Sue asked a good question "did you actually mean tooth number #17 and 18"?????
Because if the answer is yes....tooth number #18 is a second molar and not a third molar.
I interpreted your question as saying tooth numbers # 16 and 17.
In all the care I administered to my patients as a hygienist for (seven years)
and observed as a US Army Dental clinic supervisor (15 years)it was a matter of "standard procedure" to ALWAYS administer Anti-biotic before and
after "any" medical condition that necessitated it. When the patient sits in the chair you hand them a form that
they should examine and indicate any diseases or abnormalities they have(maybe things changed??????) But my patients signed it.
It appears the defendant acted reckless and negligent in his treatment of the plaintiff.
Defendant is trying to protect the buttocks/practice/and insurance company from going defunct from
the malpractice law suit.
It may seem responsible that the plaintiffs attorney request "change of venue" to afford the plaintiff
a fair and unbiased case based upon a representation of the defendants peers.
When a dentist completes a procedure. It is their responsibility to "SIGN" his signature
on the patients record which indicate the prognosis and diagnosis. (A matter of procedure).
Periapical X-rays would have been taken of the area to show the progress of the infection(A matter of policy for impacted third molars). Toothâs number #16 is the upper rear left wisdom tooth.
Tooth number #17 is the lower left rear wisdom tooth. Sometimes pain telegraphs from one tooth to
another based on location. In laymanâs terms you feel pain in one tooth and it goes to near-
by teeth. Which brings up the issue of why (2) teeth were extracted. It seems likely that
Diseases of the gingival/bone/ (laymanâs term "gums") spread from adjacent teeth. Since you only asked for my
Unprofessional "OPINION". I will say from my knowledge of dental practice that a lot of dentist
extract wisdom teeth unnecessarily(routinely) to pad the bill. Extraction of wisdom teeth is a big myth perpetrated to
make a lot of money for unnecessary procedures. Some third molars (wisdom teeth) never impact and need no extraction.
In Reference to the dermatology aspects I think the defendant did not want to bring a
Board certified dermatologist on his defense team because he/she knew that on cross examination
the expert witness would not lie when asked crucial questions that would taint the case.
The billing code has a certain amount of days for the clinic administrator to examine the
records and statement and make corrections to errors.(In my day) Dentist routinely at the end of the day sat down and did this.
But when work backs up they sometimes forget or the record could have been "refiled"without
checked for accuracy. Which is what I do not think happened. Oral surgeons make big pay checks.
There needs to be an internal audit of the doctorâs practice to establish how many errors have been made.
Those necessitating litigation and those that went unnoticed. How many complaints that were lodged with the
ADA and local chapters of his/her profession.
wrote: Need your opinions on this case. will donate $5 per opinion to the schiff
thanks in advance for your thoughts.
An oral surgeon did not prescribe antibiotics infection prior to pulling two
of PlaintiffÃ¢â¬â¢s wisdom teeth.
(1) Did an infection spread due to not prescribing antiiotics?
(2) Whether the infection and subsequent trauma and medical treatment
was responsible for causing severe and extensive depigmentation (Vitiligo) of
PlaintiffÃ¢â¬â¢s face, neck, chest and arms.
PlaintiffÃ¢â¬â¢s Statement of the case:
Plaintiff is a 28-year-old single African American female who sought dental
care for tooth pain that had lasted three weeks. Defendant diagnosed Plaintiff
with having Ã¢â¬Åacute pericoronitisÃ¢â¬Â (an infection around her lower left wisdom
tooth) and informed her that she needed two of her wisdom teeth extracted.
Surgery was scheduled 11 days later where the defendant extracted teeth numbers
16 and 17 without administering antibiotics. Within 24 hours of the surgery,
PlaintiffÃ¢â¬â¢s head, neck and face swelled to the size of a basketball and she
was rushed to the hospital because she could not breathe. The infection and
resulting swelling in her face and neck were so severe that Plaintiff required a
tracheotomy to open her airway as well as emergency surgery to drain the
infection from her face and neck. Plaintiff remained in the hospital for 19 days
and remained in ICU for most of that time. For several days, doctors could
not predict whether she would survive and prepared the family for the
possibility of her death.
Plaintiff survived and was out of work for three months while she recovered.
Approximately 3 months after she was discharged from the hospital, plaintiff
began to experience significant depigmentation changes in her skin that have
now spread extensively from all the areas where she had surgical trauma: Over
her face, where surgical incisions were placed to drain the infection; across
her neck, where she had her tracheotomy inserted; and on both her arms, where
she had IVÃ¢â¬â¢s inserted. She is now disfigured and looks like a burn patient.
The oral surgeon admitted in his deposition that it would have been medical
error not to prescribe an antibiotic in the presence of pericoronitis, but
denies that Plaintiff had pericoronitis. This is true despite the fact that the
words Ã¢â¬Åpericoronitis Ã¢â¬â symptomatic third molarsÃ¢â¬Â were written in the doctorÃ¢â¬â¢s
own handwriting and despite the fact that his office billed the diagnosis as
one for Ã¢â¬Åacute pericoronitis.Ã¢â¬Â Defendant states he wrote the word Ã¢â¬Å
pericoronitisÃ¢â¬Â in the wrong place in the medical records and meant to imply only that
the Plaintiff had a history of pericoronitis Ã¢â¬â not that it was active when he
saw her. Defendant could not explain the Ã¢â¬Åacute pericoronitisÃ¢â¬Â billing code
because he said he did not do the billing for his practice.
PlaintiffÃ¢â¬â¢s first expert is an Oral Surgeon who teaches other oral surgery
residents at a prestigious university and teaching hospital. This expert
testified that given PlaintiffÃ¢â¬â¢s symptoms, the diagnosis of pericoronitis, the fact
that an amount of bone was removed with a dental drill during the surgery and
because the steroid given during the surgery would mask any infection,
administration of an antibiotic was absolutely required to prevent the infection from
spreading as it did after the surgery.
PlaintiffÃ¢â¬â¢s second expert is a board certified dermatologist that attributes
the Vitiligo to the infection and trauma from the hospitalization. He
testified that Vitiligo is generally understood to be a process of immune system
dysfunction where the immune system attacks the pigment producing cells in the
Although Plaintiff had vitiligo as a child, she testified that the
depigmentation was in remission and was not actively spreading. Plaintiff has casual
pictures taken during her lifetime that clearly shows the vitiligo was not
physically visible during her teens and 20Ã¢â¬â¢s. At the time of her surgery,
Plaintiff had a very small depigmented spot in the corner of her right eye, on her
lip, left hand and top of each foot that was easily covered with makeup.
PlaintiffÃ¢â¬â¢s dermatology expert testified that the flare-up of the Vitiligo after her
surgery was, within a reasonable degree of medical certainty, caused because
of the infectious process that occurred after her teeth were extracted.
DefendantÃ¢â¬â¢s Statement of the Case:
Defendant is a board certified African American oral surgeon who provided
care and treatment to Plaintiff including the surgical extraction of two of
PlaintiffÃ¢â¬â¢s left side wisdom teeth. Surgical extraction was recommended because
Plaintiff was in pain. All of the care and treatment Defendant provided to
Plaintiff was reasonable, appropriate and consistent with the established standard
of care. Following the surgical extractions, Plaintiff developed an
infection that necessitated medical treatment and hospitalization. The infection was
not the result of any improper action on the part of Defendant and could not
have been foreseen.
In his deposition, the defendant doctor was nervous and intimidated, and,
therefore, wrongly admitted it was a deviation from required standard of care not
to prescribe an antibiotic. Defendant denies he made a diagnosis of active
pericoronitis and instead mistakenly wrote her history of having pericoronitis
in the wrong area of the medical chart. Because defendant does not do the
billing for his practice, he cannot explain why Plaintiff was billed for
treatment of Ã¢â¬Åacute pericoronitis.Ã¢â¬Â
DefendantÃ¢â¬â¢s expert is a local board certified oral surgeon who testified that
it is never a deviation from the standard of care not to prescribe an
antibiotic before, during or after an extraction where a patient has been actively
diagnosed with pericoronitis. This expert testified he determined the standard
of care by talking to nine other local oral surgeons. This expert also
testified that the tracheotomy performed on Plaintiff while she was in the hospital
was not necessary and probably caused unnecessary trauma in the neck region.
Defendant has not retained an expert to dispute the opinions of PlaintiffÃ¢â¬â¢s
dermatology expert that the trauma resulting from the infection and subsequent
treatment brought about the reoccurrence of PlaintiffÃ¢â¬â¢s vitiligo because he
contends that the vitiligo was a documented, pre-existing disease that Plaintiff
had before she came in for oral surgery. Defendant argues that the small
depigmented spots on the corner of her right eye, on her lip, on her wrist and on
her feet is evidence that the disease was spreading.
PlaintiffÃ¢â¬â¢s Pros and Cons
Plaintiff is an articulate, educated and credible witness
Plaintiff had a child-hood history of vitiligo and had some depigmentation
(though minor) present at the time of surgery
PlaintiffÃ¢â¬â¢s childhood history of Vitiligo was not severe until after the
surgery and hospitalization
The case is pending in a conservative jurisdiction where juries tend to give
the benefit of doubt to medical providers
PlaintiffÃ¢â¬â¢s dermatology expert is a local doctor
PlaintiffÃ¢â¬â¢s oral surgeon expert is not a local doctor
Defense Pros and Cons
Case is pending in a predominantly white jurisdiction that is conservative
with damage awards
Defendant admitted it would be a deviation from the standard of care not to
prescribe an antibiotic if pericoronitis was diagnosed
DefendantÃ¢â¬â¢s expert is an accomplished local doctor, familiar with how other
oral surgeons practice medicine in the Atlanta Area.
The Standard of Care is NOT what a (city) Oral Surgeon would do and Defendant
risks having his expertÃ¢â¬â¢s testimony stricken.
Plaintiff had been diagnosed with vitiligo before her oral surgery
Defendant has not retained a dermatology expert to rebut causation of the
Vitiligo is an autoimmune condition and is therefore difficult to identify a
single trigger for its the recurrence.
Jury may conclude that Defendant lied in his deposition to cover his mistake
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