When informal conversations replace direct doctor–patient communication, even a routine implant can spiral into serious complications. This case highlights how miscommunication, delayed follow-up and blurred professional boundaries led to infection, litigation and a costly lesson in post-operative care.
Posted in Dental Insights on Friday, February 27, 2026
Wayne Edmonds, DDS, had a small-town dental practice where he practiced for many years. Dr. Edmonds’ longtime dental hygienist Margie urged her nephew Mike to see Dr. Edmonds when he moved to town.
Upon evaluation, Dr. Edmonds learned that Mike had not seen a dentist for more than five years. Therefore, Dr. Edmonds advised Mike to get back to regular dental care. He needed to work on his home oral hygiene, and he had potential periodontal problems. Dr. Edmonds also noted an area where a tooth had been extracted long before in the lower right area of Mike’s mouth. The dentist recommended placing a single implant or preparing a bridge to replace this missing tooth.
Dr. Edmonds and Mike discussed the implant process, as well as its risks and benefits, and Mike said he needed to think about it before proceeding. Dr. Edmonds advised he would schedule an appointment for a few weeks out. That way, if Mike was still worried, they could reschedule, discuss it further or cancel the appointment. Dr. Edmonds gave Mike brochures about the implant placement, risks, surgery and post-operative care. He also provided Mike with consent forms on implant placement.
After the appointment, Mike became nervous because he had not been to the dentist in a long time and now was considering an implant. He called Margie to talk to her in more detail about what could happen and whether he should have an implant. Margie told Mike that it was not that difficult and lots of patients had it done without problems. When Mike asked her what would happen after the surgery, she explained that he would have some swelling and might be sore. Nevertheless, that was not unusual, and he would be up and about and back to work soon thereafter.
Upon hearing all this, Mike decided to proceed with the implant placement. However, on the day before surgery, he got cold feet. He talked to Margie again, and she reassured him that he would be fine. Mike asked Margie if he should talk to Dr. Edmonds about his concerns, and Margie responded that the doctor was with patients, but he should try back later.
Mike was concerned that if he talked more about the procedure, he would cancel it. Consequently, he did not call back. When he arrived for the procedure, he did not ask any questions when he saw Dr. Edmonds and signed off on all the documentation before the implant was placed.
The procedure was uneventful. Mike received postoperative discharge instructions stating that some swelling and pain was normal, but that he should call if problems worsened or if he had other questions or concerns. He made a follow-up appointment for the next week.
Post-Operative Complications
On the day after the surgery, Margie talked to Mike to see how he was doing. He told her there was some swelling and pain. Margie said that was to be expected, but that if it got worse, he should call Dr. Edmonds. She told Dr. Edmonds about the call, and he said that if the swelling did not reduce, Mike should come in for an examination. Dr. Edmonds prescribed a course of antibiotics just to be on the safe side.
Mike did not have the prescription filled until a couple of days later. When he took the antibiotics, they made him nauseous so he did not take them as directed. Mike talked to Margie five days post-surgery and told her that he still had some minor swelling. She relayed the conversation to Dr. Edmonds who told her to have Mike return immediately.
When Mike came in the next day, he had significant swelling in the mouth and neck, as well as pus and exudate from the area of the implant. Dr. Edmonds immediately diagnosed Mike with a severe infection, removed the implant and referred him to an oral surgeon for further management of the infection.
The oral surgeon continued the antibiotics. However, when Mike’s symptoms worsened, the surgeon performed an incision and drainage procedure and ran a culture and sensitivity test. Eventually, the infection, which was later diagnosed as osteomyelitis, resolved.
The Allegations
Mike subsequently filed a lawsuit against Dr. Edmonds and claimed the dentist:
- Neglected to properly advise him of the risks of the procedure
- Performed the procedure improperly
- Failed to manage his postoperative care
- Caused a serious infection due to his negligence
During discovery, it became clear there was miscommunication between Mike and Margie. Mike claimed he didn’t think the swelling was really bad, but that he did not know what “really bad” was. He said he didn’t call Dr. Edmonds directly because he thought he was supposed to talk to Margie, even though no one told him that.
Margie testified that Mike had said the swelling wasn’t bad, and he never told her about any pus or exudate. Had he done so, Margie said she would have immediately informed Dr. Edmonds. Dr. Edmonds agreed that after a procedure like this some swelling is normal. However, a patient should know from the pre-operative and post-operative discussions and materials when to call with worsening symptoms, such as pus, exudate, and swelling into the neck area.
Dr. Edmonds testified that he specifically told Mike to call with any questions, problems or abnormalities. He testified that when he received the message from Margie about swelling two days after the operation, he properly prescribed antibiotics. He further said he believed the message was properly conveyed to Mike to come in if his condition worsened, but that Mike did not follow this advice.
Expert Opinions and Resolution
Mike’s attorney retained an oral surgeon expert who was critical of Dr. Edmonds. This expert contended that Dr. Edmonds’ oral and written instructions to Mike should have been clearer. Further, at the patient’s first complaint of swelling, Dr. Edmonds should have examined him. Any miscommunication was the fault of Dr. Edmonds and his staff—not Mike.
Dr. Edmonds’ attorney retained an oral surgeon expert to defend the care. This expert reviewed the testimony and materials, and he felt that proper steps were taken to ensure proper follow-up care. This defense expert felt that Mike had the responsibility to follow up and properly advise Dr. Edmonds of worsening symptoms of swelling, pus, and exudate. It was also Mike’s responsibility to take the antibiotics as prescribed or to contact Dr. Edmonds if he could not do so.
Because of the battling experts, as well as Mike’s own alleged contributory negligence, the case ultimately resolved in the low five figures.
What Can We Learn?
Conversations and recommendations with patients who have specific complaints, especially following a dental procedure, must be clearly communicated and documented. In other words, the dentist must be the one to talk directly to the patient. Better yet, a patient with continued complaints post-procedure should be told by the practitioner of the imperative need to come to the office to be seen and evaluated.
In this case, the informal communications between Mike and Margie did not create a clear picture for Dr. Edmonds to have made a diagnosis or to recommend treatment. This was further complicated by Mike’s failure to promptly take antibiotics as directed. When Mike had ongoing complaints post-procedure, the best course would have been for him to come to the office for evaluation. Dr. Edmonds could then assess the condition, emphasize the importance of antibiotic therapy, and determine what to monitor and when to have the patient come back in.
Mike and Margie’s informal calls only served to cloud the issues. Their informal familial relationship got in the way of clear dental care and treatment by Dr. Edmonds. This case serves as yet another reminder that treatment of family and friends are oftentimes handled outside the norm of typical patient care. Consequently, those processes can be fraught with problems.
Risk Management Tips for Triaging Phone Calls
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Have only the dentist and designated staff provide telephone triage services.
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Document all clinically relevant telephone encounters and include the name of the staff person. This includes follow-up conversations and calls concerning previously discussed problems, recommendations, and test results.
- Record the specifics of each call in the patient’s medical record, including the advice/instructions provided. Clear, timely documentation of your communications avoids disagreements about what was said and to whom.
- Train staff members in telephone triage and authorize them to interrupt the dentist or dental specialist as necessary.
- Provide non-clinical personnel with guidelines to appropriately respond to emergency/urgent care concerns.
- Develop procedures to address and document patient requests, concerns and issues in a timely manner.
- Document calls and conversations with family members, friends, and staff, and relay this information to the dentist or designated staff member.
- Rather than having a patient call the dentist back, have the dentist or designated staff member return the call.
About the Author
Linda J. Hay is a partner in the Chicago office of HeplerBroom, LLC. Ms. Hay has practiced in the professional liability defense arena for more than 25 years and has tried numerous cases to verdict. She is actively involved in a variety of defense bar, professional liability and risk management organizations.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.