Philadelphia County (41005)
The plaintiff alleged the defendant general dentist misused a needle
during extraction of her wisdom teeth, causing the needle to break
off in her gum. The needle tip could not be removed due to its proximity
to the alveolar nerve and remains in the plaintiffs gum. The defendant
dentist contended the needle was appropriately selected and used.
The defendant maintained the needle breakage resulted from a manufacturing
defect and named the manufacturer of the needle as an additional (third-party)
defendant in the case. The manufacturer denied the needle was defective
and agreed with the plaintiffs position that the needle was misused
by the defendant dentist.
The female plaintiff was 20 years old on August 28, ________, when the
defendant attempted to perform an extraction of all four of her wisdom
teeth. During the procedure, the needle being using to anesthetize
the left lower portion of the plaintiffs jaw with Lidocaine broke
at the hub (where the needle meets the syringe).
The defendant informed the plaintiff of the breakage and attempted
to extract the needle from her gum. When the defendant was unable
to retrieve the needle, he drove the plaintiff in his car to an oral
The oral surgeon was also unable to remove the needle. The plaintiff
went to Temple University Hospital two weeks later to have it removed
under general anesthesia. However, doctors felt continued attempts
to remove it would pose too great a risk of nerve damage, due to the
proximity of the needle tip to the left alveolar nerve. The needle
fragment, which is just under an inch long, remains in the plaintiffs
The defendant contended he specifically chose a 30 gauge short needle
(a short, thin needle) to minimize the plaintiffs pain. He had anesthetized
all other quadrants of the plaintiffs mouth with the same needle,
so the needle had been used for eight punctures and broke on the ninth
The plaintiffs dental expert testified that the defendant used the
needle too many times during the procedure, thus weakening it. The
plaintiffs expert opined the defendant was using the wrong kind of
needle which was too short and too thin (30 gauge). A longer 27 gauge
needle, which is thicker and stronger, should have been used, according
to the plaintiffs expert.
The plaintiffs expert also concluded that the defendant misused the
needle by bending it when he inserted it into the gum tissues. The
plaintiff contended the needle was bent severely and pushed down to
the hub, causing it to break. The plaintiffs expert testified that
needles should never be pushed all the way to the hub.
The plaintiff testified she suffered continued pain and swelling of
the left jaw and there were times when she was disabled due to jaw
pain. The plaintiff missed several days of work from her employment
as an insurance underwriter. She claimed her jaw pain affected her
ability to concentrate and caused a facial disfigurement due to swelling.
The plaintiff also expressed a fear the needle could migrate in the
future. Testimony established she will never be able to undergo an
MRI of the head, so long as the needle fragment remains.
The defendants oral surgeon testified it is within the standard of
care to use the same needle for all punctures in the same sitting.
This expert testified he has used the same needle up to 12 times.
The defense argued there are "two schools of thought" regarding the
size of the needle used. The defendants expert testified he personally
prefers a larger 27 gauge needle. However, he testified that use of
a 30 gauge needle is perfectly acceptable and is preferred by some
The defendant dentist testified he did not push the needle into the
plaintiffs gum down to the hub. The defendants expert testified
the distance the needle had to traverse from the outside of the tissue
to the location for injection of the anesthesia was less than one
inch and the needle was longer than one inch. Accordingly, the defense
argued the defendant would not have pushed the needle to the hub as
The defendant dentist called an expert metallurgist who testified
he examined the needle fragment left on the end of the syringe and
found the needle was defectively manufactured. He testified that examination
under an electron microscope revealed a microscopic hole or inclusion
occurred during the manufacturing process. The inclusion represented
a foreign body which was incompletely smelted out of the steel and
left a fossilized hole in the metal, according to the defendants
expert. He concluded the inclusion was located in the area where the
crack in the needle began to propagate, the needle failed under very
low stress and was not being bent in any unusual manner.
The additional defendant manufacturer called an engineer who testified
there was no manufacturing defect in the needle in question and it
broke due to excessive force and improper use. This expert testified
that the so-called "inclusion" described by the defendant dentists
expert is inherent in the stainless steel manufacturing process and
would represent, at most, a potential weakening of the needle wall
in the amount of 4/________ of one percent. The defendant manufacturers
expert also testified he discovered, through use of electron microscope
photographs, that the needle had struck and gouged the funnel-shaped
hub walls which could only have happened if the needle had been severely
The additional defendant manufacturer was granted nonsuit as to the
plaintiffs claim, but remained in the case on the claim for indemnification
brought by the defendant dentist. The jury found the defendant dentist
was not negligent.