Case Study: Providing Witness Testimony After a Failed Tooth Extraction

Jeff Rabinowitz

Dental Expert Witness

Post Publish Date

August 27, 2021

Post Categories

Failed tooth extractions are rare, but they do happen. If you’re representing either party in a dental malpractice suit involving failed tooth extraction, it’s imperative that you retain the services of a dental expert witness who has considerable experience with these procedures.

During the course of my decades-long career, I’ve provided testimony in numerous malpractice cases involving tooth extraction. Let me explain to you what can go wrong during a tooth extraction, and what questions your dental expert witness should be prepared to answer.

dentist preparing for testimony

Tooth Extractions Briefly Explained

Numerous situations might require a tooth extraction. These include:

  • Removing wisdom teeth
  • Removing severely infected, decayed, or fractured  teeth
  • Removing teeth with associated cysts, abscesses or masses
  • Removing impacted teeth (i.e. wisdom teeth or canines or supernumerary (extra) teeth 
  • Making room for other teeth to shift into place (for patients with orthodontic braces)
  • Removing teeth to keep the mouth healthy during chemotherapy or organ transplants

Most tooth extractions are relatively routine  procedures, but they can be more involved (and difficult) if the tooth is broken down or impacted.

Top Tooth Extraction Risks

While most tooth extractions are successful, complications can occur. The most common complications include:

Injury to Surrounding Tissue

Dentists who are struggling to extract a tooth, rather than gently and surgically removing it,  can sometimes exert too much pressure on the tooth – and pull instead of finessing its removal. This force may damage the patient’s gums or jaw.

Infections

Incomplete tooth extractions can sometimes lead to infections in the mouth that can spread locally or a distance in the body. Dentists must be careful to remove the entire tooth in question during each extraction to prevent infections.

Using inappropriate instruments  or failing to treat the area hygienically after the procedure can also cause infections. In certain cases, patients who have recently had joint replacement surgery may also require antibiotics before and after tooth extraction to prevent infective complications.

Damage to Surrounding Teeth

Using too much force when extracting a tooth can also damage the teeth around it. Being too forceful or not precise enough can even lead to breaking other teeth in some cases.

Extracting Teeth Without Consent

Before any tooth extraction, the dentist must explain what is about to happen and obtain  proper consent from the patient. A clear discussion of the planned procedure, including  its associated risks and benefits as well as any alternatives to the proposed procedure, must take place and must include questions and answers. Not obtaining informed consent before extracting a tooth is a departure from the standard of care and can constitute malpractice on the part of the dentist.

Avoidable Trauma Due to Negligence

A dentist who isn’t careful in planning and during a tooth extraction may inadvertently cause damage to the patient’s jaw bone, nerves, tongue, cheeks, or gums. Sequelae of these injuries can result in appreciable morbidity, including pain, functional limitation and disfigurement. 

Reviewing the case

Case Study: Infection After Extraction

To understand how a malpractice case could form around a tooth extraction, let’s look at a hypothetical example. A 63-year-old patient (we’ll call him Mr. Brown) requires a tooth extraction after having undergone a knee replacement. His dentist notes this in the patient’s medical and surgical  medical history, but he does not prescribe antibiotics after the procedure—despite the fact that Mr. Brown complains of severe pain and discharge from the extraction site – signs consistent with probable localized dental infection .

Mr. Brown repeatedly follows up on the telephone with his dentist, but no post-operative check-ups are scheduled and no antibiotics are prescribed. Finally, he consults a different dentist, who finds that the extraction site is infected and prescribes antibiotics. However, by this point, the infection has spread to the knee replacement—causing long-term complications for Mr. Brown, who initiates legal proceedings against the practitioner. By not following prudent, preventive antibiotic chemoprophylactic protocols for dental treatment of patients with artificial joint replacements, the doctor has breached the recognized standard of care. 

Denstist performing a tooth extraction

Questions For the Dental Expert Witness

If you were engaging a dental expert witness to provide testimony for either party during the tooth extraction case above, you’d want to ask the following questions:

  • How often do they perform tooth extractions in their clinical practice and what is their academic and professional surgical background, training and experience ?
  • How often have they performed tooth extractions for patients who have had joint  replacements?
  • What additional measures would the expert have taken to prevent a similar infection in one of their patients?
  • Have any of their patients ever experienced similar outcomes in a case such as this one?

Essentially, you want to be certain that your potential dental expert witness understands the factors at play in the case at least as well as (and preferably, better than) the dentist involved in the suit. You’ll also want to consider your potential expert witness’.

Retaining a dental expert witness with these advanced qualifications and asking them specific questions about the factors of your tooth extraction case beforehand will help ensure that you secure a witness who is prepared to offer accurate, relevant, and compelling testimony to support your case and client. The key here, and in every alleged case of malpractice, is to assess and define the accepted standard of care in the diagnosis and treatment of the patient – and whether or not it has been met. This is true for attorneys representing both defendant dentists and plaintiff patients.

Vewing a jaw model and x-ray

The Right Witness Can Transform Your Case

Tooth extractions can be complicated, but cases involving them become much more straightforward when you have the right expert witness at your disposal – one with extensive professional experience.  To learn more about finding a dental expert witness for cases involving failed tooth extractions, feel free to reach out and contact me with your questions.

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Jeff Rabinowitz

After earning his Bachelors and Doctoral degrees from the University of Pennsylvania, Dr. Rabinowitz completed residency training at the Mount Sinai Medical Center in New York City. He subsequently completed Fellowship training in Implantology and Periodontics at New York University and in Parenteral Conscious Sedation at St. Joseph and Brookdale Medical Centers. He established a multi-specialty group practice in Manhattan, he taught at Mount Sinai and he has pursued years of extensive advanced education programs and has maintained an active practice in implantology, complex restorative and prosthodontic care, periodontics, oral surgery, bone and soft tissue grafting, Invisalign and cosmetic dentistry. Dr. Rabinowitz holds a faculty appointment, teaching dental students at Touro College of Dental Medicine.

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