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Dental case-comments

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  • Jurydoctor@aol.com
    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
    Message 1 of 2 , Aug 10, 2007
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      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
      stress.
      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
      did
      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
      the
      damage done regarding SOC for antibiotics. However, that said, the issue of
      whether acute pericoronitis was actually present at the time of surgery
      needs
      to be resolved somehow--possibly by getting records from her PCP and
      pharmacy
      records for previous antibiotics, steroids, etc [review at least the
      previous
      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
      would
      imply the Vitiligo was active. Since the defendant operated on her, it
      would
      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
      issue.
      Pre op prophylactic antibiotics in the absence of infection are common in
      most
      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?

      YES

      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?

      NOPE

      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?

      qood questions


      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.

      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
      "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!!!!!!!

      _____________________
      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.


      ((((((((((((((((((((( "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.--
      Will need to find out)))))))))))))))))))))))))))))))))))
      _______________________











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    • suesarkis@aol.com
      In a message dated 8/10/2007 7:34:43 A.M. Pacific Daylight Time, Jurydoctor@aol.com writes: Do you think that due to the failure to prescribbe antibiotics,
      Message 2 of 2 , Aug 10, 2007
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        In a message dated 8/10/2007 7:34:43 A.M. Pacific Daylight Time,
        Jurydoctor@... writes:

        Do you think that due to the failure to prescribbe antibiotics, the
        infection
        caused her severe Vitiligo?



        Amy -

        I will answer with a resounding YES. However, the subsequent series of
        events were, as reported, the most likely cause of the advanced development in
        that she suffered extreme trauma to the localized areas coupled with the
        understandable emotional distress.

        What did the doctors attribute the swelling to? Based on the little bit of
        information you have provided, I'm assuming it was septic shock considering
        her length of stay and the need for ICU. If it was, she's lucky to be alive
        since only 75% of patients survive septic shock. Having a Hx of a weakened
        immune system put her high on the list as being at greater risk of developing
        septic shock.

        The fact that she had swollen enough to require a tracheotomy leads me to
        believe that there were a lot of toxins from the bacteria that got into her
        system rather fast. That would confirm the seriousness of the infection in and
        of itself. How low was her B/P upon admission to the ER? Was she mentally
        alert? Fever? Chills? Any indication of permanent organ damage? I would
        assume no since she went septic within 24 hrs. and not a few days later.

        I'd be curious as to other things as well. What was her 02 Sat upon
        arrival? 3 days later on oxygen? What were her BUN results. What were her white
        counts? Was she checked for lactic acid? If so, results? What were the
        results of the C&S? How open was the IV, i.e., drip rate?




        Sincerely yours,
        Sue
        ________________________
        Sue Sarkis
        Sarkis Detective Agency


        (est. 1976)
        PI 6564
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