Tort/Negligence – Dental Malpractice – Lack of Proximate Cause

Plaintiff failed to forecast competent expert evidence establishing that any alleged breach of the standard of care proximately caused a delayed cancer diagnosis or worsened outcome.

We affirmed summary judgment for an oral surgeon and his dental practice.

Plaintiff sued Defendants dentist and his dental practice, University Dental Associates (UDA), asserting negligence, corporate negligence, and negligent supervision based on Defendant’s July and August 2020 evaluations, during which Defendant diagnosed temporomandibular joint disorder (TMJ) and did not order a biopsy. Plaintiff later was diagnosed in 2021 with naso-oropharyngeal squamous cell carcinoma and claimed the delay increased his morbidity.

The record showed extensive medical encounters. In June and July 2020, an otolaryngologist found no tumor and imaging was negative. On July 24, 2020, a UDA dentist felt a small mass under Plaintiff’s left jaw and referred him to Defendant the same day. Defendant conducted visual and palpatory cancer screenings, found no masses or lesions, diagnosed TMJ, and prescribed conservative treatment. At an August 2020 follow-up, Plaintiff reported improvement and Defendant again found no tumors or lesions. Multiple primary care visits through late 2020 and early 2021 documented no mouth, throat, or neck masses or complaints. In March 2021, another dentist identified a hard mass and a bleeding lesion, leading to referral, biopsy, and, by May 2021, a confirmed diagnosis of naso-oropharyngeal cancer and treatment.

Plaintiff’s theory was that Defendant should have biopsied in July 2020 and that the failure caused a delayed diagnosis. On summary judgment, the dispositive issue was proximate cause. The court reiterated that in medical malpractice cases, causation generally must be established through expert testimony stated in terms of probability, not speculation. Evidence that earlier diagnosis might have improved the patient’s chances is insufficient without specific, probable causal linkage.

Plaintiff relied primarily on two experts. While both criticized Defendant’s examination and documentation and opined the standard of care was breached, neither could state with reasonable medical certainty that the submandibular swelling in July 2020 was cancer, that Plaintiff had cancer at that time, or that the later-diagnosed oropharyngeal cancer was the same process. One expert acknowledged he could not say the July 2020 mass was cancerous or quantify any degree of improved outcome from earlier detection, conceding such opinions would be speculative and better addressed by oncology specialists. The other expert similarly declined to opine on when the cancer began, how it progressed, or whether the earlier finding was cancer, and could not state that imaging or disease burden would have been different months earlier.

Because the experts’ testimony amounted to speculation about possibility rather than probability, Plaintiff failed to forecast evidence that any breach by Defendant proximately caused his injuries. Without proximate cause, the negligence claim failed as a matter of law. We further held that the derivative claims for corporate negligence and negligent supervision against UDA also failed, since they likewise required proof that Defendants’ conduct caused Plaintiff’s injuries.

Affirmed.

Griffin v. Brown (Lawyers Weekly No. 011-026-26, 15 pp.) (John Tyson, J.) Appealed from Forsyth County Superior Court (John O. Craig III, J.) Angela Gray Law, P.A., by Angela N. Gray, for the plaintiff-appellant. Cranfill Sumner LLP, by Samuel H. Poole, Jr., Steven A. Bader, and Kelley M. Petcavich, for the defendants-appellees. North Carolina Court of Appeals