Articles Posted in Dental Nerve Injuries

A female patient was injured during the installation of a dental implant procedure due to the alleged negligence of the general dentist, who failed to adequately measure the distance of the tooth to the underlying dental nerve. The plaintiff claimed that the failure to properly measure the distance to the nerve caused the inferior alveolar nerve injury and related damages.

A lot has been written about whether the course of the inferior alveolar nerve can been seen radiographically. The course of the lingual nerve and the inferior alveolar nerve and seen with high resolution Magnetic Resonance Imaging (HR-MRI). This procedure will result in a 3-D image of the course of the nerve and can be used to plot many dental procedures such as root canals, extractions and dental implant procedures. Importantly, the lingual nerve is in the jaw on the other side of the lingual plate from the teeth, while the inferior alveolar nerve runs lengthwise in the jaw under the mandibular teeth. Inside the inferior alveolar nerve is the inferior alveolar neurovascular bundle, which, once again, can be seen on HR-MRI films.

Almost all operative dental procedures in the mandible require Pre-operative assessment of the position and course of the trigeminal nerves in the mandible. While some general dentists rely on x-rays to map these nerves, a cone beam CT Scan, at a minimum, is required because x-rays are not 3 dimensional and do not have the accuracy of a cone beam CT scan. For this reason, a cone beam CT scan is the standard of care during pre-operative planning for many dental procedures and failure to utilize this results in dental malpractice. The use of plain radiographs (x-rays) such as periapical films is not routinely used in Georgia and is not within the standard of care to assess risk of a dental nerve injury prior to one of the dental procedures listed above. CBCT provides a 3 dimensional look of the anatomy including the nerves with much less radiation exposure to the patient and is far superior to x-rays due to the minimal distortion compared to traditional x-rays. CBCT can be used for pre-operative dental procedure risk assessment.

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.

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.

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.

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.

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.

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;

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.