On March 22, 2012, plaintiff Terrell Barnhart, 66, a retiree, presented to Dr. Jamshid Khazian, a dental implant specialist in California, and was noted to have some inflammation. Barnhart first saw Khazian in 2004, and then returned for cleanings and other dental care starting in 2012. During the March 2012 appointment, Barnhart’s dental hygienist noted that the patient had slightly inflamed tissues around teeth 8 and 9, which are located in the upper, front section of the mouth. Barnhart continued to see Khazian over the next few years, and then on Oct. 22, 2015, the hygienist again noted inflammation of teeth 7, 8 and 9. The hygienist diagnosed Khazian with ulcerated, necrotizing gingivitis, a periodontal condition. The three teeth had also started to become loose. The following month, Khazian extracted the three noted teeth and replaced teeth 7 and 9 with implants. Three months later, in February 2016, Barnhart began to experience additional inflammation in the area of the implants. She was prescribed antibiotics, and the inflammation subsided. However, the inflammation returned in April 2016, at around the same time that Khazian was performing cosmetic surgery on the front of Barnhart’s mouth. The inflammation continued in May 2016 and June 2016, and Barnhart was prescribed more antibiotics. In early July 2016, Khazian took photographs of Barnhart’s mouth. He noticed that the upper, front portion of her mouth looked redder and more inflamed than it did when he performed the cosmetic procedures in April 2016. As a result, on July 18, 2016, he scheduled Barnhart for a biopsy. She underwent the procedure on July 21, 2016 and, a few days later, she was diagnosed with a form of oral cancer called squamous cell carcinoma. Barnhart sued Khazian (who was initially erroneously sued as “Kanzian” on the original complaint). Barnhart claimed that Khazian should have diagnosed her cancer sooner and that his failure to do so constituted malpractice. The plaintiff’s treating otolaryngologist testified that Barnhart’s cancer was present for at least two years, and possibly as far back as March 2012. Thus, Barnhart’s counsel argued that Khazian should have diagnosed the cancer on Oct. 22, 2015 and perhaps even on March 22, 2012. The plaintiff’s general dentistry expert testified that once Barnhart began complaining of loosened teeth and inflammation, the dentist should have performed a biopsy to determine if cancer was present. The expert opined that Khazian violated the standard of care. Defense counsel maintained that the cancer had not been present for several years and that Barnhart’s previous inflammation and teeth loosening were the result of periodontal disease. Counsel also pointed out that Barnhart had periodontal issues for several years prior to the inflammation. The defense’s expert oral surgeon testified that the cancer was present for eight months, at most, prior to Khazian’s cancer diagnosis and that if the cancer had been present for two years or more, it would have been much more advanced when it was discovered. The expert also opined that Khazian properly ordered the biopsy once he noticed the chance in Barnhart’s condition in July 2016. Thus, the expert concluded that Khazian followed the accepted standard of care., On Aug. 18, 2016, Barnhart underwent oral surgery to address her cancer. The procedure involved a partial maxillectomy, a split thickness skin graft reconstruction of the resulting defect, and the placement of a palatal obturator, which is similar to a retainer and requires cleaning after meals. The surgeon specifically removed teeth numbers 5, 6, and 10 and the bones surrounding teeth 5 through 10. After the surgery, Barnhart’s cancer was classified as stage 2. However, her treating doctor stated that in December 2017, he re-classified the cancer as stage 4. Plaintiff’s counsel argued that if Barnhart’s cancer had been caught sooner, the surgeon would not have had to remove as many teeth and that Barnhart would have required a smaller obturator. Counsel also argued that Barnhart would have had a better prognosis if the disease had been diagnosed earlier. While Barnhart was considered for radiation and chemotherapy, doctors determined that the treatment wasn’t necessary. Instead, Barnhart was monitored every few months after her surgery. Barnhart claimed that her obturator made it hard for her to eat or kiss. She also claimed that it causes her to drool and that she has to plan her life around it. Specifically, she claimed she has to avoid certain foods, like corn, that can get stuck in the obturator. She also alleged that she has to find time to clean the obturator whenever she goes out to eat and that it all causes her emotional distress. Thus, Barnhart sought recovery of $300,000 in total damages. Defense counsel argued that any emotional distress was the result of the cancer diagnosis and not of any actions by Khazian. Counsel also contended that Barnhart had a good prognosis. The defense’s otolaryngology expert opined that there was an 80 percent chance Barnhart’s cancer would not return and that even if the cancer had been diagnosed in October 2015, Barnhart would have still required the same surgery and treatment. In addition, defense counsel argued that the plaintiff’s otolaryngologist did not provide a legitimate reason for changing the cancer’s staging from a stage 2 to a stage 4.