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Dental Standard of Care

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I thought I would share a recent experience we had here that might help others understand the way dental offices operate.  Dentists are required to operate based on laws set forth by each state, but the “Standard of Care” is not written down anywhere.

The Standard of Care is the minimum level of care.  It is established via case law, meaning until someone complains and a lawsuit follows, each dentist can operate how they see fit.  Once a complaint is argued, judgments are passed and the minimum level is set.

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Patients entering a dental office come under the care of the dentist and team.  The dentist is now responsible for the oral health of the patient and related systemic issues.  Diagnostic records (x-rays, photographs, models, etc) are needed in addition to clinical examinations to determine someone’s level of health.  The absence of current records means that a proper diagnosis cannot be determined.  After a diagnosis, proper care is recommended.

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An example would be if a new patient entered an office to get their teeth cleaned.  If for some reason they did not want x-rays taken of their teeth, the doctor would only be guessing what their condition was.  Since the patient does not have the same dental education, they are not qualified to waive the standard of care and decline the x-rays.  The dentist must decide if they require the records or if it’s a “big enough deal”. Some offices give in and don’t take the x-rays. If they have access to recent records, those often suffice.

If during the examination it was determined that periodontal disease is present (active) or maintained (dormant), a “cleaning” cannot be performed.  In a dental setting, a prophy (a cleaning) is both a service and a diagnosis.  Performing a prophy means that the person has a healthy mouth without history of periodontal therapy or disease.  Generally, a patient must decide if they want treatment in the general dental office or in a periodontal specialist’s office.

Standard protocols are in place for the safety of the public.  Violations of these standards simply put people at risk, and dentists are at risk should something go wrong.  There ARE offices that operate below the standard of care and that is their choice.  If nothing goes wrong, then nothing happens.

The lawyers have decided what the minimums are.  In our office, we don’t strive for the Standard of Care; we desire to exceed the standard, or a Standard of Excellence.

Nobody can force anyone to do anything against their will here.  If a new patient comes to our office and wants JUST a cleaning (no exam and no x-rays), then they simply are not a good fit to our office.  They don’t HAVE to have x-rays, but we don’t HAVE to treat them.  It truly is “My way or the highway,” when it comes to standard protocols.

With the litigious society we live in, this office will not risk everything just to placate a person’s desire.

We recently had a patient come through our office that questioned everything that we did.  She had left several other offices and shared her many complaints of how she was treated, and her non verbal communication made it clear that she didn’t see the point of our diagnostic records.  She just wanted her teeth cleaned, even though she had a history in a periodontist office (you go to a periodontIST if you have periodontAL disease).

Her previous offices caved in to her demands.  I believe they operated below the standard of care…  and that is their choice.  She had every right to not follow my advice, but I also had every right to refuse to treat her.

We did NOT treat her, and she is NOT a member of the practice.  She (anyone) can join our practice, but it is by OUR rules.

Finding the right dental office that fits both ones personality and philosophy can be a challenge for patients and dentists alike.  When the match is found, the relationships can last a very long time.

For more information (and “slightly” more official) visit http://jada.ada.org/cgi/content/full/135/10/1449

I hope you learned something about the legal aspects of dental care and how we do our best to provide the best dental care. Our standards go above and beyond those required by any laws.

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