Any dental procedure performed while there is an
infectious process going on is a "real bad". Your
mouth has the most germs in it in your whole body and
she is quite lucky she didn't wind up with
endocarditis as well. The dentist is a liar. As far
as the vitiligo goes, I am unfamiliar with the process
of how this is spread but if the plaintiff's expert
witnesses are good enough to convince the jury that
this is a legitimate occurrence within the scope of
what she was dealing with, she is the winner. This
may have started to spread on her face prior to the
surgery, but his inactions just might be enough to
have aggrravated and sped up the process of making it
happen long before it was due to happen (if at all) to
the extent that it did - imagine going to the dentist
for help with pain and ending up looking like a freak.
What a nightmare this must be!
People care a lot about appearances, especially women. He's got to hire and
expert to rebut the plaintiff's regarding the Vitiligo exacerbation,
otherwise, they will presume he has no argument. I'm not familiar with this
disease, but any autoimmune disease is at risk of exacerbation with severe
Was the infection well documented with positive cultures? Most autoimmune
disease exacerbations would put her at risk for increased inflammation with
associated swelling, but I don't know if that is true about this disease. I
read that having it increases the risk for some other diseases--another
reason that an expert on that disease is important--and to counter some of
damage done regarding SOC for antibiotics. However, that said, the issue of
whether acute pericoronitis was actually present at the time of surgery
to be resolved somehow--possibly by getting records from her PCP and
records for previous antibiotics, steroids, etc [review at least the
3-5 years, or more]. She could have been on chronic steroid use at some
point, past or present. That would increase the risk for infection and
imply the Vitiligo was active. Since the defendant operated on her, it
seem unlikely that she had an active infection with no antibiotics because
that would have been a pretty bonehead mistake, but may be what happened,
except for the presence of the autoimmune disease, which complicates the
Pre op prophylactic antibiotics in the absence of infection are common in
surgeries, but I don't know how standard it is with wisdom teeth.
This is an unusual case, for certain. Did you actually mean extraction of
17 and 18?
For starters, although there is no known cause for Vitiligo, emotional
distress is top on everyone's list along with hereditary. Considering the
trauma, especially the tracheotomy, she will have no difficulty proving
emotional distress. Also, Vitiligo is a known autoimmune deficiency
The infection attacked her autoimmune system. Her attorney will have no
difficulty proving that "emotional distress" is number one on the list
with physical trauma to the areas and the infection itself, two other known
Defense will be able to show that pericoronitis was probably caused by
plaintiff's poor oral cleanliness as the bacteria had to be breeding for
sometime for the operculum to have been that inflamed and painful which
apparently then spread to the pulp and roots of #'s 17 and 18. It appears
to me that
that is the ONLY thing he has going for himself. What Adam Henry would Dx
same and not Rx for infection if the condition had turned chronic, no longer
acute at 3 weeks, and surgical interception yet another 11 days away? The
doctor will have to live with his written Dx and that's all there is to it.
Extraction is not used to treat pain. Why else would he have extracted 2
if the infection hadn't spread from the operculum to two of her teeth?
anyone EVER mention anything about septicemia? Sepsis? Anything similar?
Pericoronitis equals bacterial infection. Bacterial infection without
antibiotics with surgery in the general vicinity equals serious exposure to
getting into the bloodstream which equals bacterial sepsis aka septicemia.
I see too many holes in the Dr's. testimony, at least from what has been
How would he know she has a Hx of pericoronitis? How long had he cared for
her? Does her chart reflect same?
The fact that he included "symptomatic
third molars" is going to be his downfall. Again, why did he extract TWO
(presumably 17 and 18) if the pain and other issues weren't caused by the
As far as the Plaintiff's Vitiligo is concerned it is my understanding that
it has been known to come and go but once there's been a serious trauma,
whether physical or emotional, it is not likely to go into remission again.
plaintiff will definitely need a Vitiligo expert.
Have you visited the ADA website to see what they list as the "standard of
care" for pericoronitis?
Last, but definitely not least, what kind of a QUACK oral surgeon would
testify to the medical necessity of a tracheotomy provided by a medical
physician? How dare he? I hope the plaintiff has the MD on call for
for the case in chief.
I hope you represent the Plaintiff. I personally think it is obvious that
the defendant is a lying sack of dung.
Do you think that due to the failure to prescribbe antibiotics, the infection
caused her severe Vitiligo?
. Re: Dental case
Date: Thu Aug 9, 2007 3:04 pm ((PDT))
As a former paramedic, with over 20 years experience, I would like to weigh
in on this one. Here's my thoughts.....
First and foremost, we must consider the anatomy and physiology of the teeth
and gums, as it relates to the rest of the body. The mouth (as a whole) is
considered one of the most contaminated areas of the body. ANY lacerations,
polyps, wounds, or breaks in the skin within the mouth are inheriantly dangerous
due to the general "nastiness" of the mouth. For example, if two humans are
fighting and one bites the other, breaking the skin of the opponant, that person
(the one who was bitten) is generally ADMITTED to the Hospital for IV
antibiotics, because the "biter's" mouth is considered so contaminated with generally
Your teeth and gums are very venous (lots of veins) which route directly into
either (1) your Internal and External Jugular Veins or (2) your Carotid
Arteries. Both your Jugulars and Carotids route directly to the "great vessels" of
your heart. Any infection in your teeth, is easily transferred through this
system to the heart muscle and commonly leads to "pericarditis" an infection of
the sac which lubricates the heart, which can cause permanant heart muscle
This patient presents with a 3 week history of toothache, obviously being
caused by some reason. Most frequently tihs pain is found to be caused by either
pressure from a phyiscal ailment (misalignment or shifting of the teeth) OR
more commonly INFECTION. Given that any infection in an area that is inheriantly
known to be "nasty" (such as the mouth), the Oral Surgeon certainly should
have placed the patient on (at minimum) "prohylactic" antibiotics just in case
there was an infection.
The Oral Surgeon then decides to wait 11 days before operating on a patient
with a 3 week history of toothache. WHY would the Surgeon allow his patient to
suffer 11 more days (on top of the 3 weeks) before he operates??? Either (1)
He has too much work to do and should have deferred her elsewhere or (2) HE WAS
WAITING FOR THE INFECTION TO CLEAR UP before he operated!!! Yes, this is the
same infection that he claims didn't exist, although he obviously had it on
his mind when he wrote it on her chart, even if he did write it in the wrong
place. Also, being that she has a prior history of infection (in the past) is all
the more reason to place her on an antibiotic as a precaution!!!
Additionally, since she has a history of Vitilgo (autoimmune disease) That in itself
should have "red flagged" the Surgeon that the patient has an AUTO-IMMUNE DISEASE
(in other words, she is much more likely to develop an infection than your
"typical" patient!!!! If there was ever a reason to err on the side of caution,
this patient was a walking billboard advertising it!!!! Then, to further bury
himself, the Surgeon didn't even prescribve antibiotics AFTER the surgery!!!!
Perhaps the only other palce which contains more "Nasty" germs than the mouth
is the intestines (feces). Why would you operate on the 2nd most nastiest
place in your body (for germs) on an already immune depressed patient and NOT
PRESCRIBE ANTIBIOTICS after the surgery???? This is like playing Russian
The patient then develops a systemic (bloodborne) infection which travels
throughout the vessels in her gums, to her neck (jugulars and carotids) to her
upper chest (great vessels of the heart) and causes gross swelling and overall
deterioration of the patient.
The Oral Suregeon then wants to argue that the Tracheotomy wasn't
necessary??? After all the errors he made, I'd refrain from beliveing anything else he
had to say!
The tracheotomy is MANDATORY in this type of situation for the following
The airway can generally be maintained (short-term) with an endotracheal tube
inserted orally (through the mouth) or nasally (trough the nose) and into the
trachea. This is the preferred airway management technique to maintain a
"ventilated" (breathing machine) patient. However, in this case, you have a
patient who has a gross amount of swelling to the neck and related structures
(within the neck) and trachea. If you put a hard plastic endotracheal tube into this
trachea, and the swelling continues, the swelling presses against the tube,
and the resultant pressure causes necrosis (tissue death) of the trachea
because it can't get adequate blood supply. How do you prevent this??? You perform a
tracheotomy (as was done in this case) so that the hard plastic tube isn't
If I was the Oral Surgeon, I think I'd settle this one out of court!!!!!!!
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
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
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"
on the patients record which indicate the prognosis and diagnosis. (A matter
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
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
Board certified dermatologist on his defense team because he/she knew that on
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
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
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.
((((((((((((((((((((( "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
I interpreted your question as saying tooth numbers # 16 and 17.--
Will need to find out)))))))))))))))))))))))))))))))))))
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