The patient/plaintiff, a man in his fifties, had been experiencing swelling and pain in his lower jaw. He had been to a primary care physician, who prescribed a broad-based antibiotic. After a seven-day course, the patient’s symptoms had not changed, so the primary care physician prescribed another round of antibiotics at a higher dosage. After that round of antibiotics did not give the patient any relief, the patient sought help from the defendant dentist. The dentist determined the problem was with tooth number thirty-one and he extracted it. 

After the extraction, the patient reported the pain and swelling did not change. The patient then saw a periodontist who noted the lump the patient had earlier described as being soft was now hard and fixed. The periodontist called the dentist, who advised that the patient was simply healing from the tooth extraction. As time went on, the patient’s symptoms worsened, and he sought care from an oral surgeon who quickly diagnosed actinomycosis, a rare infection. 

The patient was hospitalized and underwent three additional surgeries within the next few years, which left him with a permanent cosmetic deformity. The patient alleged that if the defendant dentist had simply taken a culture when the patient sought his help, he would have discovered the infection earlier, treated it, and the prolonged problems and extra surgeries could have been avoided. 

The dentist denied any wrongdoing and maintained that he could not have diagnosed such a rare infection, and he did not have enough tissue or drainage to test. The dentist also stated that he did not test or take cultures as a matter of practice. 

A verdict of over $1 million was returned by the jury at the conclusion of the malpractice trial, including over $750,000 for pain and suffering and over $200,000 for loss of consortium.
 

Controlling the risks associated with infections

Infections are potential unwelcome sequelae for almost any dental procedure. Infections often precede or exist concurrently with dental treatment, possibly compromising the treatment’s outcome or complicating the health status of the patient. Therefore, it is understandable that malpractice claims against dentists often cite infection as the claimant’s injury. For more information, please refer to the Dentist’s Advantage and CNA Dental Risk Management Manual chapter on Infections, or the full Risk Management Manual.

Responding to an infection

• Thoroughly evaluate the patient and assess all possible sources of the infection.
• Clearly inform the patient of his or her condition.
  • Explain the urgency of treatment.
  • Explain the potential consequences of no treatment or delayed treatment.
• Recognize and refer immediately when the patient’s condition is beyond your treatment expertise.
• When appropriate, prescribe an antibiotic regimen suitable in dosage, duration, and choice of medication.
• Consider antibiotic sensitivity testing for infections that do not respond to initial therapy. You also may wish to consider medical consultation or referral, if determined to be in the patient’s best interest.
• It is prudent to increase follow-up and monitoring efforts for patients that do not respond to initial interventions. Establish and emphasize direct communication for specific/potentially severe signs or symptoms.

Case study reproduced with permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.


_{© Dentist’s Advantage, 2022 © The National Society of Dental Practitioners, 2022
Risk Management services are provided by Dentist’s Advantage and the NSDP to assist the insured in fulfilling his or her responsibilities for the control of potential loss-producing situations involving their dental operations. The information contained in this document is not intended as legal advice. Laws are under constant review by courts and the states and are different in each jurisdiction. For legal advice relating to any subject addressed in this document, dentists are advised to seek the services of a local personal attorney. The information is provided "AS IS" without warranty of any kind and Dentist’s Advantage and NSDP expressly disclaims all warranties and conditions with regard to any information contained, including all implied warranties of merchantability and fitness for a particular purpose. Dentist’s Advantage and NSDP assume no liability of any kind for information and data contained or for any legal course of action you may take or diagnosis or treatment made in reliance thereon.}