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Orthodontic Treatment Causes TMJ Syndrome in case against Florida orthodontist

The plaintiff was a twenty-five year old legal secretary when in June, 1981, she visited the offices of a general dentist for a routine examination. The dentist suggested that she consult with the defendant who was an orthodontist and who worked in that general dentist's office one day per month. The defendant orthodontist owned family dentistry clinics throughout south Florida where he would see patients one day a week in each location. After examination of the plaintiff, the defendant made an entry in his office record describing his patient as an "extraordinary case". Notwithstanding this, he made no study casts, took no photographs and failed to conduct a cephalometric analysis to determine whether the patient had any skeletal defects and to determine the relationship between the jaws or the teeth to the jaws. The defendant decided that his patient needed space for the repositioning of her teeth so he ordered the extraction of four premolar teeth. After the teeth were removed he applied orthodontic brackets and elastic traction. A couple of months later, his patient complained of headaches and muscle pain in her neck and shoulders. He saw her monthly and made adjustments and she repeated her complaints each time stressing their increasing severity. The defendant apparently made no connection between her complaints and his treatment. At some point during treatment, the patient started complaining of pain in her temporomandibular joints, yet the defendant did nothing. The patient began seeing ENT surgeons, internists, neurologists and chiropractors. One of the many chiropractors she had seen suggested that she had TMJ Dysfunction Syndrome and referred her to a dentist who limited his practice to treatment of that disorder. He told her that the orthodontic treatment was causing the TMJ symptoms and referred her to another orthodontist for a second opinion. The consulting orthodontist concurred and suggested she have her braces removed. She returned to the defendant and he referred her to one of his orthodontic employees who worked in one of his other clinics. That orthodontist told her that the braces were moving her teeth in the wrong direction and removed the appliances. The patient started orthodontic treatment again, this time in the right direction and shortly thereafter had jaw repositioning surgery which she apparently needed from the outset. The defendant never realized the need for surgery since he never took the necessary cephalometric x-rays. Claim was not made for the surgery inasmuch as the patient had the skeletal defect upon presentation to the defendant who merely delayed that aspect of treatment. The case was settled after jury selection for $85,000, representing intangible damages only, inasmuch as the patient had full health insurance. Kenneth P. Liroff, D.D.S., J.D., of THE DENTALAW GROUP Ft. Lauderdale, FL represented the plaintiff. Carl M. Jenkins, Esq., Ft. Lauderdale, FL represented the defendant.