Case Study: Providing an Expert Second Opinion on Dental X-Rays

Jeff Rabinowitz

Dental Expert Witness

Post Publish Date

September 22, 2021

Post Categories

You might assume that x-rays make dental malpractice cases extremely open-and-shut affairs—after all, how complicated can a suit possibly be when there’s visual evidence of the work that’s being disputed? But the reality is that to some extent, even x-rays are open to interpretation. Certain dentists have even been known to apply a little too much—well, let’s call it creative license—to the way they read x-rays.

A picture may be worth a thousand words, but people who look at the same image don’t always see the same thing. The years I’ve spent providing second opinions on dental x-rays have taught me the value of retaining an expert witness who can help a courtroom see the same thing your client is seeing. Keep reading to learn how having the right dental expert witness in your corner can benefit you the next time x-rays are presented as evidence.

What Do Dental X-Rays Show?

Dental x-rays are used in a wide variety of situations to display details that cannot be properly assessed during a visual examination. Using electromagnetic radiation, x-rays allow dentists to look at areas beneath a patient’s skin and diagnose issues related to:

  • Teeth
  • Bones
  • Soft tissues
  • Restorations and Implants

Dental x-rays are often used to identify dental decay, bone loss, and hidden dental structures like wisdom teeth. However, different types of dental x-rays exist for various purposes.

Types of Dental X-Rays

Common types of dental x-rays include:

Bitewing X-Rays

These x-rays provide a single view of both the upper and lower back teeth. They are often used to examine the alignment of the upper and lower teeth with each other, and to show  dental decay between the teeth. In cases of severe gum or bone disease or infection, bitewing x-rays may also be able to show bone loss.

Periapical X-Rays

These x-rays display entire teeth, including:

  • The tooth’s exposed crown
  • The end of the root
  • The bones that surround and support the tooth

Periapical x-rays are particularly useful for finding dental problems underneath the gum line and inside the jaw. Abscesses, cysts, tumors, and impacted teeth can all be diagnosed this way, along with certain bone changes.

Occlusal X-Rays

These x-rays allow dentists to examine the roof and floor of the mouth. Like periapical x-rays, occlusal x-rays can detect cysts and abscesses. However, they are also especially helpful for finding growths, clefts, jaw fractures, malpositioned and supernumerary (extra) teeth—including those that have not yet broken through the patient’s gums.

dental xray

Panoramic X-Rays

These x-rays can take images of several areas at once, including the teeth, jaws, and sinuses. Panoramic x-rays can also help dentists examine a patient’s nasal cavities and temporomandibular joints. Dentists may use panoramic x-rays to look for impacted teeth, cysts, solid growths, fractures, bone abnormalities, and infections.

Case Studies: When Do Malpractice Suits Involve X-Rays?

Dental x-rays can become critical evidence in malpractice suits under many circumstances, but some of the most common claims involve:

  • A dentist who failed to take x-rays
  • A dentist who mis-read, mis-interpreted or misdiagnosed x-rays
  • A dentist who failed to act on the results of an x-ray
  • A dentist who misrepresented the results of an x-ray

We won’t spend too much time discussing dentists who allegedly fail to take x-rays, since that’s fairly easy to prove or disprove—either the x-rays exist or they don’t. But it’s worth noting that most dentists take a full mouth series of periapical x-rays for each new patient during their first visit and that they should be repeated on a regular, safe and therapeutic basis and frequency.

Bitewing x-rays should also be performed periodically during checkups, and occlusal or panoramic x-rays should be taken as needed when looking for specific issues. Dentists who don’t take x-rays as often as they should aren’t protecting their patients (or themselves).

When considering dentists who allegedly fail to act on x-ray results, expert witnesses become much more valuable. Consider a patient (let’s call her Sarah) who received bitewing x-rays during a checkup and later experienced a root canal as the result of severe tooth decay. Imagine that she sues her dentist, alleging that her x-rays revealed the tooth decay during her checkup and that her dentist failed to provide appropriate treatment in a timely manner.

In this case, a dental expert witness could prove invaluable for either party. An expert witness for the plaintiff might review the x-rays and find information that substantiates Sara’s claim, whereas an expert witness retained by the defense  might help prove that the x-rays did not show sufficient tooth decay for her dentist to have taken a different course of action.

Importantly, recommending taking or not taking dental x-rays is a matter of professional judgment that dentists are responsible for. Missing pathology by not taking x-rays is inexcusable, even if insurance or finances may influence decisions. Placing an implant that injures a nerve because a dentist did not bother to take or interpret a 3-D CT scan is similarly negligent. Dentists are best serving their patients by doing the right thing – recommend x-ray imaging that is safe, prudent, properly timed and effective diagnostically. It supports good dental diagnosis and care and it protects both patient and practitioner.

Dental X-Rays as Fraud Protection

Dental expert witnesses can also be extremely useful in cases involving fraud. These cases aren’t terribly common (and they certainly shouldn’t be), but they do happen from time to time.

Before a patient visits the dentist, someone from the office usually checks with that patient’s insurer to see what radiographic services they’re covered for. That means the dentist knows exactly what services are considered by the carrier every visit—and unfortunately, some dentists take that for granted.

An unscrupulous dentist may commit fraud by recommending a treatment based on what they are likely to be reimbursed for instead of what will actually help the patient most. If the patient suspects this and sues, any x-rays taken prior to treatment become critical pieces of evidence in the case. An expert witness can review them to determine whether the recommended treatment was appropriate, or whether the dentist acted improperly.

Choosing Your Dental Expert Witness

When choosing a dental expert witness for a case involving x-rays, make sure to look for the following qualifications to ensure your witness has hands-on experience with the techniques and technology involved:

Witness the Results

Dental x-rays can be extraordinarily useful when you’re involved in a malpractice suit, but they aren’t enough to guarantee the outcome you want by themselves. It’s also vital that you retain an expert witness who can confirm your interpretation of the x-rays and support your argument when preparing or presenting your case.

Learn more about finding the right expert witness for malpractice suits involving x-rays by reaching out to me with your questions. I’ll be happy to tell you more about how I approach cases involving x-rays and help you make an informed decision about how to proceed with your case.

dr Jeff Rabinowitz

Jeff Rabinowitz

After earning his Bachelors and Doctoral degrees from the University of Pennsylvania, Dr. Rabinowitz completed residency training at the Mount Sinai Medical Center in New York City. He subsequently completed Fellowship training in Implantology and Periodontics at New York University and in Parenteral Conscious Sedation at St. Joseph and Brookdale Medical Centers. He established a multi-specialty group practice in Manhattan, he taught at Mount Sinai and he has pursued years of extensive advanced education programs and has maintained an active practice in implantology, complex restorative and prosthodontic care, periodontics, oral surgery, bone and soft tissue grafting, Invisalign and cosmetic dentistry. Dr. Rabinowitz holds a faculty appointment, teaching dental students at Touro College of Dental Medicine.

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