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Re: [infoguys-list] Dental case

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  • 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 1 of 6 , Aug 9, 2007
      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 2 of 6 , Aug 9, 2007
        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 3 of 6 , Aug 9, 2007
          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 4 of 6 , Aug 9, 2007
            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 5 of 6 , Aug 11, 2007
              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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