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Dental case

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  • Jurydoctor@aol.com
    Need your opinions on this case. will donate $5 per opinion to the schiff Liver center. thanks in advance for your thoughts. amy An oral surgeon did not
    Message 1 of 6 , Aug 9, 2007
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      Need your opinions on this case. will donate $5 per opinion to the schiff
      Liver center.
      thanks in advance for your thoughts.
      amy
      An oral surgeon did not prescribe antibiotics infection prior to pulling two
      of Plaintiff’s wisdom teeth.
      Questions Presented:
      (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
      Plaintiff’s face, neck, chest and arms.
      Plaintiff’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 “acute pericoronitis” (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,
      Plaintiff’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 IV’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 “pericoronitis – symptomatic third molars” were written in the doctor’s
      own handwriting and despite the fact that his office billed the diagnosis as
      one for “acute pericoronitis.” Defendant states he wrote the word “
      pericoronitis” in the wrong place in the medical records and meant to imply only that
      the Plaintiff had a history of pericoronitis – not that it was active when he
      saw her. Defendant could not explain the “acute pericoronitis” billing code
      because he said he did not do the billing for his practice.
      Plaintiff’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 Plaintiff’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.
      Plaintiff’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
      skin.
      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 20’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.
      Plaintiff’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.
      Defendant’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
      Plaintiff’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 “acute pericoronitis.”
      Defendant’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 Plaintiff’s
      dermatology expert that the trauma resulting from the infection and subsequent
      treatment brought about the reoccurrence of Plaintiff’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.

      Plaintiff’s Pros and Cons

      Pros
      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
      Plaintiff’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
      Plaintiff’s dermatology expert is a local doctor
      Plaintiff’s oral surgeon expert is not a local doctor

      Defense Pros and Cons

      Pros
      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
      Defendant’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 expert’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 recurrence
      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



      ************************************** Get a sneak peek of the all-new AOL at
      http://discover.aol.com/memed/aolcom30tour


      [Non-text portions of this message have been removed]
    • suesarkis@aol.com
      Amy - 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,
      Message 2 of 6 , Aug 9, 2007
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        Amy -

        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 post op
        trauma, especially the tracheotomy, she will have no difficulty proving
        emotional distress. Also, Vitiligo is a known autoimmune deficiency condition.
        The infection attacked her autoimmune system. Her attorney will have no
        difficulty proving that "emotional distress" is number one on the list coupled
        with physical trauma to the areas and the infection itself, two other known and
        accepted theories.

        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 quite
        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 teeth
        if the infection hadn't spread from the operculum to two of her teeth? Did
        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 toxins
        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
        shared.

        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 teeth
        (presumably 17 and 18) if the pain and other issues weren't caused by the
        infection?

        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. The
        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 rebuttal, not
        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.


        Sincerely yours,
        Sue
        ________________________
        Sue Sarkis
        Sarkis Detective Agency


        (est. 1976)
        PI 6564
        _www.sarkispi.com_ (http://www.sarkispi.com/)

        1346 Ethel Street
        Glendale, CA 91207-1826
        818-242-2505
        818-242-9824 FAX

        "one Nation under God"

        If you can read this, thank a teacher. If you can read it in English, thank
        a military veteran !



        ************************************** Get a sneak peek of the all-new AOL at
        http://discover.aol.com/memed/aolcom30tour


        [Non-text portions of this message have been removed]
      • Dennis Forrester
        Amy, 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
        Message 3 of 6 , Aug 9, 2007
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          Amy,

          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 "nasty" germs.

          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 damage.

          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 Roulette!!!!

          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 reason:

          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 necessary.

          If I was the Oral Surgeon, I think I'd settle this one out of court!!!!!!!

          Just a thought!

          Dennis Forrester
          GA Lic. PI #PDE046467
          forrester@...





          ----- Original Message -----
          From: Jurydoctor@...
          To: forensic-debate@yahoogroups.com ; infoguys-list@yahoogroups.com
          Cc: legalinvestigation@yahoogroups.com
          Sent: Thursday, August 09, 2007 12:51 PM
          Subject: [infoguys-list] Dental case


          Need your opinions on this case. will donate $5 per opinion to the schiff
          Liver center.
          thanks in advance for your thoughts.
          amy
          An oral surgeon did not prescribe antibiotics infection prior to pulling two
          of Plaintiff’s wisdom teeth.
          Questions Presented:
          (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
          Plaintiff’s face, neck, chest and arms.
          Plaintiff’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 “acute pericoronitis” (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,
          Plaintiff’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 IV’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 “pericoronitis – symptomatic third molars” were written in the doctor’s
          own handwriting and despite the fact that his office billed the diagnosis as
          one for “acute pericoronitis.” Defendant states he wrote the word “
          pericoronitis” in the wrong place in the medical records and meant to imply only that
          the Plaintiff had a history of pericoronitis – not that it was active when he
          saw her. Defendant could not explain the “acute pericoronitis” billing code
          because he said he did not do the billing for his practice.
          Plaintiff’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 Plaintiff’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.
          Plaintiff’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
          skin.
          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 20’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.
          Plaintiff’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.
          Defendant’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
          Plaintiff’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 “acute pericoronitis.”
          Defendant’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 Plaintiff’s
          dermatology expert that the trauma resulting from the infection and subsequent
          treatment brought about the reoccurrence of Plaintiff’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.

          Plaintiff’s Pros and Cons

          Pros
          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
          Plaintiff’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
          Plaintiff’s dermatology expert is a local doctor
          Plaintiff’s oral surgeon expert is not a local doctor

          Defense Pros and Cons

          Pros
          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
          Defendant’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 expert’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 recurrence
          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

          ************************************** Get a sneak peek of the all-new AOL at
          http://discover.aol.com/memed/aolcom30tour

          [Non-text portions of this message have been removed]





          [Non-text portions of this message have been removed]
        • Dennis Forrester
          Sue, You Rock on this one!!!!!! All I can say is AMEN!!!!!! Dennis Forrester GA PI Lic #PDE046467 forrester@bellsouth.net ... From: suesarkis@aol.com To:
          Message 4 of 6 , Aug 9, 2007
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            Sue,

            You Rock on this one!!!!!!

            All I can say is AMEN!!!!!!

            Dennis Forrester
            GA PI Lic #PDE046467
            forrester@...


            ----- Original Message -----
            From: suesarkis@...
            To: infoguys-list@yahoogroups.com
            Sent: Thursday, August 09, 2007 3:43 PM
            Subject: Re: [infoguys-list] Dental case


            Amy -

            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 post op
            trauma, especially the tracheotomy, she will have no difficulty proving
            emotional distress. Also, Vitiligo is a known autoimmune deficiency condition.
            The infection attacked her autoimmune system. Her attorney will have no
            difficulty proving that "emotional distress" is number one on the list coupled
            with physical trauma to the areas and the infection itself, two other known and
            accepted theories.

            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 quite
            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 teeth
            if the infection hadn't spread from the operculum to two of her teeth? Did
            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 toxins
            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
            shared.

            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 teeth
            (presumably 17 and 18) if the pain and other issues weren't caused by the
            infection?

            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. The
            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 rebuttal, not
            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.


            Sincerely yours,
            Sue
            ________________________
            Sue Sarkis
            Sarkis Detective Agency

            (est. 1976)
            PI 6564
            _www.sarkispi.com_ (http://www.sarkispi.com/)

            1346 Ethel Street
            Glendale, CA 91207-1826
            818-242-2505
            818-242-9824 FAX

            "one Nation under God"

            If you can read this, thank a teacher. If you can read it in English, thank
            a military veteran !

            ************************************** Get a sneak peek of the all-new AOL at
            http://discover.aol.com/memed/aolcom30tour

            [Non-text portions of this message have been removed]





            [Non-text portions of this message have been removed]
          • Charles Williams
            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
            Message 5 of 6 , Aug 9, 2007
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              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). Tooth’s 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 layman’s 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/ (layman’s 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 doctor’s 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.


              Jurydoctor@... wrote: Need your opinions on this case. will donate $5 per opinion to the schiff
              Liver center.
              thanks in advance for your thoughts.
              amy
              An oral surgeon did not prescribe antibiotics infection prior to pulling two
              of Plaintiff’s wisdom teeth.
              Questions Presented:
              (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
              Plaintiff’s face, neck, chest and arms.
              Plaintiff’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 “acute pericoronitis” (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,
              Plaintiff’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 IV’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 “pericoronitis – symptomatic third molars” were written in the doctor’s
              own handwriting and despite the fact that his office billed the diagnosis as
              one for “acute pericoronitis.” Defendant states he wrote the word “
              pericoronitis” in the wrong place in the medical records and meant to imply only that
              the Plaintiff had a history of pericoronitis – not that it was active when he
              saw her. Defendant could not explain the “acute pericoronitis” billing code
              because he said he did not do the billing for his practice.
              Plaintiff’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 Plaintiff’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.
              Plaintiff’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
              skin.
              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 20’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.
              Plaintiff’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.
              Defendant’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
              Plaintiff’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 “acute pericoronitis.”
              Defendant’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 Plaintiff’s
              dermatology expert that the trauma resulting from the infection and subsequent
              treatment brought about the reoccurrence of Plaintiff’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.

              Plaintiff’s Pros and Cons

              Pros
              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
              Plaintiff’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
              Plaintiff’s dermatology expert is a local doctor
              Plaintiff’s oral surgeon expert is not a local doctor

              Defense Pros and Cons

              Pros
              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
              Defendant’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 expert’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 recurrence
              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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            • Jurydoctor@aol.com
              thanks for your comments. Do the following independent expert opinions change your mind? Thanks, amy Dr. A, anesthesiologist and dentist ,states that it is
              Message 6 of 6 , Aug 11, 2007
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                thanks for your comments.
                Do the following independent expert opinions change your mind?
                Thanks,
                amy



                Dr. A, anesthesiologist and dentist ,states that it is not as necessary as
                they once thought to pre-medicate (antibiotics) as was originally thought, and
                Dr B, Plastics and Dermatology, said you cannot be sure the swelling is due to
                infection unless cultures were taken and to decide which antibiotics would be
                effective in light of the fact she had an autoimmune disease. It could be
                argued that she had the autoimmune disease from childhood cased the teeth
                problems causing tooth buds to not erupt properly. Where they erupted or not prior
                to surgery? It's always a risk to do wisdom teeth at age 28. The jaw bone is
                no longer soft. Certain antibiotics (sulfur) could have made her worse
                (autoimmune reaction.)

                The answer to this - and you can ask Dr.C , DDS that if someone eats
                bananas for a week before an extraction the potassium leaches into the gums,
                leaving very little swelling or bleeding if any. He is an awesome surgeon, does
                mainly wisdom teeth but also facial reconstruction.

                She could have had an autoimmune reaction in her airway to an inflammatory
                responds to *which beta 1-2-3 blocking - and cleansing and lots of IV solutions
                and low residue diet and prednisone could have cured. So if you go with
                Medical Standards of Practice it is a case of merit. Should have had antibiotics
                postoperatively, She already had an IV. No big deal giving them.

                She should win but probably will not in light of no research on Vit what ever
                it is see: Michael Jackson's skin care problem!
                ______________________________________________________________________________
                ________________________

                From Ohio:
                Defendant'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.

                Do the docs get more money if extracting infected teeth? Or with a diagnosis
                of pericoronitis? It would be interesting to see his overall billing records.

                Did a dentist make the referral and what were his/her notes on pericoronitis
                or infection?


                Q. #1. Who knows, the amount of antibiotics prescribed prior to dental care
                may have not fought off the extent of the infection and/or have even been
                suseptable to the bug, but I bet if he had prescribed the antibiotics he would
                not be in this situation.

                Q. #2. Why the immune cells attack the melanocytes and kill them is
                unknown. Did this infection of the mouth lower her resistance and give the Vitiligo
                more strength?







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