When it comes to evaluating a case for dental damage, regardless if it is a motor-vehicle accident, slip and fall, or assault, there are 7 broad categories that I assert are important to evaluate;
- The plaintiffs complaint
- The history of the injury – i.e. pre-existing issues if any
- Past medical history
- A review of all the records, including medical, dental, police report, EMS report, all pre and post DOL (date of loss) x-rays, all depositions, any prior depositions, any written reports – especially from other experts
- Performing an IME/DME; and
- Written report that includes the assessment and of course the conclusions
I am always interested in the pre DOL condition of the patient. There have been countless times that I am examining a plaintiff who asserts that the accident has caused a loss, yet the pre-DOL records indicate otherwise. That is why ascertaining the plaintiff’s overall general health, dental health, and prior treatments, as well as prior diagnosis that may or may not have been treated is essential.
For example, a patient on medications that causes xerostomia (dry month) will have devastating dental effects. Saliva acts as a natural lubricant for the teeth; with a decreased salivary flow, we can expect higher incidence of cavities and more dental infections (oral candidiasis), as well as many other problems affecting the dentition. Knowing this medical condition helps the dental expert determine the current dental condition and helps better evaluate the purported complaints.
Understanding the mechanism of injury is another crucial component of the evaluation process. It is important to remember that the mechanisms for injury may be present (i.e., a face hitting a steering wheel), but causation is an issue according to the medical records. For example, let’s say the plaintiff states that the force of the MVA caused their face to hit the steering wheel, thus knocking teeth loose. However, the medical records show no bruising on the face, no hospital records with any facial complaints and no dental follow up for a period of time post DOL with any diagnosed dental damage, then there is a strong argument that there is no causation.
It is important to keep in mind that the mechanism of injury refers to the circumstances or the conditions in which an injury occurred, not if there is actual damage. Causation is the causal relationship between the conduct and the result, a connection to the injury.
So, in order for the defendant to be held liable for the tort of negligence, the defendant must have proved 4 conditions:
(1) the defendant owed the plaintiff a duty of care (the implicit responsibilities held by individuals towards others within society);
(2) the defendant breached that duty;
(3) by so doing caused damage to the plaintiff; and
(4) that damage must not have been too remote.
Causation is but one component of the tort.
The last item – damage must not have been too remote is crucial as I often see that the plaintiff has tremendous pre-DOL conditions that they are now claiming were caused by the accident.
And finally, I find the IME/DME one of the best times to truly evaluate the case, learn from the plaintiff what their issues are and take my studies, photos, x-rays and models if appropriate. Without this, the limitation of the record review severely limits the overall picture.