Articles Posted in Dental Malpractice

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.

The alleged improper surgical technique of the defendant dentist was at the center of a recent $875,000 dental malpractice settlement in Atlanta. The plaintiff, a woman in her late 20’s, went to the dentist for the removal of her lower left wisdom tooth. During the extraction, the defendant dentist severed the plaintiff’s lingual nerve. The plaintiff was then referred to an oral surgeon. After numerous surgical attempts to repair the nerve, it was determined by the oral surgeon’s office that the nerve was not repairable and the nerve injury was therefore permanent.

The plaintiff argued at trial that the technique used by the defendant dentist was not taught by any dental school. The defendant dentist claimed that the technique he used was proper and had been taught to him by the head of a college oral surgery department. The defendant dentist also claimed that the nerve injury was from the use of an elevator to extract the tooth, which was a common practice.

During the re-trial of this case, the plaintiffs were able to locate and bring to trial, much to the surprise of the defendants, the dental school professor referenced by the defendant dentist as having taught him his technique (and whom the defendant dentist had claimed was deceased). This witness for the plaintiffs testified that neither he nor any other instructor at the college would have taught such a surgical technique.

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Many times, potential clients who have suffered a dental nerve injury are not sure which type of doctor is best equipped to diagnose an injury to the inferior alveolar, lingual or mental nerves. While many specialists are trained to diagnose and treat pain and nerve damage, a microneurosurgeon is, many times, the best equipped for these types of injuries. Trigeminal nerve injury diagnosis, treatment and management is considered a subspecialty of oral and maxillofacial surgery. As such, microneurosurgeons usually possess additional training, experience and clinical skills to treat these nerves after damage caused by dental treatments.

Other medical providers that may be involved in the care and treatment of a dental nerve injury sufferer are neurologists, anesthesiologists, pain management doctors, oral surgeons, general dentists, and in many cases dental physical therapists who may try to address dental nerve injury signs or symptoms much like they do for tempromandibular disorder patients.

It has been my experience that these additionally listed medical providers may be helpful, but that they often lack the expertise that a microneurosurgeon has in regard to the trigeminal nerve injuries that we have focused on in this article which are the lingual nerve, inferior alveolar nerve, the mental nerve and the infra-orbital nerve. The reason for this is the microneurosurgeons usually deal with injuries to these nerves on a daily basis, whether it is examining and diagnosing these nerve injuries or performing subsequent surgery to try to repair the nerves after they have been damaged during a dental procedure. As discussed elsewhere, these dental nerves can be damaged during routine dental procedures such as extractions (especially of mandibular molars, the placement of dental implants, and the performance of root canal therapy. Once the injury occurs, a general diagnosis such as “trigeminal neuralgia’ is not very useful, and a diagnosis of “Bells Palsey” is often harmful and wrong. This is why it is preferable that a micro-neurosurgeon be involved early and, if possible, take the lead in caring for these type of serious injuries.
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As a recent dental article notes, antibiotics are frequently used in dental practice. To be sure, this is a broad statement and, as we all know, the devil is in the details. While the standard of care in dentistry certainly does not require the administration of antibiotics before and after every dental procedure, it does require this for certain patients who suffer from serious medical and dental conditions who are undergoing certain procedures. In other words, whether it is dental malpractice to not prescribe antibiotics when a dental procedure is performed is very fact-specific and is decided on a case-by-case basis.
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