11. What are grounds for revocation of a dental license?
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.
12. What issues may constitute a defense against malpractice?
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.
13. Which elements are contained in a complete dental record?
• Identification data
• Medical history, including updated antibiotic regimens for prophylaxis of subacute bacterial endocarditis, effects of medication on birth control pills, and medical consultations as needed
• Dental history
• Clinical examination
• Diagnosis and interpretation of radiographs
• Treatment plans
• Progress notes
• Consent forms for surgical procedures
• Completion notes
14. How should records be written and corrections be made?
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.
15. How is the practice of dentistry broadly governed?
The ethical rules and principles of professional conduct for the practice of dentistry are set forth in the American Dental Association (ADA) publication, Principles of Ethics and Code of Professional Conduct, which describes the role of the professional in the practice of dentistry.
16. List the five fundamental Principles that form the foundation of the ADA Code of Ethics.
1. Beneficence—being kind and/or doing good
2. Autonomy—respect of the patient’s right of self-decision
3. Justice—the quality of being impartial and fair
4. Non-maleficence—First, do no harm
5. Veracity—telling the truth
17. How does the code define beneficence in the practice of dentistry?
The dentist is obliged to do the following:
1. Give the highest quality of service of which he or she is capable.
This implies that professionals will maintain their level of knowledge by continued skill development.
2. Preserve healthy dentition unless it compromises the well-being of other teeth.
3. Participate in legal and public health–related matters.
18. Who is expected to be responsible for the practices of preventive health maintenance?
The patient is expected to be responsible for his or her own preventive practices. The dentist is responsible for providing information and supportive care (e.g., recall, prophylaxis), but the patient has the ultimate responsibility to maintain oral health.
19. Outline the essential elements implied in the principle of autonomy.
The principle of autonomy requires respect for the patient’s rights in the areas of confidentiality, informed consent for diagnostic and therapeutic services, and truthfulness to the patient. The dentist should work with patients to allow them to make autonomous decisions about their care. The dentist is obliged to provide services for which the patient contracts.
20. How does the dental profession serve justice, according to the code?
The individual dentist and the profession as a whole are obligated to be just and fair in the delivery of dental services. Self-regulation is a basic tenet of this obligation, as well as calling attention to any social injustices in the allocation of societal resources to the delivery of dental health services.
21. A 29-year-old patient with poor oral hygiene and multiple caries requests full-mouth extractions and dentures. A complete examination reveals a basically sound periodontium and carious lesions that can be restored conservatively. What ethical principles apply to this basic case of neglect without advanced disease?
Respect for the patient’s autonomy and requests is evaluated and judged against the duty of the dentist to provide the highest type of service of which he or she is capable. After full disclosure about the long-term effects of edentulism, as well as the costs and benefits of saving teeth, the assessment of the patient’s motivation is most important. Saving teeth that will only fall into disrepair through neglect and the patient’s lack of commitment to maintain oral health must be considered carefully before a final treatment is elected or rejected.
22. A patient rejects the use of radiographs for examination of his teeth. How should this situation be handled, according to the code?