In a recent 3-day trial in Palm Springs, Tom Wianecki tried a statute of limitations case on behalf of defendant Dr. Chun Kim, a dentist. The case arose out of a past patient making unsupported accusations about her treatment with Dr. Kim. Dr. Kim was wrongfully accused of intentionally not informing the patient and lying to her. After one hour of deliberations, the jury returned a defense verdict in favor of Dr. Kim. We are honored to have protected the reputation of Dr. Kim.
Archives for Dental Malpractice
March 23, 2012
Dental charts are nothing like medical records from a hospital. Many patients are familiar with the typed narrative reports from hospital records. Examples include the History & Physical, Consultation, Operative Report, and Discharge Summary. While some dentists are attempting to go paperless, most offices still utilize handwritten entries. The progress notes or services rendered portion of the chart records for the dentist and staff what took place on a particular day. Abbreviations are commonly used. It is an acquired skill to interpret what dental charts actually say. Here are some basic items to look for:
1. The note should be dated and signed or initialed.
2. All medications administered should be identified in addition to the quantity delivered. Pen VK is an antibiotic. Lido is lidocaine or an anesthetic. EES is erythomycin, another antibiotic. The amount of anesthetic is usually indicated with the number of carpules (as a unit of measurement). 1:100,000 indicates the presence of epinephrine as a vasoconstrictor. Another common antibiotic is carbo or carbocaine.
3. The actual dental procedure is usually abbreviated. XB=extraction, RCT=root canal therapy, comp=composite filling, RPRS=root planing and root scaling, exam=examination, OHI=oral hygiene instruction, cr=crown, prophy=cleaning or prophylaxis. M,B,O,L refers to the surface of the tooth (mesial, buccal, occlusal, lingual), NG=night guard, BB=bridge, PA=periapical x-ray, BW=bite wing x-ray, pano=panoramic x-ray, CT=computerized tomography, RC=recall date, perio=periodontal gum tissue or treatment, ortho=orthodontics or orthodontist, endo=endodontist or endodontic treatment, OS=oral surgeon or oral surgery.
4. For general dentistry, the teeth are numbered from #1 to #32. (Orthodontists have a separate system which lists the teeth by quadrant). Moving from the patient’s upper right is tooth #1. Then arching all the way across the front upper teeth to the upper left is #16. Drop down to the lower left, #17 and then go all the way around to the lower right, #32. The upper anterior teeth have the numbers #7,8,9,and10.
5. Particular dental procedures call for measurements or further detail in order to describe them accurately. Root canals are measured to the radiographic apex of the tooth. You’ll see various file sizes (numbered) and file lengths (in millimeters). Extractions are often described as full or partial boney. When the tooth is popped out intact, it is usually with the twist of an elevator. When the tooth breaks up, it is cut up or sectioned. The number of roots can be noted particularly if there is an accessory canal which was unanticipated or didn’t appear on x-ray.
6. X-rays are not often translated with a narrative description in the chart. They should be mounted or accessible electronically for digital systems. Intra-oral photographs might also be part of the chart. They document what the dentist is seeing. It is fairly easy to see failed dental restorations such as deformed amalgam or mercury fillings.
7. Gum pocket depths should be periodically taken. Each tooth can be measured (with 6 readings per tooth) or quadrants can be spot checked. 2s and 3s are good. 6,7, and 8 are not. These depths are measured in millimeters.
In order to evaluate whether a dentist has met the standard of care, a review of records is needed by a dentist. However, an experienced dental malpractice attorney can be fairly accurate in predicting when a dentist has met the standard of care and when he or she has not. Being able to accurately read the dentist’s chart notes is obviously a necessary starting point in the analysis.