associated with numb lip, chin and gums). Regardless of the nerve injured, the key to reversing the nerve damage is timely treatment. The longer one goes without the feeling in your lip, cheek, gum or tongue coming back, the more likely that the injury will be permanent. If the nerve damage is identified and treated in a timely manner, some cases of nerve damage can be repaired with microneurosurgery. The problem many times is that the dentist who caused the nerve injury is not familiar with the standard of care required of a dentist after the nerve injury has occurred. Many dentists string the patient along without properly treating the patient’s injury. In this scenario, the dentist simply keeps assuring the patient that the injury is temporary and it will get better with time. Unfortunately, I have spoken with many injured dental patients who have followed this improper advice and who have lost their legal rights due to the expiration of the statute of limitations (or the amount of time in which you have to file a lawsuit based on malpractice).

As an attorney who handles many Georgia dental malpractice cases, it concerns me greatly when clients suffer from permanent nerve damage. These are particularly tough injuries to live with and they affect your life every day in many ways that are not apparent until you suffer this type of injury. While not every dental nerve injury is caused by malpractice, it is imperative that an injured patient be timely referred to an oral and maxillofacial surgeon who is experienced in treating nerve injuries for a complete nerve evaluation as soon as possible after the injury is sustained. There are many tests that can be run to pinpoint which dental nerve has been injured, the extent of the injury, whether the injury is getting better or worse, and whether surgical intervention may be indicated to repair the nerve or whether the better course of treatment is to wait and hope that the nerve recovers without surgery.
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Radiation diagnostic procedures have always been sparingly used among children and adolescents because of the risk of overexposure to cancer-causing radiation. However, the same kinds of precautions are not taken when children are in a dentist’s chair, getting an x-ray or a scan before a routine dental procedure. This is in spite of the fact that many dentists continue to use outdated x-ray film that expose patients to unnecessary excessive amounts of radiation. If used too frequently, these unnecessary and frequent radiation exposures could pose a serious health risk that simply is not necessary. At this point, it is axiomatic to say that frequent and/or unnecessary exposure to radiation should be avoided so as to avoid possible cancer and other health risks related to increased exposures to radiation.

That is not the only thing that should concern any Atlanta dental malpractice lawyer. According to the New York Times, more and more orthodontists and dental specialists around the country are now using a new scanning device that releases much more radiation than conventional diagnostic machines. The device is called a cone beam CT scanner, and is meant to provide 3-D images of the skull, including teeth, roots and jaw.

The technology has been heavily promoted by manufacturers, who say that it gives orthodontists and other dental specialist the chance to identify specific and precise problems, and devise treatment strategies more efficiently. What they don’t mention in all their marketing jargon, is that there is little scientific research to prove that these machines are safe. There have been few tests that have been conducted on the scanners to determine their efficiency that have not been sponsored or promoted by the manufactures of the scanners.
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Both lingual nerve injury and inferior alveolar nerve injury can occur during oral surgery procedures. Both of these injuries can result in permanent or temporary loss of sensation in the mouth. In some cases, the lingual nerve may be injured, while in others, the inferior alveolar nerve may be injured. In some cases, both may be injured. While both conditions can be painful, inferior alveolar injuries tend to be more common than lingual nerve injuries. These injuries also tend to be tolerated better than lingual nerve injuries. The reasons for this are not clear, but some hypothesize that it has something to do with the structural differences between these two nerves.
Tooth extraction is one of the main causes of lingual nerve injury and inferior alveolar injury. Typically, these injuries occur during extraction of the wisdom teeth. Both lingual nerve injury and inferior alveolar injury can also occur during injections of local anesthetic administered during the dental procedure. A lingual nerve injury may end in pain to the mucosa on the side of the teeth close to the tongue. The pain is usually a burning kind of pain, or a dull throbbing pain. There may also be some numbness.
If you have suffered a nerve injury during a dental procedure, you should immediately consult a dental surgeon. As an Atlanta dental malpractice attorney, I’ve noticed that it can take time for a patient to realize that he has indeed suffered a nerve injury after the anesthesia wears off. Once you have been able to determine that you have indeed suffered an injury, it’s important to consult with a surgeon. Timely care and treatment is critical to the proper treatment of a dental nerve injury. Once you become aware that you may have such an injury, you must report the signs and symptoms that you are experiencing to a trained dental professional who is qualified to diagnose and treat nerve injuries (not all dentists are).
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The vast majority of the Atlanta Dental Malpractice cases that we litigate involve damage to the Lingual Nerve or the Inferior Alveolar Nerve (or both). Recent studies in dental journals have identified common factors that contribute to the incident of nerve damage. Most are secondary to a dental procedure such as installing dental implants (when the nerve is crushed due to the implant being installed too deep), oral surgery (usually when a tooth is extracted and the nerve is damaged by a dental instrument of the root of the tooth itself or severed during wisdom tooth extraction).

The factors identified as substantially increasing the risk of lingual nerve damage are: increased age of the patient undergoing the dental procedure; un-erupted wisdom tooth extraction; raising the lingual flap; and lingual split technique (splitting the bone to remove the tooth), drilling the osteotomy for a dental implant too deep, drilling past the root end and into the underlying inferior alveolar nerve or negligent extraction techniques which traumatize the nerve from excess force or contact of the nerve with dental instruments.

The factors identified as substantially increasing the risk of Inferior Alveolar Nerve damage are: the depth of impact; the difficulty of the surgery; and radiographic signs that the wisdom tooth root is lying in close proximity to the Inferior Alveolar Nerve or, similarly, that the nerve has grown into and created a groove into the wisdom tooth root.

When any of the above factors are present, there is much greater risk of injury and permanent dental nerve damage.

As an Atlanta dental malpractice lawyer who frequently meets with patients suffering from these injuries, I know how important it is to properly evaluate patients before oral surgeons extract teeth or install dental implants. Sometimes, dental malpractice occurs in the form of over treatment because the procedure is not warranted. Other times, the malpractice occurs because the dentist is not properly trained to perform the procedure that caused the injury. Still other cases are the result of a failure of the dentist who caused the nerve injury to properly chart the injury and timely refer the patient to a competent nerve specialist to timely treat the injury caused by the malpractice.
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Articaine is a local anesthetic that is used widely around the United States. Worldwide, more than 100 million dental patients are believed to be treated with Articaine every year. However, since the drug was approved by the Food and Drug Administration in 2000 under the brand-name Septocaine, there has been concern about its links to lingual nerve damage.

There has been substantial research into the lingual nerve injury risks of using Septocaine. In 2005, the Danish Medicines Agency published a report, which studied the risks from the use of this nerve block in dental treatment. The study was done to deal with concerns that Septocaine was linked to a high number of cases of lingual nerve damage reported to the Danish Dental Association, and reports of side effects reported to the Danish Medicines Agency. Danish authorities were particularly concerned about the development of paresthesia from the use of Septocaine. The study concluded that there needed to be more research into this issue. However, in an apparent acknowledgment of the link between Septocaine nerve blocks and lingual nerve damage, the Septocaine package insert was changed to reflect the high incidence of Septocaine nerve blocks resulting in lingual nerve damage.
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