Well, that's where it gets sticky, doesn't it?  The issue medicolegally
really isn't whether it was unforseen, but whether it was reasonably
unforseeable, which is certainly arguable in many situations.
    As far as not disclosing risks that may alarm the patient, these are
exactly the risks that are most important to disclose--if not, how
"informed" is your informed consent?

Steve   

  If this were a

This sort of situation can/does occur.  A "bad result" is NOT malpractice --  
it is impossible to predict all the potential risks for any procedure.
Risks that are small and rare do not need to be disclosed to the patient.
Risks that might cause alarm to a patient usually don't need to be
disclosed, as disclosing of these risks might make a patient steer away from
treatment that is needed.  Whether your tooth needed to be extracted or not
should have been explained to you, and obviously, simply showing up for your
appointment and sitting in the chair would be evidence of consent on your
part.  The dentist should explain risks prior to treatment, and if this were
an unforseen risk then it need not have been disclosed.  If this were a
forseen risk, it probably should have been disclosed.  At any rate, right
now, I would be more concerned about fixing the problem rather than deciding
on who to sue or what to pay.  If you have a good relationship with your
dentist, this should be no problem at all!  Good luck.

    I wouldn't necessarily characterize the communication problem as
"stupid", but yes you should have had explained the precise reason for
the extraction and any significant risk that would have entailed.
    Many dentists choose to extract an unopposed third molar before it hits
the opposite gum.  Supereruption of an upper third molar also frequently
leads to a food impaction area between it and the second molar, and not
infrequently to decay on the distal surface of the second (as well as
third) molars.  Adjusting the bite would have confirmed that the contact
was causing the pain, but would not have prevented further
supereruption, so it is possible this would have been a continual problem.
    It doesn't sound to me as if you have a big problem here, and I
wouldn't judge anyone too harshly.

Steve

Steven Bornfeld,

I FINALLY think I see what you are trying to say. To summarize what I
got from your postings (please correct me if I have misread you):
1. Let the dentist lead the discussion, as he probably has a lot more
experience at this than I do.
2. Expect any "settlement" to be in services only.
3. There was NO stated risk, and no pressing reason to extract the
wisdom tooth other than its possible contact with the opposing crowned
and root canaled 2nd molar that was having some minor pain, possibly
from contact with the super-erupted wisdom tooth. Had I known about any
significant risk from extraction, then I probably would have left it
right where it was.

*HERE* is where the breakdown occurred, because I certainly didn't know
of any significant risk, and was not told of any. Indeed, I had been
saving that wisdom tooth to anchor a bridged 2nd molar if I should ever
need to for some reason, then in extracting the wisdom tooth, the very
tooth that it had been saved for was damaged. I would have been a LOT
better off by simply grinding some of the wisdom tooth off to avoid
contact with the opposing 2nd molar. All this from a stupid lack of
communication of what you have been explaining here.

Applying what you said to my precise situation, probably the wrong
decision was made (to extract the wisdom tooth) due to a lack of
communication (about the risks), incurring a needless risk (of damaging
the 2nd molar) that resulted in some hopefully minor damage (that the
dentist will probably fix for free). Hence, I should stop worrying about
this unless/until I run into some REAL problem. I have an appointment
for tomorrow when I should know a LOT more about this.

Thanks for your help here. I'll probably be a much nicer patient for it!

Steve Richfie1d
==============================

    Depends on the nature of the fracture.  You've already stated your chip
was small, so this is only an academic exercise.  A big fracture may
require crowning; there could be a need for crown lengthening;
conceivably root canal treatment; or maybe the tooth would be lost.

 What is a second molar

    Obviously there is no "open market" on second molars.  Also, obviously
this is not a dental question.  If you're asking what kind of settlement
this might lead to in a court of law, I cannot answer because I do not
know.  I'm guessing it would hinge not only on the value ("damages" in
legal terms) and the implication of negligence.  It certainly could be
negligence, but IMO not necessarily, because you would have to assume
that another dentist exercising due care would be able to do the
extraction without damage.  Depending on many factors which I can't go
into this is not necessarily a valid assumption.  I can tell you that
not infrequently an oral surgeon will decline to extract a wisdom tooth
for me for any number of reasons, but obviously if the extraction is
urgent sometimes a certain amount of risk must be assumed by the dentist
and surgeon and you hope for the best.  Here is where informed consent
is important, but all possible complications cannot always be predicted.
 That's just the nature of the beast.

    This is probably just as likely to happen with the amalgam.

    I'm sorry--I'm sensing a troll here, and I'm not going to get into a
complicated argument here.  Yes, unexpected things happen--to me too,
and I'm not an unsympathetic guy.  So in a situation where something
unexpected happens, I go over the situation with the patient and we come
to an agreement.  I'm not going to discuss the process, because it
depends on the situation.  But I've had very few serious conflicts over
30 years in practice, and I've never paid a patient for some perceived
harm.  I just don't see this scenario as realistic when two grownups are
dealing with each other.

    Doesn't matter what I think--I don't know enough about the particulars
of the case, and as I said I can't determine from what you've said that
there has been anything done incorrectly at all.  You'll have to work
that out with your dentist.

Steve

Steven Bornfeld,

How should such a major fracture be handled? What is a second molar
worth on the open market?! What would be a fair settlement?

It was by another dentist, but I'd rather wait as long as practical to
have my teeth last as long as I do. Most of these have big cracks but
are not broken (yet), and I presume that once the amalgam is dug out and
the tooth is crowned, that it will abscess in 15-20 years or so like the
last one I did, because of leakage through the crack, and have to be
pulled then. I expect to be around for more than 20 years, but who knows.

You didn't cover any of the interesting cases - where substantial repair
may now be needed that wasn't needed before the extraction. To my
untrained eye, this looks like a good candidate for some sort of an
inlay/onlay to replace the massive old amalgam, which now has a groove
the length of the tooth that I can stick the end of my fingernail into
leading from the point of damage. How do you deal with expensive repairs
to dentist-caused damage?

There has been much commentary here about the stress of dentistry,
obnoxious patients, etc. How does a patient go about NOT being obnoxious
yet still be treated fairly (whatever that is).

I was considering going in for a routine examination of the tooth
without first mentioning the extracted tooth and see what he says. If HE
decides that it needs expensive repair, then open the discussion as to
who pays what to have it done. Perhaps fair would be for me to cover his
out-of-pocket expenses, but have him work for free in repairing the
tooth that he damaged.

What do YOU think would be fair?

Steve Richfie1d

    The answer depends upon the state of the tooth.  If it is a small sharp
edge it may just need to be smoothed--no biggie.  If this is a massive
old amalgam you must understand that the tooth is probably fragile and
would have been a maintenance problem whether the wisdom tooth were
extracted or not.  Under the circumstances, a minor chip on the next
tooth might be considered a normal risk of the extraction, while a major
fracture leading to the loss of the second molar would not.
    If the tooth was considered a candidate for a crown beforehand, I don't
think the small chip changes the situation, though you may think about
having it done now.

Steve

I just had a super-erupted wisdom tooth extracted. After leaving his
office, I noticed that the 2nd molar was sharp, and on further
examination it appears that part of the filling is missing and possibly
a small part has been chipped off of the rear of the 2nd molar.

The 2nd molar now has a massive old amalgam that would have to be
replaced with something else.

What is a reasonable way of handling this, without yelling, screaming,
getting everyone's blood pressure up, etc? I am looking for fair and
reasonable rather than legal advice? Should I expect the dentist to fix
this for free, or chip in for part of the restoration?

Any thoughts?

Steve Richfie1d