Connecting Lawyers with Expert Witnesses

Burton Bentley II, M.D., FAAEM

CEO, Elite Medical Experts

www.EliteMedicalExperts.com

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According to the National Practitioner Data Bank (NPDB), dental malpractice accounts for approximately 11.5% of all medical malpractice payments against health professionals. While dentistry negligence spans every element of practice from bridge placement to tooth extraction, nerve injury is one of the most common complications resulting in substantial payouts.

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Nerve injuries from dental procedures are often devastating. Litigating dental malpractice claims requires an understanding of common nerve injuries, the specific roles of dental subspecialties, and the importance of aligning the right expert witnesses to address the standard of care and associated harm.

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Dental Anatomy 101

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The human jaw consists of the upper jaw (maxilla) and the lower jaw (mandible). The maxilla is stationary and holds all upper teeth, while the mandible is moveable and holds all lower teeth. The trigeminal nerve originates in the brainstem and provides branches to the maxilla (maxillary nerve) and the mandible (mandibular nerve). The mandibular nerve then gives rise to the most commonly injured nerves—the inferior alveolar nerve and the lingual nerve.

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The inferior alveolar nerve (IAN) runs through a canal in the mandible, starting near the temporomandibular joint (TMJ) and ending near the chin. The lingual nerve (LN) runs along the inner side of the mandible near the third molar region. Understanding this anatomy is crucial for grasping how nerve injuries occur during dental procedures.

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The IAN is commonly injured during tooth extractions, particularly third molar (wisdom tooth) extractions, the placement of dental implants in the lower jaw, and root canal procedures. Patients may experience numbness, tingling, or pain in the lower lip, chin, and gums. In severe cases, there can be permanent loss of sensation or pain, impacting speech and quality of life.

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LN injuries often occur during the extraction of lower wisdom teeth and other oral surgeries involving the floor of the mouth. Symptoms include numbness, loss of taste, pain, and altered sensations in the tongue. Some patients may have difficulty with speech and swallowing, and in severe cases, these symptoms can be permanent.

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Trigeminal nerve injuries frequently arise from root canal treatments and other surgical procedures involving the upper and lower jaws. This can lead to trigeminal neuralgia, a chronic condition characterized by severe facial pain, which can be debilitating and difficult to manage.

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Dental Specialties

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Each dental subspecialty plays a unique role in both causing and diagnosing these injuries.

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• General Dentists provide a broad range of dental care, including routine check-ups, fillings, crowns, and some extractions. They perform a variety of procedures, including routine nerve blocks, and are often the first point of contact for procedures that lead to nerve injuries.

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• Endodontists specialize in treating the interior of the tooth, including root canal therapy. They are often involved in cases where root canal procedures have led to nerve injuries.

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• Oral and Maxillofacial Surgeons (OMFS) handle complex surgeries involving the face, mouth, and jaws, including wisdom teeth extractions and dental implants. They frequently deal with IAN and LN injuries, but many OMFS specialists are covered by carriers who discourage expert witness testimony against other OMFS specialists.

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• Periodontists focus on the prevention and treatment of periodontal disease and the placement of dental implants. They may be involved in cases where implant placement has resulted in nerve damage.

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• Prosthodontists specialize in the design and fitting of dental prosthetics, such as bridges and dentures, which can sometimes lead to nerve compression or injury if improperly fitted.

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• Orthodontists deal with the alignment of teeth and jaws. While less commonly involved in nerve injury cases, improper orthodontic procedures can still result in nerve damage.

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Selecting Optimal Expert Witnesses

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Aligning optimal expert witnesses is mission-critical in nerve injury cases. In addition to aligning the correct dental specialist on standard of care, litigation often requires a variety of other experts to provide critical insights into the medical, psychological, and economic impacts of nerve injuries.

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• Neurologists are essential for evaluating and treating nerve injuries. They can provide detailed assessments of nerve damage, including the extent and permanence of the injury.

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• Pain Management Specialists are crucial for cases involving chronic pain resulting from nerve injuries. They generally testify about pain management strategies, the effectiveness of treatments, and the impact of chronic pain on the patient's quality of life.

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• Oral Medicine—the newest subspecialty of dentistry—focuses on the diagnosis and management of complex oral health issues that may not require surgery. They can provide detailed insights into non-surgical treatments and the long-term management of conditions resulting from nerve injuries.

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• Psychologists assess the psychological impact of nerve injuries, including anxiety, depression, and other mental health issues resulting from chronic pain and disability. They can provide evaluations and testify about the emotional and psychological toll on the patient, including the need for ongoing mental health support.

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• Psychiatrists can diagnose and treat mental health conditions that arise as a result of nerve injuries. They provide expert testimony on the psychiatric impact of chronic pain and disability, including medication management and long-term mental health prognosis.

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• Vocational Rehabilitation Specialists assess the impact of the nerve injury on the patient's ability to work and perform daily activities. They provide evaluations and testify about the patient’s employment prospects, potential for retraining, and necessary accommodations.

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• Forensic Economists analyze the financial impact of the injury, including lost wages, medical expenses, and the cost of future care. They perform detailed calculations and testify about the economic damages, ensuring a comprehensive understanding of the financial implications of the injury.

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• Life Care Planners develop comprehensive care plans for individuals with significant injuries, outlining the medical and support needs over the patient’s lifetime. They provide detailed plans that include medical treatments, rehabilitation, assistive devices, home modifications, and other necessary care, ensuring that the long-term needs of the patient are fully addressed.

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Conclusion

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Nerve injuries in dental practice present significant challenges both clinically and legally. Understanding the specific roles of dental subspecialties and the complexities involved in securing expert testimony is essential for effectively handling these cases. Legal professionals must be adept at navigating these intricacies to advocate effectively for their clients, whether representing the plaintiff or the defense.

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By comprehensively understanding the causes, symptoms, and expert roles related to nerve injuries in dental practice, attorneys can better prepare for and manage these complex malpractice cases.

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Dr. Burton Bentley II, M.D., FAAEM

CEO, Elite Medical Experts

Dr. Bentley is a board-certified Emergency Medicine physician and a nationally recognized authority on medical liability and complex issues at the intersections of Medicine, Business & Law. Dr. Bentley earned his M.D. degree at the University of Arizona, completed a residency in Emergency Medicine, and practiced Emergency Medicine full-time for 21 years before devoting his energy to Elite Medical Experts, a consulting firm he founded in 2010. Elite aligns university physicians and surgeons as experts in complex litigation and serves over 4500 law firms, insurers, governmental entities, and corporations across the United States and internationally.

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