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- DENTAL MALPRACTICE - ALLEGED MISUSE OF NEEDLE DURING EXTRACTION OF WISDOM TEETH - NEEDLE BREAKS IN GUM - CONTINUED JAW PAIN - ALLEGED ALTERED APPEARANCE - FEAR OF MIGRATION.

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 plaintiff’s 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 plaintiff’s 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 plaintiff’s 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 surgeon.

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 plaintiff’s gum.

The defendant contended he specifically chose a 30 gauge short needle (a short, thin needle) to minimize the plaintiff’s pain. He had anesthetized all other quadrants of the plaintiff’s mouth with the same needle, so the needle had been used for eight punctures and broke on the ninth puncture.

The plaintiff’s dental expert testified that the defendant used the needle too many times during the procedure, thus weakening it. The plaintiff’s 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 plaintiff’s expert.

The plaintiff’s 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 plaintiff’s 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 defendant’s 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 defendant’s 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 dentists.

The defendant dentist testified he did not push the needle into the plaintiff’s gum down to the hub. The defendant’s 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 alleged.

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 defendant’s 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 dentist’s 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 manufacturer’s 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 bent.

The additional defendant manufacturer was granted nonsuit as to the plaintiff’s 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.