Keeping up with the shifting standard of care in dentistry

Addressing the "standard of care" for patients brought up a recent conversation with a dentist. The dentist felt that it was acceptable to never take a patient's blood pressure before administering anesthesia. He didn't write clinical notes because the ledger and imaging showed what was done. 

This situation is, regrettably, a typical conversation with dentists who fail to understand the consequences of not following the standard of care. Unaware of the potential risks, these dentists face board complaints, lawsuits, and adverse actions involving their licenses.

Understanding the standard of care is critical for dentists' livelihoods regarding dental malpractice. This standard represents the minimum level of care the law expects from dental care. These laws may fluctuate from state to state, so it is imperative to stay current.

What the law says about the standard of care

In the case of Barr v. the Department of Health Board of Dentistry, Dr. Barr was accused of not providing proper care to a patient during a root canal treatment and not keeping good records. A judge found Dr. Barr guilty of not meeting the standard of care because of his poor recordkeeping. However, an appeals court disagreed.

The appeals court said that while good recordkeeping is essential, it's separate from whether Dr. Barr provided good care to the patient. The law, the court said, makes a distinction between these two things, so the court decided that Dr. Barr's only mistake was in not keeping proper records. 

In the case of Ruby v. Rocky, the case expert, a general dentist, and Dr. Rocky's dental school classmate, opined that the dentist "violated the standard of care by failing to obtain informed consent for the restoration; failing to advise Ruby of the risks of the restoration; failing to advise him of other options besides the restoration; and by failing to perform the restoration, including root canals and bite adjustments, in a clinically acceptable manner." The dentist ended up paying $200,000 in damages.

What types of issues create a shift in the standard of care? Below are just a few of the issues:

• Failure to obtain informed consent and the signature of the patient or guardian before treatment
• Administering the wrong anesthesia when the patient has a history of reactions to something in the anesthesia, such as breathing problems, faster heart rate, sweating, nausea, dizziness, anxiety, and fear
• Not reviewing the patient's health history for new medications or changes
• Not checking the premedication for conflicts with specific dental procedures
• Delaying treatment for or misdiagnosing a dental condition
• Prescribing the wrong medication or dosage
• Causing injury to the tissues, face, jaw, or teeth during dental procedures
• A dental infection that is the result of unsanitary instruments/lack of barriers, such as gloves or rubber dam
• Dismissing a patient under the effects of a drug, such as nitrous oxide
• Failing to refer a patient to a specialist
• Failing to order diagnostic tests 
• Poor supervision of dental staff

Dentists need to know that the standard of care continually evolves with the addition of new materials, new procedures, new court rulings, and their state's current recommended standard of care.

Most malpractice cases allege that the dentist, by act or omission, failed to provide proper care to the patient. Charges may assert that the dentist's actions harmed the patient during dental treatment and failed to treat the patient within acceptable standards. 

Proving malpractice in court can be complicated. It usually involves a "battle of the experts," in which each side presents expert opinions to the jury. Dentists can maintain the standard of care by staying current with the latest practices, following evidence-based dentistry, keeping detailed records, and promptly addressing patient concerns to mitigate risks.

What can dentists do to stay up to date?

Paricipate in continuing education

Participate in ongoing educational programs to stay updated on advancements and best practices in dentistry. In all states, taking a patient's blood pressure is the standard of care. Recording the height, weight, and baseline vitals is mandatory if a patient is sedated.

Prioritize evidence-based dentistry

Prioritize evidence-based practices using scientific research to inform clinical decisions. Subscribe and read clinical journals in their specialty. Computed tomography scans are now considered the standard of care for endodontics, as they prevent doctors from drilling into fractured roots or other pathology.

Join professional organizations

Join reputable dental organizations such as the ADA, the Academy of General Dentistry, the American Academy of Pediatric Dentistry, the American Association of Orthodontists, the American Association of Endodontists, the American Association of Oral and Maxillofacial Surgeons, etc. They frequently publish white papers on current practices and accepted standards.

Collaborate with peers

Join study clubs in your area, collaborate and discuss cases, and learn from each other's experiences to enhance clinical skills and adherence to standards.

Regularly review cases

Review and analyze your cases regularly with your team to reflect on treatment outcomes, patient experiences, and feedback for improvement.

Inform your liability insurer of potential claims

When a patient's dental insurance is involved, notify your professional liability carrier immediately if you anticipate that a claim or lawsuit might be filed against you. Failure to do so could result in the carrier denying the claim.

Dental malpractice cases often hinge on whether the dentist adhered to the standard of care. Don't get comfortable, and don't get left behind. Your license depends on it!

Editor's note: References are available upon request.

Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive. 

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.