About three weeks ago I published a post about a patient named Lyndi who had a large sinus perforation after her extractions. She responded telling me about her subsequent experiences, and I gave her some additional advice. Here is a copy of the follow-up correspondence with her.

Hi again Dr. Hall,
I thought I would send an update. I waited the full 2 weeks and saw the oral surgeon for the follow-up this week. In the meantime, I developed yet another bad sinus infection. I had my family doctor call me in antibiotics because I was really scared this infection would spread. I am still having a ton of drainage, but only from the left side, where the perforation occurred. It still pours out my left nostril when I gargle and I have had that same drainage in my denture. The oral surgeon poked around with a q-tip, which was very painful, and said the hole is sealed. He also had me plug my nose and blow (I didn’t blow hardly at all for fear I’d make it worse). I questioned him due to the above symptoms and he basically crossed his arms and said “look I told you the hole is healed and you don’t need surgery. You should be happy.” I explained that news sounds great, but I’m confused and that was the end of my appointment. I’m so lost, still quite sick (4 weeks straight now) and really don’t know where to turn.

I don’t want to make trouble but I am extremely frustrated. I’m out of sick pay, so I’ve lost some pay and also had to work even though I’m sick. I am emotionally and physically exhausted. I still can’t eat well, can’t chew at all for the pain is intense and not worth it. I’ve lost at least 15 lbs and I’m small to begin with. I deal with this horrid smell/taste all day every day and I know it is the infection. I explained all this to the original dentist. Again, any advice would be much appreciated. I am a social worker and advocate for people every day, but for some reason I’m having trouble being heard in this situation.
Lyndi C.

Lyndi,
I’m just going on what you were able to tell me, but the feeling I got from what the oral surgeon told you as opposed to what the ENT doctor told you was that the ENT doctor was the one you should trust. I don’t like it when doctors talk to you the way you are saying this oral surgeon was talking to you. Lecturing you that you should be happy? You’re not happy, and he should care enough to listen to why. There are two ingredients to quality medical and dental care–competence and caring. One without the other isn’t quality care.

Why don’t you just stick with the ENT doctor? It doesn’t sound to me like this oral surgeon cares whether you are sick or not or how much work you are missing. And the oral surgeon could well be buddies with the dentist. He probably gets referrals from her, so part of what is going on may be that the oral surgeon is trying to downplay the seriousness of your complications to protect the dentist.
Dr. Hall

Second follow-up, a couple of weeks later

Dr Hall,
You have been so kind to answer my questions and I appreciate it a great deal. I do still have a small hole that does not want to heal for some reason. I’m under the care of yet another ENT who appears to be taking me seriously. I wanted to update you as I finally received my medical records from the original dentist. My “informed consent” does not have a date, nor my signature. As a matter of fact, on the signature line it states, “reviewed with patient, not signed due to sedation.” Apparently they said they went over this with me the morning of my procedure, while I was under the influence of benzos, as I had been prescribed and told to take both pills 1 hour prior to my appointment. The dentist is refusing to pay my medical bills, saying they forgave my balance with their office in order to free up my money so I could pay the medical bills. I am completely aghast. I have called an attorney but still waiting for a call back. Any comments or advice is appreciated.
Thank you for your time.
Lyndi C.

My response:

Lyndi,
From what you have told me, you have a very valid complaint, and I have some words of advice for you.
First, I would tell the dentist that you are contacting an attorney and let them know that they could make this a lot easier on themselves if they just pay your medical bills, if that’s all you’re asking. When you mention that an attorney is going to get involved, that should trigger a call by your dentist to her malpractice insurance carrier, and they would likely advise her to settle this before it gets out of hand and may reimburse her for any expenses involved in settling it.
You didn’t give them consent, so they are on pretty shaky ground. It seems reasonable to assume that you were too sedated at the time to sign your name, so clearly you were too sedated to give consent. But you have more grounds than just that, as, from what you have told me, they fell short of the standard of care in several important respects.
I may not be getting all this right, but I’ll make a list of what is in my head of their mistakes, as I remember your case and refresh my memory by scanning your emails.

Mistakes made by this dentist:

1. Not getting informed consent from you (consent under sedation isn’t consent).
2. Poor extraction technique resulting in bone fragments being left at the surgical site, a large sinus perforation, and infection (and, I suspect, material being pushed up into the sinus).
3. Not telling you on the spot that there was a sinus perforation.
4. Not beginning treatment of the sinus perforation until the day after.
5. Starting off with the wrong antibiotic.
6. Not changing the antibiotic in a timely manner.

They should compensate you for all the post-operative care expenses you incurred, not to mention the time you missed from work, in my opinion. And, if your case got into court, I think you would be entitled to significant pain and suffering damages and possibly a punitive award.
You also have remedies beyond just going to an attorney, and you might want to let them know you are aware of those. You could complain to the state dental board, and you could complain to the dental insurance company. The dentist would not want either of those to happen.

You could let the attorney know that you have shared details of this with me and that I said I believe you have a strong case. A requirement of any successful malpractice case is the opinion of another professional that the care was substandard. But hopefully the dentist will be reasonable and you won’t need to take that step.

The oral surgeon is very possibly a buddy of the dentist, which could be why you didn’t get very good care there and had to go to the ENT physician.

Dr. Hall

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