Download learn more - Dental Expert Witness

What is a Dental Expert Witness?
Dental Expert Witness (DEW) is a professional who can be called upon to provide accurate answers
to questions posed by a legal case. A DEW must provide relevant, concise and understandable reports
in a timely fashion. Their findings and opinions must be independent and impartial as their role is to
assist the court (or legal team). Such reports assist the courts in making their decisions. A DEW must
have mastered the clinical aspects of dentistry as well as having a wide experience of the many facets
of the profession, (preferably over many years of practice). Dr. Bray is internationally trained and
experienced and can provide this service.
Why use a dental Expert Witness?
When expert information and an opinion are required to help in making a decision, the legal team
relies upon the dental expert witness. In the case of personal injury, information may be clear
(broken teeth, cuts or bruises) but sometimes, injuries are not so clear-cut. Sometimes pain or
dysfunction may occur at a different time or a different place, easily missed by the untrained eye.
Without recognizing this, the claimant may unwittingly forgo appropriate care or recompense. A
responsible lawyer will therefore request such investigation through a dental expert witness for
their client.
For what injuries?
Headaches, neck or shoulder pain may appear following a car accident or fall, and consequent head
or face injury. Long experience and many studies show that whip-lash type injuries affect the neck,
jaw and jaw joints (temporomandibular joints) too. The two jaw joints (one located in front of the
area of each ear) are complicated and problems often surface in other areas, possibly later in time –
hence the difficulty of recognizing their association. The determination of pre-existing disease is
important as without which, defendant may feel it was there before, yet plaintiff (claimant) knows
the accident is to blame. Determination assists the legal team by explaining the association of
accident and injury. Dr. Bray can assist in this area.
A responsible lawyer will employ a DEW with “jaw joint expertise” to assure that if a claim is made, it
is robust and supportable with a factual basis, optimizing the chances of a fair and equitable
settlement. Without such knowledge, the injured party may miss an opportunity to have the true
condition considered in full. Dr. Bray has advanced training and experience in the jaw joint area.
When should The Dental Expert Witness be sought or involved?
Please read on....
Let us consider the following scenarios…
1. A 45-year old lady is involved in a rear end car accident; she starts to get headaches
immediately after it. Are the headaches connected, and could she make a claim based
on this?
2. Eight people sustain similar whiplash type injuries in a two-car accident. Should they
make claims and all be paid for their injuries?
3. A 17-year old girl experiences chronic headaches and her dentist recommends braces.
Is this the right thing to do, what if it didn’t work?
4. A 30-year old man slips on a construction site, banging his mouth. Two of his front
teeth are lost as a result of the blow. He makes a claim for money to replace the teeth
lost. Where did the DEW enter the picture?
5. A 65-year old man seeks care for his jaw joint pain from numerous dentists, without
satisfaction yet pays no one. What role did the DEW play?
6. A 58-year old lady with a long history of stopping breathing during snoring, high blood
pressure and constant tiredness attends her doctor regularly and has a stroke. Should
a reasonably competent doctor have foreseen that the symptoms reported to him
could result in a risk that the patient might suffer a stroke?
7. A 45-year old man sees his dentist for snoring and is made an oral snoring appliance.
He has a heart attack later that year. Could these facts be related?
8. A 57-year old lady is the victim of a hit and run incident, she suffers a broken jaw and
teeth. Her jaw is “set” in a hospital. After her jaw heals her “bite” doesn’t seem right.
Would a DEW report help her claim?
9. A 29-year old man goes to his dentist as his teeth are “wearing down “making him look
old. The dentist makes a nighttime “grinding guard” to protect his patient’s teeth, why
might this not be the right thing to do?
10. A 65-year old lady is retiring and her dental insurance running out, so she has her
front 6 teeth re-crowned but her smile looks “horsey” and her neck has started to ache,
she is disappointed but puts the latter down to the stress of her forthcoming
retirement. Might there be other issues of which she is not aware?
11. A 56-year old lady was told that she had “gum disease” and could have a dental implant
placed when the tooth was eventually lost. Many years later it was lost, but her new
dentist said that she couldn’t have. Should a reasonably competent dentist have
foreseen that the symptoms reported to him could result in a risk that the patient
might lose teeth without appropriate treatment?
12. A patient (Mrs. T) had quite extensive work performed, with all of her upper teeth
crowned. It looked really great and she was very pleased, as was the dentist. It was
never considered to repair or change her lower teeth because they didn’t show. Then
she got head, neck and shoulder pain. Was there a connection?
How often do you think stories like these occur?
Do they seem strange or unreasonable?
More importantly what have they got to do with personal injury or the DEW?
Let me share the background to these experiences,
(Some of the details have been altered for privacy).
1. A 45-year old lady involved in a rear end car accident starts to get headaches immediately
after it.
History
When stopped in a traffic jam, Mrs. A was involved in a rear end collision. The impact was estimated
to be around 30 mph. She felt shaken up and dizzy when the ambulance arrived but had not lost
consciousness. She was sent to hospital. As nothing significant was found, she was sent home but told
to come back if any problems arose. She saw her doctor regarding headaches who prescribed
physiotherapy. Mrs. A. tried that, but preferred her chiropractor’s treatment. Her headaches
persisted. She commenced a personal injury claim against the other motorist and his insurance
(ICBC). Her lawyer recognized the possibility of jaw joint involvement and contacted the DEW.
Investigation
The DEW determined that Mrs. A. had experienced some jaw joint dysfunction previously and
estimated the degree of this dysfunction. His report was prepared in readiness for court but upon
reading the report, evidencing the likelihood of headaches and dizziness by the injury and that
intervention would be required, ICBC chose to “settle out of court”.
Review
Without involvement of a Dental Expert Witness the connection between the injuries and her
apparently unrelated symptoms would likely not have been made. Without his report to assist in
presenting the facts, the offer made by ICBC would likely have been lower, the case may have gone to
court and Mrs. A’s symptoms may have not been identified as treatable.
Question
Did Mrs. A’s claim benefit from the DEW’s report? More than likely than not.
2. Eight people sustain similar whiplash type injuries in a two-car accident.
History
Eight people (four in each car) sustained similar type injuries when two cars collided late one
evening at a poorly lit intersection. No drugs or alcohol were believed to be involved although none
of those injured spoke English, so determination of the facts was harder to achieve. Each had claimed
that they’d hit their mouths but since little damage appeared to have been done to the cars, the
insurance company asked the DEW to review the case.
Investigation
The people were examined but inconsistent findings noted. Further careful investigation of previous
dental records by the DEW revealed a previous and similar accident in which two of these eight
claimants were also involved. The facts were incorporated into the DEW’s report and submitted to
the defendants counsel. A pretrial meeting saw the case dropped by the claimants counsel. The
defendant’s counsel intimated the possibility of a counter claim but it was not pursued.
Review
From the Dental Expert Witness’ Report it was clear that the “accident” was a scam. Such actions may
drive up the cost of insurance premiums. While whiplash injuries are sometimes less easy to
apportion costs to than direct and more “obvious” injuries (like a fractured bone), an experienced
clinician can often determine the likelihood of injury. Experience (and a degree of insight) can allow
the Dental Expert Witness to investigate appropriate records and discover aspects of a case that
would otherwise not likely come to light.
Question
Would this spurious claim have been recognized without investigation? Do you think this example is
unique? The DEW can prepare a report for a defendant or claimant (plaintiff).
3. A 17-year old girl experiences chronic headaches and her dentist recommends braces.
History
The dentist of 17-year girl, Ms. B; discussed treatment for her headaches with her mother. Ms. B was
fit and well with no significant medical history. Her doctor had prescribed painkillers that she chose
not to take. Her teeth were “crowded”, said the dentist, and this was likely the cause of her
headaches. He recommended, “Invisilign® braces” as they would straighten her teeth quickly and not
be visible (Ms. B. wasn’t keen on braces as she’d had them before and her crowding had relapsed).
The dentist felt that this was the only way forward and he’d seen excellent results with this approach
on the patients he’d treated previously (although he’d not treated headaches in the past). They
proceeded and the headaches initially improved. However, after a few months the headaches
returned, “worse than before” it was reported. The dentist suspended treatment and instructed her
to leave her braces out. The pain diminished slightly and the dentist said he’d only charge the mother
for the cost of the diagnosis and manufacture of the braces. The mother spoke to a lawyer who in
turn suggested obtaining a Dental Expert Witness’ Report.
Investigation
Ms. B was examined and a report prepared. The investigation had illustrated her headaches had
initially commenced following her original orthodontic treatment some time ago; when teeth were
removed and her crowded teeth straightened. Her history went on to show that these earlier lowgrade but chronic headaches had worsened into “migraines”(as described by the mother) at times
now. Their worsening seemed to coincide with exams at school and it was suggested by the DEW’s
report that these might indeed be tension type headaches. The orthodontist had blamed the previous
failure of orthodontic treatment on Ms. B for not wearing her retainers.
With no evidence indicated that orthodontics would manage headaches (despite straightening teeth)
either, the general dentist chose to refund all monies to the mother.
A discrepancy between Ms. B’s bite (jaw position) when her teeth were apart and then together, just
before her teeth touched (and without the influence of her teeth at the end of closure) was noted,
appearing as a shift of her lower jaw backwards and to the side, upon tooth closure. This was noted
as significant, as literature does support this as a possible factor in precipitating headaches.
Review
While the orthodontist refused to consider that his treatment might have initiated Ms. B’s headaches
her general dentist recognized that orthodontics is not a treatment for headaches and refunded all
monies paid in full. The report made recommendations as to present and future options.
Question
It may be possible to prove a cause and effect relationship (despite the strong belief held by
orthodontists that their treatment cannot cause headaches and/or dysfunction) because the judge is
not an orthodontist.
4. A 30-year old man slips at a construction site, banging his mouth. Two teeth are lost as a
result of the accident.
History
Working on a BC construction site a 30-year old man Mr. C. slipped and hit his mouth on some wood,
loosing two front teeth. Mr. C. was covered by site “work safe” insurance and claimed through a local
dentist for treatment to replace them. His dentist submitted a claim to replace them. After hearing
comments made in the local bar, the site manager suspected something was amiss, as it appeared
that Mr. C was soon to leave his employ and move to a different Province.
Investigation
A Dental Expert Witness Report was requested by the company’s counsel and upon his clinical
examination; the sockets from which the teeth were lost appeared advanced in their healing. There
was therefore some question as to whether the teeth were actually lost at the time of the reported
accident. Careful investigation uncovered dental records indicating that the teeth had been removed
as an emergency procedure three days prior to the alleged accident, by a dentist in Mr. C’s home
Province (to which he would be moving shortly) thus demonstrating that the loss of the teeth was
not due to the alleged fall. Upon discussing this with Mr. C. he said that he’d seen blood and thought
they were two different teeth. His claim for a replacement fixed bridge was withdrawn.
Review
Such actions drive up the cost of insurance premiums and the cost of “doing business” for companies.
Relying on honesty may not work for everyone. Both the alleged injured claimant and the dentist
claiming for the work to be performed can make mistakes. The use of a Dental Expert Witness’
Report is a responsible and prudent response to personal injury claims.
Question
A claim for dental treatments to replace two teeth may only be less than $5000, but is it acceptable to
continue to lose on spurious claims and monies just because each is relatively small? Departments
such as WorkSafeBC have the responsibility to ensure that system is operated fairly and equitably.
5. 65-year old man seeks care from numerous dentists, without satisfaction and pays no one.
History
In an interesting UK case, an older gentleman (Mr. D) went from London dentist to London dentist
seeking care for his “TMJ pain” (temporomandibular joint pain). He was dissatisfied with each dentist
he saw (whether merely consulted or providing treatment). Her moved on without paying anyone
anything, despite running up several significant bills. The local Dental Association made note of it in
their Journal as it had occurred so frequently! Mr. D was intercepted leaving a dental office and
detained by the police.
Investigation
Those with “TMJ pain” sometimes find adequate care hard to find. The resultant frustration and
mental stress can lead some to lose their usual insight and move from dentist to dentist.
Unfortunately, this has resulted in some dentists believing that such pain is “all in the patient’s head”.
While acute pain is useful (moving your hand when leaning on a hot surface), chronic pain has no
such function, it develops a “life of it’s own” and can result in affective mental disorders such as
depression. In this case it was determined that these factors aside, there was no excuse in not paying,
or at least discussing payment; with the many dentists involved. These are the factors illustrated in a
Dental Expert Witness’ Report that assisted the court in its determination.
Review
Mr. D. was fined by the court and ordered to repay all of his outstanding dental bills. A referral to a
postgraduate dental facility was arranged for a reversible and non-invasive splint as intervention for
his pain at the recommendation of the report. While it is not known if pain management was a
success, there is a need for an independent and impartial opinion in cases where many dentists have
been unsuccessful yet the patient’s involvement is not understood. This benefits both parties and
provides a basis for determinations.
Question
Did the previous dentist give appropriate treatment and an adequate explanation of the procedure
and it's possible success? Would both sides of the case be illustrated equitably without a Dental
Expert Witness’ report?
6. A 58-year old lady with a long history of stopping breathing during snoring, high blood
pressure and constant tiredness attends her doctor regularly without receiving treatment,
has a stroke.
History
Prompted by her husband who found her snoring to be both disruptive and worsening, Mrs. E.
attended her doctor of six years, Dr. M. Upon hearing her story he took her blood pressure, (for the
first time in six years) and told her that it was higher than normal and that she should see the
pharmacist next door for some advice sheets including weight loss. She attended and the pharmacist
took her blood pressure and informed her that it was high at 180/155. He said that normally it would
be around 130/90 at her age. The pharmacist gave her an advice sheet that advised her to limit salt,
eat a balanced diet, exercise, stop smoking, and lose weight. He suggested it be checked again in a
week.
Later she asked again about her snoring again and that her husband said she occasionally stopped
breathing. Dr. M. said that it was likely that she had some nasal congestion and could prescribe nasal
spray, but that her high blood pressure needed to be treated (he wrote a prescription for an ACE
inhibitor hypertension drug).
Mrs. E. continued to see her pharmacist and her blood pressure slowly reduced. Three months after
her initial consultation with her doctor, Mrs. E experienced ischemic stroke.
Investigation
Upon diagnostic imaging at the hospital to which she was admitted, it was noted that she had
suffered several ‘silent strokes’, of which she was unaware. Her attending neurologist seemed
interested in her story of gasping during her chronic and loud snoring, her husband’s claims that she
would occasionally “stop breathing for 20-30 seconds at a time” and her high blood pressure.
Following his requested sleep test a diagnosis ‘moderate level’ obstructive sleep apnea (OSA) with
loud snoring was made. Asked if Dr. M. should have known this, Mr. E was told “probably”.
Mrs. E. was contacted by a CPAP company who told her that the Dr. M. had asked them to provide
CPAP. She went and asked if they could provide a dental appliance for her but was told that they
didn’t work as well as CPAP and offered her a CPAP trial instead. After two weeks of trying it, she
found it impossible to wear all night gave up on treatment and decided to continue without
treatment. Six months later she experienced a debilitating stroke.
Review
Mr. E. discovered that his wife had treatment options that he was not offered and contacted a lawyer
who discussed the scenario with the DEW. While the facts of the matter appear clear, there are many
issues that must be addressed in a report and expert opinion to ensure that accurate facts are
presented robustly. An apparent lack of knowledge and insight prevented the physician from
providing impartial advice whereupon a severe and debilitating stroke may have been avoided. The
same can be said of the CPAP provider; alas the industry has no regulation. Following a report well
evidenced with current Canadian studies and guidelines, the case was settled ‘out of court’, to avoid
‘unnecessary court time and cost’.
Question
How many times are we, as professionals; reluctant to consider alternatives? If the doctor had
recognized the potential dangers of snoring and obstructive sleep apnea would her stroke have been
avoided? Is the doctor negligent in only offering one option when in fact several exist? In a disease
that affects up to 20% of the adult population and has been shown to be associated with high blood
pressure, heart attack, stroke and diabetes - why do many physicians frequently not pose the
relevant questions to their patients and when they do, why do they often only offer one option (that
may not be accepted to the patient?)
7. 45-year old man sees his dentist for snoring and is made an oral snoring appliance. He has
a heart attack later that year.
History
Mr. F. was fit and well and a regular dental attendee with ‘good teeth’. He asked Dr. P. (his dentist)
about a ‘snore guard’ as his new girlfriend complained about his snoring. His dentist said that he had
read up on these appliances, and with the help of a commercial dental laboratory made a dental
appliance for this condition. Mr. F. tolerated it well and his new girl friend said he only snored after
he had been drinking, so all appeared well. Alas Mr. F experienced a heart attack three months later,
which he survived.
Investigation
Unaware of the transgression of law and guidelines Mr. F accepted both his snoring and his heart
attack as unrelated. This may not have been the case as Mr. F’s snoring may likely have been
associated with obstructive sleep apnea (OSA). Also snoring may also cause heart attack and /or
stroke independently. Dr. P. should have referred Mr. F. to his medical doctor in arranging a sleep
test for Mr. F to discussing or making any dental appliance. By treating Mr. F.’s snoring, Dr. P. may
have masked a disease that was potentially the cause of the heart attack.
Review
Should Mr. F. or his medical doctor has known of the well known, reported and accepted connection?
Question
Without asking appropriate questions and taking legal counsel, the victim is unlikely to ever know
the facts - although it has to be said that a legal advocate needs to be aware of the benefit of expert
witness services in a situation like this too. While it is not wished to see litigation encouraged, the
rights and expectations of the duty and standards of care need to be withheld.
8. 57-year old lady is the victim of a hit and run incident, she suffers a broken jaw and teeth.
Her jaw is “set” in a hospital. After her jaw heals her “bite” doesn’t seem right.
History
Ms. G. was returning from her job at a motel at around 11pm. when was hit by a car that mounted the
pavement, but did not stop or report the incident. Observed by another pedestrian the emergency
services were called immediately. Police and ambulance attended, Ms. G. was taken to hospital
suffering several broken bones (ribs, arms, legs and jaw) and soft tissue laceration, the identity of the
driver was never determined although the car was identified. Ms. G. had x-rays taken of her arms and
legs but not her ribs or jaw (the latter was not recognized for 36 hours following the injury). Her
upper and lower teeth were ‘wired together’ to immobilize her jaw fracture promptly upon discovery
(a step was felt through her gum). It was removed six weeks later. Ms. G. experienced headaches
throughout the period and attributed to her accident. Slowly, she recovered but her headaches
continued.
Her legal advocate referred her to Dental Expert Witness (DEW) for examination; he had advanced
knowledge of the jaw joint, and recognized the possibility of the involvement of this structure. The
DEW confirmed the involvement and was instructed to provide a forensic report. The case went to
court and the Judge preferred the evidence provided by the DEW who illustrated that by wiring the
teeth together yet without recognizing bone end movement at the jaw fracture, such an oversight
was likely responsible for muscle spasm, resulting in her symptoms of tension type headaches (TTH).
Investigation
The report helped the judge to understand the cause and effect of her pain, as well as her options to
resolve it. Unfortunately for Ms. G., following discussion with lawyers and despite a final ruling in her
favor; the claimant’s award was reduced considerably given that the driver had not been established.
Alas her orofacial injuries had to take second place to her inability to walk.
Review
Despite the benefit of a report to help the Court, and even when a Judge prefers the claimant’s
evidence, there may be points of law that dictate the final outcome. The defense team are present to
represent the defendant regardless of “what seems fair” and act as advocates, the DEW reports
impartial evidence for, in this case; the judge.
9. A 29-year old man goes to his dentist and is informed his teeth are “wearing down
“severely. The dentist prescribed and made a nighttime “grinding guard” to protect his teeth.
History
Mr. W. a fit and well 29 year old regular dental attender was aware that his teeth were worn badly
when his dentist recommended a “night guard” (or “bite guard”) to protect his teeth from further
wear at night when it was taking place. Alas some time afterwards he started to experience jaw joint
pain and headaches, the dentist advised him to not wear the appliance but Mr. W couldn’t
understand why it hadn’t worked, nor why his dentist apparently didn’t understand either.
He was now faced with his teeth continuing to wear and faced expensive second opinions from
specialist s that didn’t all had their own ideas.
Investigation
An independent examination, appraisal, interpretation and report highlighted that the appliance
made had the effect of pushing the lower jaw back against the jaw joints. Mr. W’s bite (the way in
which his teeth meshed) and general facial structure, had not been discussed previously but
appeared to predispose Mr. W for such headaches. The inappropriate design of appliance made the
situation worse and likely precipitated the symptoms. Recommendations were offered including a
sleep disordered breathing assessment and therapy in order to protect Mr. W’s teeth - he was also
found to be suffering from obstructive sleep apnea.
Studies also incidentally support the findings that a single arch grinding guard may worsen sleep
disordered breathing (i.e. obstructive sleep apnea).
Review
Despite the clear benefits of an independent assessment prior to treatment, reporting after the fact
did provide answers. An adequate report would include the assessment (and management if present
of a sleep disorder.)
10. A 65-year old lady is retiring and her dental insurance running out, so she has her front 6
teeth re-crowned but her smile then looks “horsey” and her neck has started to ache, she puts
it down to the stress of her forthcoming retirement. Might there be other issues of which she
is not aware?
History
The lady in question worked hard and long hours and looked forward to the plans she had made for
her retirement. She decided to have her front crowns replaced as she and her dentist had noticed
gum recession around them. She requested an estimate for ‘crowns’ (caps) on her upper six front
teeth. She proceeded and looked forward to her new smile.
After her numbing had gone and she could move her lips to smile again, she was disappointed in the
permanently cemented crowns, assuming more would be accomplished than just her temporary
crowns had. She didn’t like to say anything but over the next few months her friends noticed a
change in the way she smiled, she attempted to show a limited smile.
Investigation
An independent examination, appraisal, interpretation and report would have highlighted the
patient’s involvement by way of relevant and specific questions to ask.
Also, it would have provided some insight into the process by which the patient could assist herself.
Review
Independent dental report writing is a service, which if performed in order to provide insight for the
patient (much like forensic report writing does for the judge) can save countless hours of
disappointment and thousands of dollars of expenditure. An independent dental report prepared by
an impartial and independent expert who does not plan to take the work for him/herself can be
priceless.
11. A 56-year old lady was told that she had “gum disease” and could have a dental implant
placed when the tooth was eventually lost. Many years later it was lost, but her new dentist
said that she couldn’t have. Does she have a case to be answered?
History
The lady in question (Mrs. J) had a long history of gum disease. She went to her dentist’s office as
directed, every 3 months for cleanings. Her dentist told her that she might loose some or all of her
teeth due to this ‘vulnerability to gum disease’ but that she should keep coming for the cleanings. She
agreed, as it made sense; and did. One tooth at the back bothered her from time to time but although
she mentioned it, nothing was specifically done.
Some time later her dentist retired and her new dentist indicated that she should have the tooth out
as it was affecting the adjacent tooth. She agreed but asked if it could be replaced with an implant, as
she didn’t want a denture. She was told that due to the long-term gum disease there was not enough
bone to support an implant.
Investigation
An independent examination, appraisal, interpretation and report highlighted the fact that had
earlier intervention been made, there would have been enough bone. This is not an unusual scenario
as going to the dentist regularly can be extremely beneficial but can also simply become a routine.
Sometimes it is difficult in a busy practice to stop and look at the patient’s needs as if they were new
to the practice, not a regular attender. If legal counsel is taken, a DEW can assist with his knowledge.
Review
Unfortunately, occurrences such as this are not uncommon and it becomes a question of duty and
standard of care. If the dentist has simply allowed his patient to remain a fee-paying member of his
practice without review, clearly there is a breach of duty. If there has been an inappropriate decision
(or none) then there may have been a breach of standard. The new dentist may chose to offer to
correct this without cost as part of his transition good will, but he or she may not. Potentially the
patient could be out of pocket, or out of luck and may require assistance.
12. A patient (Mrs. T) had quite extensive work performed, with all of her upper teeth
crowned. It looked really great and she was very pleased, as was the dentist. It was never
considered to repair or change her lower teeth because they didn’t show. Then she got head,
neck and shoulder pain. Was there a connection?
History
A patient (Mrs. T) had quite extensive work performed, with all of her upper teeth crowned. It looked
really great and she was very pleased, as was the dentist. It was never considered to repair or change
her lower teeth because they didn’t show.
A few months later she started to have severe headaches that seemed to be coming from her neck.
Her doctor prescribed painkillers that she had to take although they didn’t seem to work well. She
sought help from a chiropractor, but despite much treatment couldn’t seem to help either. She tried
many healthcare providers but got no relief. She never made the connection with her teeth, as it had
been a while since they were done and her pain seemed to come from the base of her skull, not her
teeth. A specialist physician diagnosed them as cervicogenic headaches (starting in the neck). She
was desperate and debilitated.
Quite by chance she found a dentist who recommend that the lower jaw be stabilized in its correct
position with the upper teeth. She didn’t want to spend more money on “questionable ’ treatment.
Desperate she proceeded. She was amazed that it worked almost immediately. How could it have
been missed and why didn’t the dentist who made the upper crowns tell her of her options.
Investigation
That dentist denied any liability saying what he’d done was to a high standard and there must be
other things in her neck. After consulting a lawyer the DEW was brought in. His investigation showed
that the dentists prescription to the dental laboratory simply said, “Do your best” when it came to the
“bite”. The laboratory claimed, (correctly) that they weren’t trained to make those decisions, the
dentist should have known, or he shouldn’t have done the work.
Conclusions.
Just as with other dental and medical procedures, failure to provide options leaves all parties are
unprotected from legal action. This is the opposite side of the coin to informed consent where the
consent must include all reasonable and known risks. Clearly the dentist must acquaint the patient to
all relevant aspects of his or her therapy before commencing. This falls within the accepted standard
of care.
In this case the patient was awarded a sum (out of court) that allowed her to have her lower
treatment performed too. In this case the DEW assisted with planning. He did not perform the work
wishing to remain impartial for the benefit of the patient.
In closing...
The patient doesn’t usually know about the dental aspects of their anatomy and physiology in any
detail – it would be impossible to learn in a few weeks or months what has taken someone five years
of intensive training and then practical experience and continuing education simply to qualify as a
dentist. Dentists are human, they make mistakes. Sometimes these mistakes cost their patients
dearly, yet sometimes the dentist will put up his hand and take responsibility, not to the original
problem (which is owned by the patient seeking help) but to his or her erroneous choice(s).
Sometimes this is an understandable error and although wrong, it is made for the “right reasons”.
Sometimes it isn’t and the patient has a right to some form of restitution. This is not always an easy
thing to find, prove or correct. This is where the DEW can help.
In court the judge has a similar complex and arduous undertaking – DEW reporting to the
court must be impartial, accurate, and based on fact.
In dentistry that opinion may be about a dental or orofacial injury sustained, possibly in a car or job
site accident. It can relate to more complex issues such as jaw joint problems (TMJ) or airway issues
(Snoring or Obstructive Sleep Apnea or OSA) and their potentially serious consequences. OSA is an
airway issue, usually relating to the tongue and velopharynx (an area involved in dentistry and
shared with the medical profession). Although the standard of care has been fairly clearly defined by
the Dental College, thus;
Standard of Care (CDSBC): The dentist's role in the treatment of OSA is adjunctive, supplementary
and/or collaborative to that provided by the physician. A dentist may provide OA therapy only after
receiving a written request or prescription from the attending physician, preferably a physician with
advanced training in sleep medicine. Because of the increased rates of morbidity and mortality
associated with OSA, a physician (family physician or sleep specialist) must assess the potential for
other medical conditions, including OSA, before a dentist provides any treatment for primary
snoring.
DEW reporting can relate to alleged professional malpractice through errors or omissions in
professional care or lack of. Reporting can provide evidence in the defense of actions taken to
provide professional care. The Expert Witness' opinion should help with the understanding of the
facts of the matter. This usually takes the form of a detailed report answering certain questions or
issues that have or may arise in the case and may require support in the courtroom.
Dr. Bray is qualified to provide the following services;
a. Independent dental reports (for the patient).
b. Desktop reports (for the patient’s lawyer).
c. Robust forensic and legal reporting (impartial for court).
Personal Injury Claim reporting for the courts, involving damage to the teeth
and/or surrounding areas, with a special interest in jaw joint injury or airway
issues (Obstructive Sleep Apnea).
d. Reporting for allegations of clinical negligence in dental practice.
e. Courtroom appearance. (Impartial for court).