Atlanta Injury Lawyers Blog

A large part of my Atlanta personal injury law practice is devoted to dental nerve injuries. Unfortunately, many clients who have been injured after going to the dentist find themselves with little hope of recovery. As indicated by this article by well-regarded micro-neurosurgeon, Shahrokh Bagheri, whether surgery can provide relief depends largely upon the age of the patient and the length of time between the injury and the attempted corrective surgery. In other words, if you are young, and your lingual nerve was injured less than 9 months ago, you are a good candidate for microsurgical repair.

Lingual nerve injury is a complication most often associated with wisdom teeth extraction or other dental procedures that require administration of local anesthetics. In the case of lingual nerve damage secondary to tooth extractions, it occurs because, in the region of the wisdom tooth, the lingual nerve often lies very close to the gum and thin bone known as the lingual plate that lies just on the inside of the crown and root of the wisdom tooth. If the extraction is done below the standard of care and the lingual plate is fractured, the lingual nerve is exposed to trauma from the extraction.

The lingual nerve itself supplies taste and sensation to the front two-thirds of the tongue. So if you have a lingual nerve injury, half of your tongue, could be both profoundly numb, and devoid of the sense of taste. In addition, you could suffer from pain caused by the nerve injury. It can be a devastating injury which can negatively impact ones life and is sometimes permanent.

Repair of dental nerves in the facial region can be done if the diagnosis is made in a timely fashion. These repairs are usually performed by a maxillofacial reconstruction expert of a microneurosurgeon. The sooner the repair is attempted, the more likely the repair will be successful. However, the microneurosurgeon does not want to operate too soon, as intervention is to be avoided if the nerve will regenerate on its own without surgical intervention. Obviously, this is the best scenario, but not always possible.

Robert J. Fleming has been handling dental malpractice, medical malpractice, car accident cases and premises injury cases for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years. He practices in and around the Atlanta, Georgia area including handling lawsuits in Fulton, DeKalb, Clayton, Gwinnett, Cobb and other counties and nearby cities including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like discuss your case in complete confidence, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.
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As the year progresses, I am seeing a marked increase in the number of calls from injured dental patients. The vast majority of these injuries seems to be dental nerve injuries following dental procedures such as tooth extractions, root canal therapy and dental implants.

Not every dental nerve injury is due to malpractice. However, if you have suffered a permanent dental nerve injury and you suspect it may be the result of dental malpractice, please contact us for a case evaluation.
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Endodontic Treatment (“root canal therapy” or “RCT”) of mandibular molar teeth has the potential to result in damage to the inferior alveolar nerve due to direct trauma, pressure or neurotoxicity. As an Atlanta dental malpractice attorney, I find that many of these dental nerve injuries are caused by dental malpractice, with the biggest number of dental nerve injuries being caused by root canal overfills or over-instrumentation. Extending the root canal files past the root tip apex and into the lower jaw (mandible) causes damage to the inferior alveolar nerve and extending the root canal files past the root tip apex in the upper jaw (maxillary) can cause nerve damage in the upper face to nerves such as the infra-orbital nerve. Many times, patients who have suffered injuries due to this deviation from the dental standard of care are diagnosed with trigeminal neuralgia. However, this is not a precise diagnosis and a second opinion with a micro-neurosurgeon who specializes in oral surgical procedures may prove helpful.
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As a 2007 study indicates, overfilling the roots with sealant during a root canal procedure can cause permanent nerve damage if not treated promptly. As the article concludes, “early surgical exploration and debridement may reverse the effects of endodontic treatment that is below the standard of care and results in gutta-percha being deposited into the inferior alveolar nerve canal.

In the study, 61 patients who sustained root canal overflow injuries were tracked over an eight-year period. Eight patients were asymptomatic (i.e., they did not report any signs or symptom of an injury even though they sustained the overfill) and received no treatment. Forty-two patients exhibited only mild symptoms or were seen more than three months after undergoing root canal therapy, and they received no surgical treatment. Only 10 percent of these patients experienced any resolution of symptoms. Eleven patients underwent surgical exploration. Five of these patients underwent exploration and received treatment within 48 hours, and all recovered completely. The remaining six patients underwent surgical exploration and received treatment between 10 days and three months after receiving endodontic therapy. Of these patients, four experienced partial recovery and two experienced no recovery at all.

According to WebMD, a root canal procedure is performed as follows:

• First, the dentist will numb your gums with a substance that feels like jelly. After your gums are numb, the dentist will inject a local anesthetic that will completely numb the teeth, gums, tongue, and skin in that area. Sometimes nitrous oxide gas will be used to reduce pain and help you relax.
• The dentist may separate the decayed tooth from the other teeth with a small sheet of rubber on a metal frame. This protective rubber sheet also helps stop liquid and tooth chips from entering your mouth and throat.
• The dentist will use a drill and other tools to remove the pulp from the tooth and will fill the inside part of the tooth below the gum line with medicines, temporary filling materials, and a final root canal filling.
• After the root canal, a permanent filling or crown (cap) is often needed. If a crown is needed, the dentist removes the decay and then makes an impression of the tooth. A technician uses the impression to make a crown that perfectly matches the drilled tooth.
• The tooth may be fitted with a temporary crown until the permanent crown is made and cemented into place.

There are many reasons why a root canal overfill occurs, but since this is a complication that should not happen absent malpractice, there usually exists a dental malpractice case if you suffer from an overfill. If you are suffering from this nerve injury after Root Canal Therapy (“RCT” or a root canal), you should consult with an experienced dental malpractice attorney.
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According to some sources, between 3 and 5 million dental implants are installed each year in the United States. As an Atlanta Dental Malpractice Attorney, I have noticed that the number of injuries to the facial nerves has increased due to the increase in the number of implants being installed.

In layman’s terms, implants are installed by extracting the bad tooth, drilling a pilot hole, installing a post in the pilot hole, allowing the tissue and bone of the jaw to grow around and solidify onto the post (this is known as osseointegration), placing an abutment over the top of the post, and then placing a crown over the abutment.

In many cases, dental malpractice causes injury to the nerves that run along the alveolar ridge (the most common being the inferior alveolar nerve and the lingual nerve). Most of these injuries are caused by the dentist not properly calculating the distance to the nerve from the post. In other words, many of these injures occur because the pilot hole for the post is drilled too deep and into the nerve or the implant is screwed too deeply into the jaw which results in the nerve being crushed.

The are a number of procedures that the dentist should employ if the risk of injury is known. If, during surgery, known or observed trauma (including traction or compression of the nerve trunk) has occurred, the topical application of Dexamethasone is suggested. One to two ml of the intravenous form of Dexamethasone (4mg/ml) may be topically applied. The direct application of steroids will reduce neural inflammation and reduce compression from swelling, which may enhance recovery from neurosensory deficits. No morbidity has been associated with topical steroid application at the nerve injury site, yet significant improvement in post surgery recovery has been observed. This should be followed by a six-day regimen of oral steroids (which many patients know as a steroid pack). If known nerve trunk transection is clinically observed during the surgery, immediate referral to a nerve repair specialist is highly recommended.

The most important physiologic therapy at the time of surgery includes removal or repositioning of any irritant (implant, bone screw) in close approximation to the neurovascular bundle. In other words, if the implant was not planned properly and it is invading a nerve canal, it should be removed immediately and re-position so that it does not interfere with the nerve. A radiograph or CT scan immediately after implant placement is warranted to insure the nerve is not violated. If a post operative radiograph indicates the implant may encroach upon the IAN, it may be removed, a steroid introduced into the osteotomy site and then a shorter length implant replaced in the same site in a more ideal location.32 No bone grafting materials should be placed in the osteotomy site, since it may invade the mandibular canal and interfere with nerve repair.

Extreme care should be used by anyone contemplating a dental implant procedure. One should make sure the dentist performing the implant is experienced and skilled — and that the equipment that the dentist is relying on to properly evaluate the distance to the nerve is state-of-the-art, properly calibrated and accurate.
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According to a recent article, dental implants are riskier than many are lead to believe. As an Atlanta lawyer who specializes in dental malpractice, I have seen a wave of dental malpractice claims related to the improper placement of dental implants. To be sure, the technological advancements regarding dental implants are stunning, but the implant is only as good as the dentist who installs it.
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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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