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New Legislation In California Proposed to Increase Medical Malpractice Damage Caps: Why It is Important if you Are Having Wisdom Teeth Extracted

Posted on 13. Sep, 2014 by .


A recent piece over on titled “Dentists fight Calif. malpractice insurance ballot measure” draws attention to new proposed legislation in California (California Proposition 46) see The article discusses the previous medical malpractice legislation in California called the Medical Injury Compensation Reform Act (MICRA) which placed a $250,000 cap on noneconomic damage awards. The act did allow for unlimited economic damages and out of pocket costs.

The article then discusses Proposition 46 in California written as “The Troy and Alana Pack Patient Safety Act,” to quadruple MICRA’s cap on noneconomic damages to $1.1 million. This actually simply changes the original $250,000 non-economic damage cap established in 1975 to what it would be today if it was indexed for inflation. I have previously discussed this over at The article goes on to get commentary from a past California Dental Association president and why dentists should vote no on Prop. 46 come November. The dentist is quoted as saying

“Proposition 46 was written by trial lawyers who stand to profit from medical lawsuits. They have thrown in other provisions under the guise of so-called patient safety, but this is really about lawsuit profits.”

The dentist encourages people to visit the website. The website provides further information on their interpretation of the facts of Proposition 46. A more impartial discussion of Proposition 46 is found over at,_Medical_Malpractice_Lawsuits_Cap_and_Drug_Testing_of_Doctors_%282014%29. As stated on this website the initiative if approved does the following:

  • Increase the state’s cap on damages that can be assessed in medical negligence lawsuits to over $1 million from the current cap of $250,000.
  • Require drug and alcohol testing of doctors and reporting of positive tests to the California Medical Board.
  • Require the California Medical Board to suspend doctors pending investigation of positive tests and take disciplinary action if the doctor was found impaired while on duty.
  • Require health care practitioners to report any doctor suspected of drug or alcohol impairment or medical negligence.
  • Require health care practitioners to consult the state prescription drug history database before prescribing certain controlled substances.

I am not really sure why the proposition includes different areas that are lumped together. This has caused some controversy as the drug testing of doctors was called out as deceiving voters behind the real intent.

Nonetheless the important point here is for those young patients in California who may be having wisdom teeth removed; how will this effect them? Many young adults having wisdom teeth extracted are still in school (high school or college). Thus they are not in their chosen career yet and in many cases have no wages. The unlimited damage caps established under MIRCA only cover lost wages and lifetime earning potential. If you have your wisdom teeth removed while in school and suffer a complication and sue and win in California currently you will only get $250,000 at the most, before attorney fees. If you then can not go on to your intended career, due to disability, you won’t be seeing anything else. If you are only around 20 years of age, $250,000 won’t last you very far for 60+ years potentially.

Thus I have advocated for those in California having wisdom teeth extracted, they should get it done in another state that has higher non-economic damage caps. If you want to be able to instead see local doctors then I would consider voting yes on Proposition 46.

Several health groups are against Prop. 46 such as they California Dental Association, California Medical Association, American Medical Association, and California Association of Oral and Maxillofacial Surgeons. Look as discussed in the In My View column in AAOMS Today (June 2014) first year oral and maxilofacial surgery income is $250,000. After a few years the compensation increases to $337,000. Hence the MIRCA cap non-economic represents a year or less than a year wage of what an oral and maxilofacial surgeon makes. If you get injured while having wisdom teeth extracted in California and have not yet established your career you will be the one hurting, not the surgeon.

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The Culture of Safety in Oral and Maxilofacial Surgery

Posted on 06. Sep, 2014 by .


Previously in a post over at, I discussed how the Journal of Oral and Maxillofacial Surgery is introducing a new perspectives section which

“…will offer essays written on topics of interest to our specialty, including health policy, clinical controversies, and education and research matters, as examples.”

On of the first perspectives section is written by Suzanne Morse Buhrow and titled “Promoting a Culture of Safety in Oral and Maxillofacial Surgery: The Time Is Now!” in the February 2014 Journal of Oral and Maxilofacial Surgery, pp. 239-240. The article opens by discussing the origins of the patient safety movement in the 1980s after the Institute of Medicine said 98,000 patients will die and 1.5 million will be injured every year from preventable medical errors in the United States. The article mentions how the National Practitioner Data Bank in the U.S. shows over 10% of all malpractice payments are from dental procedures.

The article mentions a study from 2010 which said only 43% of oral and maxillofacial surgeons have reported a wrong site tooth extraction, mentioned as a leading preventable error. Further the article says only 60% of physicians share and report adverse events. The article applauds the American Association of Oral and Maxillofacial Surgeons (AAOMS) for promoting a culture of safety. The article then outlines some steps to help continuing to promote a culture of safety in oral and maxillofacial surgery

  1. Creating a sense of urgency for patient safety
  2. Providing training on the science of safety to physicians and their staff
  3. Using validated assessment tools for patient safety
  4. Creating a federally recognized patient safety organization for oral and maxillofacial surgery.

The author mentions that insuring a culture of patient safety in oral and maxillofacial surgery is vital to restoring the public confidence in surgeons who are providing the care. Further it is important to move away from a name and blame culture to a sharing and learning from errors culture.

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More Dental Patients Warned of Potential HIV and Hepatitis Exposure in Pennsylvania

Posted on 30. Aug, 2014 by .


Back in July, 2014, I discussed a case in Pennsylvania where dental patients where made aware of possible HIV and hepatitis exposure due to infection control lapses by a dentist. This led to a 74 year old dentist having his license suspended. A video interview of several students who were treated by the dentist said that sometimes the dentist didn’t wear gloves and didn’t wash his hands between patients. See the blog post located over at

An additional case of infection control lapses has also occurred in Pennsylvania. The dentist had his license temporarily suspended due to an investigation by Pennsylvania’s department of health. A press release issued said the dentist “…did not follow appropriate procedures to properly clean, disinfect, or sterilize dental tools used at his…office.”

The investigation showed the dentist admitted that he and his staff do not send out samples for biological spore testing which to make sure that sterilization is occuring. Furthermore it is not clear when the dental instruments were last sterilized including metal impression trays and dental tools.

As such the health officials have encouraged former and current patients of the practice to get tested for potential hepatitis and HIV. A few of the patients are of course shocked and surprised as they felt they could trust their dentist.

In past blog posts, other cases have been described where dentists or oral surgeons were suspected of potentially not following proper infection control procedures. See for example see the post Dental Patients Warned of Possible HIV and Hepatitis Exposure Due to Oral Surgeon’s Practices and the post Oral Surgeon Investigated for Reusing Needles and Syringes.

For more information on the dentist in question in Pennsylvania see article titled Dentist’s License Temporarily Suspended located over at and written by Nikki Kraze on June 27, 2014.

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FDA Issues Alert to Prevent Lidocaine 2 Percent Solution to Not be Used for Teething Pain for Children

Posted on 23. Aug, 2014 by .


On June 26, 2014, the FDA issued an alert warning health professionals and providers that “…prescription oral viscous lidocaine 2% solution should not be used to treat infants and children with teething pain.” The FDA says that topical pain relievers and other medications that are rubbed on the gums are not useful for infants because they wash out of the mouth within minutes. Furthermore, when too much viscous lidocaine is given to children and is swallowed it can result in brain injury, seizures, heart problems, and even death.

The FDA alert is located over at In the background information it states

“In 2014, FDA reviewed 22 case reports of serious adverse reactions, including deaths, in infants and young children 5 months to 3.5 years of age who were given oral viscous lidocaine 2 percent solution for the treatment of mouth pain, including teething and stomatitis, or who had accidental ingestions.”

The FDA advises that parents should follow the American Academy of Pediatrics’ recommendations to treat teething pain. This includes used a chilled teething ring and having the parent gently rub or massage the child’s gums. Furthemore, the FDA advises against using any over the counter topical medication to treat teething pain.

According to DrBicuspid the “The American Academy of Pediatric Dentistry recommends that all children have their first dental visit as soon as teeth begin to come in, and no later than age 1, which provides the dentist with an opportunity to chat with parents and caregivers about proper tooth care…” Further, they remind parents that teething pain is a normal part of childhood. See AAPD issues statement on FDA lidocaine alert, July 1, 2014,

As a result of the FDA alert, they are also requiring a new Boxed Warning to be added to lidocaine 2 percent solution to highlight the information in their alert. In the alert the FDA also reminds individuals about a previous alert in 2011 where over-the-counter benzocaine teething preparations can cause methemoglobinemia, a rare but serious blood condition. This results in a large decrease in oxygen carried in the blood.

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The Image Gently Campaign in Dentistry

Posted on 16. Aug, 2014 by .


If you keep abreast at all with radiation exposure from medical imaging, you may have heard of the Image Wisely campaign. The Imagely Wisely Campaign was designed to have people aware of the fact that certain medical imaging tests such as CT exams are sometimes over used and do not have to be used in certain instances. The goal is to reduce radiation exposure to patients while still providing good medical care, see The Image Gently campaign is designed to provide information to parents and others to help reduce exposure to radiation for children, see, and has been around since 2007.

The campaign is supported by the Alliance for Radiation Safety in Pediatric Imaging, which is a coalition of healthcare organizations dedicated to providing safe and high-quality pediatric imaging. Recently, it has been announced that a new Image Gently campaign in dentistry will be launched in September, 2014. The Image Gently alliance partners in dentistry consist of groups such as the American Dental Association and American Association of Oral and Maxillofacial Surgeons.

The campaign states that radiographic selection should be based on professional judgment after taking a history and clinical examination. The campaign says that x-rays should be selected for individual needs and not used routinely. For example, if proximal surfaces of the teeth can be visually inspected then it is not necessary to take bitewing radiographs. The campaign states that imaging should be done that generates images the fastest (while of course preserving quality). For intraoral radiography F-speed should be used and for digital imaging the exposure parameters should be set as low as possible to preserve diagnostic ability. The campaign says that the beam should be collimated to the area of interest.

Other insights from the Image Gently campaign in dentistry include using thyroid collars when imaging children and using less exposure time for children than adults. The campaign also says that cone-beam CT should only be used when it is essential for diagnosis and treatment. This is because it can cause more additional radiation exposure than alternative methods.

I have previously commented on using x-rays for wisdom teeth diagnosis and planning see

Source: Allan Farman. DrBicuspid. Image Gently in Dentistry: Child-size x-ray dose for kids. July 28, 2014.

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