Georgia didn’t sanction dental chain accused of infecting 23 children

Some of the children were still in preschool when their dentists put them under the drill for root canals which some say they may not have needed. That was only the beginning of the suffering they would endure, according to lawsuits filed by their parents and a CDC report.

In the weeks and months that followed, the children’s faces swelled and some had bulbous masses form in their necks. Parents took them to emergency rooms with searing jaw pain. Many had to have surgeries to remove lymph nodes and infected jawbone and tissue, leaving them with facial scars.

A spate of patients came through Children’s Healthcare of Atlanta, which found the children had two things in common: They had all been treated at the Jonesboro office of Dentistry for Children, part of a corporate-owned dental chain. And they had all been infected with Mycobacterium abscessus, a rapidly-growing bacterium known to contaminate water hoses in medical offices.

According to health officials, the Jonesboro clinic wasn't monitoring its water quality or properly maintaining water lines. But four years after the infections of nearly two dozen children, Georgia regulators have issued no public sanctions against Dentistry for Children, whose website lists at least 22 branches in metro Atlanta. Nor has the state Board of Dentistry taken disciplinary action against any of the dentists or other professionals involved in the procedures.

The only effort to hold Dentistry for Children accountable is through civil litigation against the dentists, the company itself and the parent company, Atlanta-based D4C Dental Brands. The latest lawsuit was filed earlier this month by the mother of a boy who had a pulpotomy — known as a "baby root canal" — in 2014 when he was 8 years old. Over the next six months he went through surgery, a hospitalization and antibiotic treatment, the lawsuit says.

According to his mother’s attorney, Michael McElroy, he still has scars from surgery, and he’s at risk for future hearing loss because of the antibiotics. He could also need more dental work as he gets older. He’s one of at least 23 children who became infected after pulpotomies, the lawsuit says. The CDC said their ages ranged from 3 to 11.

Mycobacterium abscessus is common in soil and groundwater and isn’t typically dangerous, even in drinking water. But microbes can settle and grow in water lines that aren’t being flushed out regularly, making the water hazardous in high concentrations — such as rinsing a tooth chamber during a drilling procedure.

“It’s somewhat disconcerting that they were doing what they were doing with the water,” McElroy said. “Why would you not use distilled water? You ought to know better. That bothers me more than if this was a mom-and-pop guy out someplace in middle Georgia.”

Another lawsuit on behalf of 11 infected children was filed a year ago. That case is still in the discovery phase, with attorneys taking depositions of the dentists who performed the root canals, according to plaintiffs’ lawyer Lee Atkinson.

Among other things, the lawsuits seek to determine who at Dentistry for Children may have been responsible for water quality at the Jonesboro branch, which closed in 2017 for what the company said were unrelated reasons, and whether the company had any policies or procedures in place to protect patients.

Citing the pending litigation, D4C’s chief dental officer, Charles Coulter, would not agree to an interview, nor did he respond to written questions about how the branch’s water supply became contaminated or who was supposed to be monitoring it. According to one of the complaints, water testing after the outbreak found microbial levels at more than 182 times the maximum acceptable level.

Coulter sent the AJC the same written statement that the company offered a year ago after the first lawsuit, describing how the Jonesboro office was deep cleaned, renovated and equipped with a state-of-the-art filtration system after the company learned that its water supply “played a role in the infection of a very small number of our patients in late 2014.”

“We offer our deepest sympathies to those who have been affected by this situation and we continue to work with the affected families,” the statement said.

McElroy, the attorney, said some families have already settled with the company.

Both of the lawsuits allege that the root canals that exposed the children to tainted water may not have been necessary, because the children would soon be losing their baby teeth, and extraction may have been a better alternative.

Corporate-controlled dental practices have come under criticism for unnecessary procedures. Companies typically fill their branch offices with young dentists, pressuring them to ring up as much in Medicaid reimbursements as possible, said industry consultant Michael Davis, a New Mexico dentist and a persistent critic of corporate dentistry.

Then when children get hurt, state regulators can be reluctant to act because there's no licensed dentist to pin the blame on.

“They don’t want to touch the corporate entities,” Davis said. “They know damn well whose fault it is. They know it goes right to the corporate. They know the doctors are just peons.”

Neither state Board of Dentistry president Richard Bennett nor Steve Holcomb, who was board president when the infections were discovered, returned messages from the AJC. Because the board’s investigations are confidential by state law, it’s unclear what role the board played, if any.

Once Children's Healthcare made the connection between the infections and the Jonesboro clinic, it notified the Georgia Department of Health, which called in the Centers for Disease Control and Prevention. In a 2016 report, the CDC linked the infections to contaminated water, which it attributed to the office's use of tap water in pulpotomies, without flushing the water lines with bleach at the end of each day as recommended by equipment manufacturers.

The CDC reported the branch had performed 1,386 pulpotomies over the previous two years, with 1% of its patients infected with the mycobacterium. The poor water quality violated both CDC and the American Dental Association guidelines, the lawsuits allege.

Most of the Jonesboro infections happened between mid-2014 and mid-2015. A year later, an outbreak occurred at Children’s Dental Group in Anaheim, Calif. At least 150 families have filed lawsuits against that clinic, with many alleging that the pulpotomies that infected their children weren’t necessary to begin with.

THE CDC’S FINDINGS

From an April 2016 report by the Centers for Disease Control and Prevention:

All were made severely ill, requiring hospitalization for a range of one to 17 days.

Seventeen patients required surgical excision and 10 received outpatient intravenous antibiotics.

* According to a statement from parent company D4C Dental Brands, the Jonesboro office closed after the outbreak, but reopened in early 2016 with the endorsement of the Georgia Department of Public Health. It closed permanently two years later for unrelated reasons, the company said.