This case involves an elderly male patient who wanted to improve his smile by removing his remaining teeth and using dentures. After the extraction and trial use of the dentures, the doctor told him that he had severe bone loss, which would cause the dentures would move and float. The patient was then told that he would need to receive dental implants in order to achieve a similar cosmetic and functional effect. According to the patient, he would not have undergone the original extraction procedure if he had been aware of the bone loss, and claimed that he lacked adequate information to consent to the procedure.
Question(s) For Expert Witness
- 1. How often do you perform tooth extraction for dentures?
- 2. Before such a procedure, do you explain the possibility of needing to use implants instead of dentures?
- 3. What is the work-up before tooth extraction and would it have revealed bone loss?
Expert Witness Response E-006947
I am a full professor and director of the General Practice Residency and Division Chief of General, Pediatric and Public Health Dentistry at my institution. I routinely remove teeth. I always discuss the need for implants to stabilize dentures before removing teeth in preparation for dentures. Radiographs and clinical examinations provide the fundamental information regarding bone quantity, contour, and quality. Regardless of the amount of preparation, quality or contour patients often have trouble tolerating dentures and may require implants for adequate retention and function. This is a problem I routinely deal with in patients who have teeth removed and replaced with dentures.
Expert Witness Response E-004499
I am an Associate Professor in the Oral & Maxillofacial Surgery department at a college of dental medicine and I’m perpetually involved in exodontia and related prosthetic fabrications and delivery. Before EVERY procedure there should be a treatment plan outlining risks & benefits, including alternative modes of treatment. An Informed Consent should also be presented and signed. A clinical examination and appropriate radiographs are tantamount to explain and perform the procedures. It seems as if the disconnect is due to communication between the patient and the provider, which is often the catalyst for litigation.