Criminal convictions involving fraud and deception in prescribing drugs, gross immorality, or conviction of a felony under state law are grounds for revocation, usually by decision of the state licensing board. A license may also be revoked for a pattern of negligent care or for gross negligence.

In theory, a dentist need not introduce any evidence to prevail in a lawsuit brought by a patient. This is because the patient has the burden of proof. In reality, a dentist will often introduce evidence to refute a patient’s assertions. If a dentist is able to refute any of the four elements that a plaintiff patient must prove, the dentist will prevail. In practice, the most hotly contested issue usually revolves around the standard of care. Typically the plaintiff has an expert witness testify on his or her behalf and the dentist has one testify on her or his behalf. The matter of causation is another area that may be hotly contested. Even if a dentist breached the standard of care, that does not mean that the breach resulted in harm to the patient. For example, assume that a patient complains to a dentist that he has had an ulcer for 6 weeks that is not healing and that the dentist responds by saying “Let’s wait another month and see what happens.” The patient happens to see another dentist a week later who does a biopsy, and the histology shows the lesion to be squamous cell carcinoma. The first dentist should certainly have biopsied an ulcer that has been present for 6 weeks and, by failing to do so, breached the standard of care. However, the 1-week delay in diagnosis would not affect the prognosis; hence, there are no damages, and the plaintiff is unable to prove all four of the required elements to win a tort suit.

All entries require ink or typed notes, not pencil, and errors must be lined out with a single line and initialed, with the substitute entry correcting the error. This procedure guards against any challenge to the reliability of record entries.

Practitioners who keep digital records (those who use a computer) should be especially careful. Because it is easy to go back and make changes, one is easily accused of making changes to the record to suit one’s needs. Practitioners who use word processing software are well advised to take precautions so that they can prove when the entries were made. Programs that record dates of entry are available but work on different principles. One program allows a person to make changes at any time, but an auditing program keeps track of when each and every keystroke was made. A different program requires one to type a word (e.g., “End”) after an entry has been completed. Thereafter, the program does not permit one to go back into previous entries. Changes to the record must be made under a new entry, which should be labeled by the dentist to indicate that it is a modification of the record. Commonly, the word addendum is used to label such an entry.