Patient is Injured by Negligent Dental Work

Oral Surgery Expert WitnessThis case takes place in Arkansas and involves a patient who had prostate cancer that had metastasized to the bone. As a result of the cancer’s effects on overall bone strength, the patient was prescribed medication to strengthen his bones. While the patient was taking the bone-strengthening medication, a dentist extracted one of the patient’s teeth. With this particular class of drugs, certain mandatory precautions have to be taken before any dental procedure can be performed, including pre-extraction antibiotics and a meticulous consent process. Medical records indicated that the dentist knew that the patient had been diagnosed with cancer, and that he was receiving this drug at the time of treatment. In spite of this knowledge, the dentist took no steps to prevent injury to the patient during the extraction. As a result of the treatment he received from the dentist, the patient suffered osteonecrosis of the jaw.

Question(s) For Expert Witness

  • 1. Do you treat patients on IV bisphosphonates? If so, how often?
  • 2. What is the standard of care for a patient on this particular drug that presents with a tooth that may need extraction?

Expert Witness Response E-000748

I do treat patients who take bisphosphonates, most commonly oral bisphosphonates and, occasionally, IV bisphosphonates. The standard of care would be to avoid the extraction, if possible. If not possible, then the standard is to make the patient aware of the risks. While the use of antibiotics may be helpful, they may not necessarily prevent BIONJ. Discontinuation of the medication is not always possible. It would also be helpful to know if the patient’s immune system was compromised as a result of chemotherapy. The key is whether the tooth needed to be removed immediately.

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