[Medical expert opinions in oral and maxillofacial medicine regarding incisor tooth trauma]. / Frontzahntraumata als Gegenstand von Gutachten.

BACKGROUND: The treatment of traumatized patients plays a significant role in the everyday life of oral and maxillofacial surgeons as well as of dentists. Traumas of incisor teeth account for a considerable part. These traumas are often followed by lawsuits. The aim of this retrospective analysis was to highlight aspects of these lawsuits of special significance and to show the consequences for surgeons and general practitioners. MATERIAL AND METHODS: A total of 398 medical expert opinions were evaluated. Moreover, an online search of databases for relevant court decisions was performed. Analysis was initially based on formal aspects of the cases and reports. It was later supplemented by a differentiated assignment of the questions addressed by the courts to the expert consultants. RESULTS: In 97 (24%) medical expert opinions traumas of the incisor teeth were the main subject. In 35% the trauma was caused by traffic accidents followed by assaults. In one-third the medical expert opinion was commissioned by accident insurance companies. The compensation for pain and suffering was between 1500 and 2000 euros per lost tooth. CONCLUSION: Traumas of incisor teeth are often followed by litigations. Clinicians performing first treatment should ensure that documentation of clinical and radiological findings is detailed and complete. This documentation plays a decisive role in medical expert opinions.

Digital radiography and electronic data storage from the perspective of legal requirements for record keeping.

In some countries physicians and dentists are required by law to keep medical and dental records. These records not only serve as personal notes and memory aids but have to be in accordance with the necessary standard of care and may be used as evidence in litigation. Inadequate, incomplete or even missing records can lead to reversal of the burden of proof, resulting in a dramatically reduced chance of successful defence in litigation. The introduction of digital radiography and electronic data storage presents a new problem with respect to legal evidence, since digital data can easily be manipulated and industry is now required to provide adequate measures to prevent manipulations and forgery.

Forensic aspects of guidelines.

In lawsuits concerning medical or dental litigation a question regularly arising is whether the treatment was in accordance with best practice. In recent times doctors and dentists have increasingly been confronted with so called recommendations, guidelines, directives etc., which should help them to reach the required standard. They are theoretically legally binding in different degrees, for example, guidelines are not binding where directives are. Such differences however can hardly be expected to be reflected in everyday legal routine and no matter whether the doctor has deviated from a recommendation, a guideline or a directive, it will complicate the chances of success in a lawsuit. It is therefore important to be aware of these potential judicial implications when formulating guidelines and other instructions or recommendations in order to avoid paving the way for legal pitfalls, which at the very least would lead to over-defensive medical/dental practice. Nevertheless, guidelines can be of value as long as they are not rigid regulations but rather readily usable, comprehensible information on the current state of practice. They could then also have a positive influence on judicially commissioned expert evidence.

[Forensic evaluation of injuries to nerves and jaw bone after wisdom tooth extraction from the viewpoint of current jurisprudence]. / Die forensische Bewertung von Verletzungen der Nerven und des Kieferknochens nach Weisheitszahnentfernungen im Blickwinkel der aktuellen Rechtsprechung.

The removal of lower wisdom teeth is one of the most frequent operations in oral surgery. Iatrogenic lesions of the lingual and inferior alveolar nerve and fractures of the lower jaw are rare, but can lead to actions for damage and compensation for personal suffering. The aim of our investigation was to elaborate recommendations for the oral surgeon from the legal point of view. Therefore we investigated in two data banks all court decisions concerning wisdom teeth and analysed them in regard to the obligation to provide information, documentation and the minimum requirements of the surgical treatment. In 57% of all court decisions the obligation to provide information was omitted by the surgeon. Surprisingly, regarding injuries of the lingual nerve we found different opinions from various law courts. In some former decisions only the fact of the damage was equivalent to a lack of care, while recently other courts had the opinion that an injury of the lingual nerve could also be caused in spite of careful treatment. With regard to lower jaw fracture all courts emphasized that the patient must be informed about the risk by the surgeon. Moreover, minimum requirements for the removal of wisdom teeth were given. In conclusion, the recent court decisions restrict the liability for complications but demand the observance of minimum requirements for the surgical treatment. Additionally, all courts stress that informed consent about the risk of nerve damage of jaw fracture must be obtained before the removal of wisdom teeth.

Non-acceptance of prosthetic appliances at the focus of forensic consequences.

Non-acceptance of prosthetic appliances is not only a clinical problem; it also gives rise to legal proceedings. Not every case of non-acceptance is psychogenically induced, there are often somatic and even iatrogenic causes. Objective treatment deficiencies are subject to forensic sanctions irrespective of any underlying psychosomatic illness. If the dentist is to manage non-acceptance in a responsible way not open to forensic consequences, competent clinical and psychological skills are needed.

The duty of the dentist to keep records--significance and relevance according to German law.

A dentist is duty-bound to keep dental records. The keeping of accurate records is in fact a legal obligation and an integral part of the medical or dental contract which can be used as evidence in court and a patient has the right to inspect and to take possession of the objective information contained in the records. Incomplete or inadequate records lead to a reversal of the burden of proof in German jurisdiction.

[Dental alloys and allergy. Case report]. / Dentallegierung und Allergie. Ein Fallbericht.

The case of a 67-year-old woman, who had been wearing an upper partial removable denture with a cast metal framework made of CoCrMo alloy for years without any problems, is described. After the extraction of a molar tooth a nickel alloy retention was soldered to the framework. Following reinsertion allergic reactions appeared. The soldered joint showed considerable corrosion. After removing the retention and the soldered joint, the allergic reactions disappeared, although an epicutanceous test had revealed a positive reaction to cobalt. This case supports the high corrosion resistance and biocompatibility reported for CoCrMo alloys in the literature and the loss of these properties due to inadequate processing. Furthermore, the case illustrates a true allergic reaction. In contrast to the rather indiscriminate use of the term allergy to describe various vague disorders, this diagnosis should be restricted to clearly identified clinical situations.