Tooth extraction brings unlikely complications

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Dave Lathrop is photographed at his workplace, Gary Electric Motor Service in Gary, Ind. Novmeber 3, 2011. | Stephanie Dowell~Sun-Times Media

Updated: December 29, 2011 8:00AM

Dental visits pose painful reminders for David Lathrop of Crown Point.

Lathrop, a 58-year-old bookkeeper, still walks with a limp and suffers weakness and slight paralysis resulting from a common, everyday dental procedure performed eight years ago.

He is still recovering from a health care nightmare that began in 2003 with a toothache and ended in a misdiagnosed brain tumor, brain surgery and hospital bills that topped $100,000.

In September 2003 Lathrop visited his dentist, complaining of pain in tooth number 31, a wisdom tooth. The dentist ordered an X-ray, which indicated no problem. But six weeks later Lathrop said he tasted something sour in his mouth and reported it to the dentist, who referred him to an oral surgeon for extraction.

“Part of the problem is that the (painful) area wasn’t red, swollen or visible,” he recalled. “It (the infection) was missed, even though I complained about it.”

Lathrop said his voluminous medical records verify that the oral surgeon used that same X-ray to prescribe the tooth’s extraction, though Lathrop wanted to save the tooth with a crown or root canal. He said the surgeon insisted on pulling it. Five days after the extraction he remembered getting a severe “temple to temple” headache that wouldn’t disappear and the next day noticed he was losing control of his right hand.

“It was like when you drink a Mr. Misty real fast, that painful, but constant,” he recalled.

“I’m a bookkeeper. At work I sign checks all day. So I noticed right away when my hand wasn’t working. My hand wasn’t moving the way I directed it. There was no numbness or pain, but a lack of control.”

Lathrop, a Gary native who has worked for Gary Electric Motor Service since 1999, said he was in otherwise fine health when this happened.

“I’d never been in a hospital a day in my life,” he said. “And I don’t smoke either.”

He saw his family physician, who sent him immediately to the hospital. Lathrop drove himself to the emergency room with his right arm totally paralyzed terrified that he was having a stroke.

Paralysis worsened

After he arrived at the hospital the emergency department staff took an MRI, which Lathrop said revealed a white mass on the right side of his head.

“They told me: ‘You have a brain tumor.’ I asked if it couldn’t be due to an infected tooth. I told them I’d just had a tooth pulled and thought it might have something to do with my tooth. I had a friend who contracted spinal meningitis from getting his teeth cleaned. But the doctors said: ‘Face it: you have a brain tumor. And it has to come out.’ What I had to say wasn’t even considered,” he said.

He was admitted to the hospital that night. “By this time my leg was paralyzed, too” he said. “I’d walked into the hospital under my own power and now my whole right side was paralyzed.”

Days later the hospital staff transferred Lathrop toanother hospital, one that offered a laser-directed gamma knife to remove the tumor. Further MRIs revealed the tumor was growing rapidly.

“They were starting to think it would be inoperable,” Lathrop said he was told by doctors. That’s when his family requested a biopsy to determine the size and stage of the tumor.

“The doctor said it was unnecessary because they would have to open my skull anyway,” Lathrop said. He said after the operation the doctor revealed there was no tumor. “Later tests show that the fluid in my brain included bacteria from my infected tooth,” Lathrop said.

He’d spent one week in the intensive care unit and two months more in the hospital.

Lathrop said if doctors had performed the biopsy, they would have discovered much sooner that it was an abscess, not cancer, and could have removed it sooner.

“And the growth wouldn’t have mushroomed from a golfball-size tissue to one as big as an orange. They never considered it could have been an abscess. They never listened to me,” he said. “I told a dozen different people at both hospitals I thought it was related to my tooth removal.”

Years of intense physical therapy have improved function, but Lathrop’s right-side paralysis has not completely disappeared, though he needed to relearn many skills, including how to drive.

Extremely rare case

Two federal agencies that track public health issues, diseases and health care quality said severe infections following dental surgery are extremely rare. A spokeswoman for the Atlanta-based U.S. Centers for Disease Control and Prevention said because post-surgical dental infections are so rare, the agency has not researched the topic or made treatment recommendations for using antibiotics during or after tooth extractions.

And the Agency for Healthcare Research and Quality, which is charged with improving health care quality through research and studies, also has not researched or studied the incidence of complications due to dental surgery.

Even the American Dental Association, the primary professional, research and lobbying organization for dentists, said it has not studied the topic or offered suggestions on the use of post-dental surgery antibiotics.

Larry Moore, president of the American Association of Oral and Maxillofacial Surgeons, said what happened to Lathrop is so rare that it barely registered in the medical literature searches he conducted.

“The chances of this happening are 1 in 1 million,” Moore predicted. “It’s so rare and the risk is so small that I can’t even provide a reliable number. If this happened frequently, there would be more literature on it. A Harvard researcher and oral surgeon I spoke to said it would be like being struck by lightning six times in a row in the same place. I’ve been practicing for 27 years and never heard of a brain abscess arising from a wisdom tooth extraction.”

Moore said bacteria gets to the brain through the blood stream or through the sinuses.

He said the AAOMS takes an evidence-based approach to practice and said the association does not recommend the use of antibiotics in dental surgery.

He said the risks of routinely administering antibiotics are much greater than the risks of not giving them. In addition, Moore said the routine use of antibiotics encourages antibiotic resistance.