Dental injuries resulting from workplace accidents can raise some complex medical and legal issues. Why does a dentist insist on treating pre-existing dental problems before addressing a dental injury resulting from a workplace accident? Who pays for the treatment of pre-existing dental problems? What if the dentist has no experience handling workers’ compensation claims?
The following example will illustrate some of these issues.
Mike and his two broken teeth
Mike is a construction worker who has neglected to take care of his teeth. When he last visited his dentist, he was told that he had periodontal disease (degeneration of the bone holding the teeth). But Mike thought that the cost of treatment was too expensive, so he skipped it. Now fast forward three years. While working on a commercial remodeling project, Mike fell off a ladder onto a concrete floor and broke two of his top incisors – the teeth at the front of his mouth.
He’s entitled to workers’ compensation benefits that can pay for the removal of the two broken teeth, plus two dental implants to replace those teeth. But when Mike visits his dentist, he’s told that he must undergo a teeth cleaning procedure and have some cavities filled. Oh, and Mike has to have a tooth pulled due to his untreated periodontal disease before the dentist can replace his two incisors.
Issues arising from workplace dental injury claims
Why do dentists insist on treating pre-existing dental problems? – Dentists are doctors dedicated to promoting good dental health. Not addressing problems such as loose teeth and degenerated bones could be considered dental malpractice. An untreated dental infection can lead to death, so dentists insist on treating the most serious problems first.
The accepted sequence of treatment in the dental profession is as follows:
- Eliminate pain or abscess
- Address emergency concerns
- Initial scaling and root planing
- Caries control
- Home care instruction
- Splint therapy
- Referrals to specialist
- Provisional restorations
- Restore mandibular anteriors
- Restore maxillary anteriors
- Restore posterior teeth
Who pays for the treatment of pre-existing dental conditions? – In the example above, Mike will have to pay for treating his pre-existing dental problems. Generally speaking, this is true but there can be exceptions.
Can a workplace dental injury claim be contested? – Insurance adjusters can question whether a particular dental injury is work-related or pre-existing. As with other workers’ compensation claims, an injured worker can get a second dental evaluation if a claim is denied for this reason.
Can TMJ be work-related? – Temporomandibular joint dysfunction (TMJ) is a jaw dysfunction that can be pre-existing, work-related, or result from post-traumatic stress. TMJ can also affect the neck, shoulders and back, as a result TMJ workers’ compensation claims can be costly and complex. When it can be shown that TMJ is work-related then it is compensable by the workers’ compensation system.
What’s the most common workplace dental injury? – Damage to incisors in the form of chipping or breaking is the most common workplace dental injury. The incisors are the front four teeth on the top jaw and the front four teeth on the bottom jaw. Because these teeth play an important role in eating and speaking, it’s important for problems involving incisors to be addressed.
Are any types of cosmetic dental treatment compensable? – In some cases, the answer is yes. Teeth serve three important functions: Teeth enable a person to speak and eat. In addition, they support the facial structure. The workers’ compensation system is responsible for restoring those functions to pre-injury status whenever possible. In Mike’s case, he is entitled to workers’ compensation benefits for the implants to replace his two front incisors.
What if my dentist has never handled a workers’ compensation claim? – There are agencies that specialize in helping dentists handle workers’ compensation claims, no matter how complex the case. Considering the competitive nature of the dental profession, it should not be hard to find a dentist who welcomes cases involving workers’ compensation claims.
If you have questions about a workplace dental injury claim, contact an experienced workers’ compensation attorney.