FAST! - Dental
Malpractice Info.
Copyright © 1996-2001, Barrington A.S. Daltrey
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Dental Malpractice/Legal Issues for the dental patient 
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Disclaimer: I am not your attorney! The information provided here is general in nature, and although I believe it to be accurate, it is provided only to give the reader an overview of the topics offered. The discussion may be incomplete. I am not providing legal advice, and before taking any action, you should verify the information here with your own attorney. If you choose to represent yourself, then you must do your own legal research to verify the accuracy of the opinions expressed in these pages, and whether additional law applies to your case.
Myofacial pain? Do you have a lot of jaw, neck,
head &/or shoulder pain? Did you recently (or not so
recently) have some crowns done, or bridgework? Mmm hmm . . . Let
me say this - I am not trying to hustle up dental cases. Return
immediately to your dentist, and if he can't help, get him to
refer you to someone who can.
Dental malpractice is not an area that receives much legal
attention. What is a tooth worth, anyway? The potential recovery
does not seem to be worth the trouble of preparing the case. I
became interested in the problem as the result of personal
friends who had inferior dental work at about the same time.
Since I was hearing about the pain they were suffering, and the
refusal of their dentists to acknowledge a problem even existed,
I began to study the matter. Initially, dentists weren't talking
- but finally I got hold of some very knowledgeable experts.
Interestingly enough, some good information came from a text book
written by a defense expert witness!
I don't think many people, not even many dentists, are
knowledgeable concerning the problems I am about to describe.
Now, I am not a dentist, and I may not get all of this in the
correct scientific terms, but remember: you read it here first!
Teeth are extremely sensitive. The sole function
of the single largest portion of your brain is devoted to
management of your mouth, bite and jaw alignment. Surprised?
Think about it. What controls the complicated functions that
result in speech? How do you avoid chewing your tongue or the
inside of your mouth when you are chewing food? The fact is, you
brain is constantly realigning your jaw, searching for the
correct resting position.
You are sensitive to minute changes in your bite.
How small of a change in surface will you notice? Would you feel
it if you bit down on a dime? On a piece of paper? When a dentist
does a crown or filing, he is likely to affect the alignment of
biting surfaces. Correctly done, it should not be a problem for
the patient. However, a number of factors can lead to
complications, and even permanent injury. The factors
include (i) hypersensitivity of the patient; (ii) failure to
maintain a proper reference point; (iii) disruption of too many
surfaces simultaneously. There can be other factors, but you get
the idea.
The injury can be serious. Misaligned teeth can
result in pain that worsens over time, rather than subsiding.
Symptoms can be "myofacial" pain (pain of the face),
pain which makes chewing difficult, headaches, neck and shoulder
pain. Inflammation can develop in the joints, making the problem
worse. You may have heard this referred to as "TMJ",
which refers to the temporo-mandibular joint. Inflammation in the
joint can move the jaw out of alignment.
The temporary crown must fit. If the temporary
doesn't fit right, what happens? Your jaw shifts to compensate
for the incorrect fit, and may develop some inflammation of the
joints. The dentist now places the permanent crown - but it
doesn't line up right, because your jaw has shifted! He does some
grinding on the crown to make it fit better, some of the
inflammation goes away, your bite shifts back toward where it was
before, but now the crown isn't right for that location. The
dentist ends up chasing the bite, with no end in sight.
An example. Let's say you need an upper and a
lower crown. They face each other. If the dentist does one crown
at a time and is careful, no problem. But what happens if he does
both at the same time? He cannot use the opposing tooth as a
reference, because he has removed the opposing tooth. After the
crowns are in, you have a hard time explaining how the bite is
off because your mouth has been open for quite a while in the
chair, the facial muscles are tired, and also you have a good
dose of novocaine.
In the following days, you have increasing pain in the facial
muscles, and chewing and talking becomes painful. The dentist
gives you pain killers and makes a couple of adjustments. The
adjustments don't solve the problem, because now your facial
muscles are experiencing "spasms" - that is, they are
tight fatigued from overwork, just like when you lift weights or
work too hard in the yard. Because the muscles are tight, the
exchange of nutrients and waste is inhibited, causing more pain
and more muscle fatigue. The dentist can't find the correct bite,
because now even you don't know what is right! This all may lead
to months or years of symptoms. The dentist may suggest that it's
all in your mind, or that its the result of some other problem
over which he has no control.
Stuff you should know. My dentist, who does a
great job, never mentioned any of this. Actually, a dentist is
suppose to write out a treatment plan and discuss it with you.
He is suppose to discuss alternative treatments, and the risks of
the procedures undertaken. He should also work carefully so as
not to disrupt the bite, and should refer to a specialist any
work that exceeds his knowledge or skill. I found that the
dentists I talked to "closed ranks." At first, not one
would criticize another, or explain these issues to me. Yet these
are issues they are taught both in first year dentistry, and in
mandatory continuing education courses. I know, because I read
the textbooks.
By the way, porcelain crowns are very abrasive and can wear
the opposing teeth. Gold, which apparently has fallen into
disfavor, is softer and easier on the opposing teeth. Of course,
gold is less cosmetically appealing. A third option is a
porcelain crown with a metal biting surface.
The main thing is, if you are experiencing the problems I have
described, get them fixed! A reputable dentist ought to listen to
your concerns and make an effort to solve them. Remember, because
the facial muscles may be bruised and tired, solving the problem
may require treatment over a period of time.
If your dentist can't help, get a second opinion. If all else
fails, contact me, since I can recommend a dentist who is
experienced in treatment of these problems. And yes, in a
grievous case we can consider the "M" word . . .
Miscellaneous Jury Verdicts go
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Generally, dental malpractice claims result in small awards. Here's an interesting case, which I haven't read, but given the size of the award, there must have been significant facts in the case. California limits awards in medical cases under a law called "MICRA" to $250,000; but this verdict was for $1,179,000. Jeffery v. Gordon - Los Angeles County Superior Court. California Bar Journal reported in October 1996 that this verdict resulted because a dentist pulled all of a woman's teeth, without providing her with accurate information concerning their condition, and without advising of the available options.
Will I Take Your Case? go
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If you are in my geographic area (Inland Empire area of
Southern California), I would be interested in reviewing your
case and possibly being retained by you. My fee arrangement could
be on an hourly billing basis, or on a contingency fee basis. If
I were to handle your case on a contingency, a typical
arrangement is that you would be responsible for costs (and I
would have the option of advancing them as needed), and that I
would receive 20% of the recovery if settled without filing a
lawsuit, 30% if settled after discovery initiated; 40% if settled
after discovery is completed and 50% if the case went to trial.
These numbers would apply to the first $100,000 of recovery, and
the percentage would be ½ as much on the portion of the recovery
that exceeded $100,000.00. Thus, if we had a trial that resulted
in a verdict of $75,000.00, my fee would be $37,500.00. I believe
this is reasonably reflective of the time and effort involved in
trying the case, combined with the uncertainty as to whether a
recovery will be obtained at all. The fee if the same amount was
obtained by settlement without filing suit would be $15,000.00,
and the fee schedule is designed to reflect the amount of work
involved at various stages of litigation.
Dental Implant Expert go
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I don't have any discussion for you on dental implants. However, here is a link for an expert on dental implants who has successfully assisted plaintiffs. Dr. David Levitt, whose website can be found here.