A 56-year old lady was told that she had ‘gum disease’ and “could have a dental implant placed when the tooth was eventually lost, although that might be years from now”. Many years later it was lost, but following her dentist’s retirement, her new dentist said that she couldn’t have an implant as there wasn’t enough bone left now. Does she have a case to be answered?
History of the claim of dental negligence
Upon reviewing the case, Mrs. J stated that she had a long history of ‘gum disease’ but she went to her dentist’s office as directed, every 3-4 months for cleanings assuming it was keeping things stable. Her dentist never indicated a deterioration but did say that she might lose some or all of her teeth due to this ‘vulnerability to gum disease’ b
ut that she should keep coming for the cleanings. She agreed, as it made sense; and continued. One tooth at the back bothered her from time to time but although she mentioned it, nothing was specifically said or done.
Sometime later after her dentist retired, her new dentist indicated that she should have the tooth out immediately as it was affecting the adjacent tooth.
She agreed but asked if it could be replaced with an implant, as she didn’t want a denture. She was told that due to the action of her long-term gum disease there was no longer enough bone to support an implant and that several of her other teeth may be lost.
He recommended a partial denture. She asked why she hadn’t been told before, but sadly lost several teeth.
An independent examination, appraisal, interpretation and expert witness report highlighted the fact that had earlier intervention been made, ‘timely treatment’ would most likely have seen enough bone to place an implant, possibly without the bone augmentation (grafting) that was now required.
As it was now, her only options were severely limited.
The situation unfortunately worsened following the removal of the back teeth she started to experience some jaw joint problems – probably related to the loss of support to the jaw joint from the loss of the back teeth.
This is not an unusual scenario as joint, ear and tension type headaches are among the not-uncommon consequences of joint problems (TMD) following back tooth removal (and removal of “tooth support” to the joint.
Which dentist should legal action be taken against?
Going to the dentist regularly can be extremely beneficial but can also simply become a ‘routine’.
There should not only be a clear and practical justification for dental treatment, but also it should be performed to the standard of care expected, and if possible, its progress tracked. In this case it was not tracked, and the results were significant and distressing.
Sometimes it is difficult in a busy practice to stop and reassess the patient’s needs routinely, as if they were new to the practice, however this level of insight is necessary for best care.
If legal counsel is taken, an impartial report from an expert witness can assist with this information.
Unfortunately, occurrences such as this are not uncommon, and it becomes a question of the standard of care which in this case was assessed to be below that expected.
The dentist had in effect s simply allowed his patient to remain a fee-paying member of his practice without review and was simply “going through the motions”, yet with the eventual placement of an implant the only option given.
The new dentist may choose to offer to correct this without cost as part of his transition good will, but he or she may not be legally responsible for the first dentist’s failures.
Potentially the patient could be out of pocket, or ‘out of luck’ regarding the dental care they now need.
The new dentist should not be critical as he or she may not know all the facts – they must however be honest, that is their duty to the patient. For causation they may need to get a second opinion.
Legal Action taken against the dentist
Legal action was commenced against the retired dentist, his insurance company recognized the failure of care and eventually made on offer of settlement.
The lawyer requested further information regarding costs which after some investigation I was able to provide regarding who could perform the procedure required. (The x-ray shown reflects the level of bone loss experienced and a grafting procedure was required).
The lawyer made a counter-offer based on the inadequacy of the initial offer, to cover all of the patients costs including travel to have the work performed, the case was settled out of court, the patient and lawyer were satisfied.
Incidentally at the advice and with the assistance of the lawyer, following my findings, the second dentist chose to provide care for the jaw joint problems that he had unknowingly caused as he had made no explanation of possible consequences prior to tooth removal.
Gum disease is an insidious chronic and often painless destructive process which must be screened for regularly and then adequately managed (with careful tracking).
Adequate clinical skill, good communication and appropriate referral may have avoided this scenario. Regardless, the patient MUST be kept informed of their disease, its progress and consequences to treatments.
If you have concerns of questions please feel free to drop me a line – I’m always happy to help where I can.
Dr. Stephen Bray DDS