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Pugh v. New Castle County, IAB No. 1354747 (Nov. 16, 2015).

The Board holds that dental treatment, including dental implants, is causally related to a compensable work accident.  Specifically, the claimant’s significant and rampant dental decay was caused by xerostomia, or dry mouth, resulting from medications used to treat his compensable low back injury.

The claimant, Virgil Pugh, filed a Petition to determine Additional Compensation Due seeking a finding of compensability for dental work.  Mr. Pugh injured his low back in a work accident on May 12, 2010.  He later underwent two lumbar fusion surgeries on January 3, 2012 and July 7, 2014.  The claimant had a prior history of medication usage and dental treatment, but was in a good state of dental health as of August 2013.  After that time, his dental health deteriorated rapidly, which coincided with an increase in his work-related medications.  Clamant testified that his teeth began to turn brown in May/June 2014 and the pain in one tooth became so severe that he pulled it out on his own.  Eighteen of his teeth had cavities when he saw his treating dentist again in September 2014.  His dentist testified that he now needed dental implants.

The employer’s dental expert agreed that the medications the claimant was taking can cause dry mouth, which is a common factor in tooth decay.  However, the employer contended that the tooth decay was related to preexisting gum disease and an extensive history of medication management dating back over a decade.


Applying the “but for” standard, the Board concluded that the work accident and injury, along with the increased pain medications, represented a significant change in claimant’s treatment that likely accelerated the preexisting dental disease and caused the need for extensive dental treatment.  Therefore, the claimant’s dental condition and need for treatment was causally related to the work accident and the petition was granted.

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