Evidence and the practice of prosthodontics: 20 years after EBD introduction.

Prosthodontics has a rich history related to the principles embedded in evidence-based health care. This paper reviews the evidence-based prosthodontics activity over the past 3 decades. It also discusses the impact of health care reform on evidence-based medicine as it relates to broader context of care outcomes. Finally, the value associated with an Evidence Stewardship emphasis in prosthodontics is presented. This emphasis suggests that combining evidence from clinical trials with evidence from clinical practice environments best equips clinicians for the management of patients in the future. Adoption of a strategic Evidence Stewardship direction is an extended commitment to change that recognizes health care reform aims and seeks to be an accountable provider group in the broader health care arena. The vision to form a representative network of prosthodontic practitioners that augments a commitment to Cochrane "clinical trial" data demonstrates a responsibility to professional transparency about who we are, adds value for patients and oral health care providers, impacts teachers and students in dental education, and provides a measure of care accountability unique in dentistry.

The Swedish patient insurance scheme and guarantee insurance for prosthodontic treatment.

During 1975-76 a no-fault compensation system for treatment injuries in dentistry and failures within prosthodontics was introduced in Sweden. The guarantee insurance scheme for prosthetic treatment has changed somewhat during the years and, in 1987, became mandatory for all dentists in Sweden. All necessary retreatment not included in the National Dental Insurance Scheme (eg allergy to dental materials, all treatment following radiotherapy-related xerostomia) is included. For fixed prosthodontics, all replacements are covered by the scheme for the first 2 years. For removable prosthodontics, this is limited to the first year. A patient may choose any dentist in Sweden to carry out the retreatment. The claim system is simple and the number of cases has steadily increased, probably because dentists are becoming more familiar with the system and are willing to use it. The costs are paid for by private practitioners, the Public Dental Service and private dental laboratories. The insurance files are available for research purposes.

Non-acceptance of prosthetic appliances at the focus of forensic consequences.

Non-acceptance of prosthetic appliances is not only a clinical problem; it also gives rise to legal proceedings. Not every case of non-acceptance is psychogenically induced, there are often somatic and even iatrogenic causes. Objective treatment deficiencies are subject to forensic sanctions irrespective of any underlying psychosomatic illness. If the dentist is to manage non-acceptance in a responsible way not open to forensic consequences, competent clinical and psychological skills are needed.

Malpractice reports in prosthodontics in Sweden.

Prosthodontics is the branch most often involved in dental malpractice cases in Sweden. The number of cases has increased with the growing production of fixed prosthodontics after the introduction of the National Dental Insurance Scheme and the increase in the number of dentists. Prosthodontic treatment accounted for one-third of the working hours of private practitioners but two-thirds of the sanctions during the period 1974-78. The patients' complaints are often justified in some parts. The most common faults are elementary and have been similar throughout the whole period 1947-1988. Bridges (2-4 units), complete dentures and single crowns are the constructions most often involved in complaints. The maxillary frontal and premolar regions are in this order the regions most often involved. There are no differences between different age groups of dentists concerning the quantity of faults, but there is probably concerning the quality of faults because older dentists get more severe sanctions than younger.

Dental implant jurisprudence: avoiding the legal failures.

The law measures the quality of dentistry by the "standard of care" as defined by the courts. The ultimate judges of the facts in a malpractice suit are usually juries made up mostly of lay people. Ignorance of the legal requirements for dentistry, and specifically dental implants, unnecessarily exposes today's dental health care provider to such suits. However, with a reasonable understanding of the legal issues and requirements surrounding the standard of care, a dentist may avoid becoming embroiled in a malpractice claim.

Quackery, fraud, and denturists.

Denturism is questionable dental practice, even in those few states where it is licensed. Incomplete or incompetent care is quackery. In the early 1980s a few states liberalized their laws to allow denturism to those who were educationally qualified. This experiment has generally failed because all accredited training programs have closed, because prices charged by denturists have about reached parity with dentists' fees, and because of limited demand for denturists' services. Because of the complexity of the message about scientifically-grounded oral health care and the populism of stories about the poor and underserved, dentists must be vigilant regarding their interactions with the media.

Of sales, services, and warranties: is the prosthodontist a purveyor of goods under the Uniform Commercial Code?

The Uniform Commercial Code (UCC) governs various commercial transactions. Article Two of the Code deals with sales of goods and, historically, has not applied to the provision of goods incident to rendering professional services. Recently, some courts have held professionals liable for economic or personal injuries caused by faulty medical devices and prostheses. Liability, when found, has been based on one or more of the UCC Article Two warranties. This article discusses these warranties and those cases in which hospitals and doctors have been held liable under them. While the number of such cases is small, there are arguments that suggest that liability under these circumstances could increase in the future. An understanding of the Article Two warranties and how they have been used in lawsuits against health professionals should help minimize the chances of successful litigation against dentists.

[Responsibility and legal aspects of implantology]. / La responsabilité et les aspects légaux relatifs à l'implantologie.

Medico-legal aspects regarding oral implantology are to be found in the Civil Right and governed by the Belgian civil code (article 1382) and by the specific nature of the relationship between the practitioner and the patient. Both the patient and the practitioner are to fulfill a number of obligations. One of these, is the compulsory 'informed consent' to be obtained from the patient. However, this consent is preceded by the information given and repeated by the practitioner to the patient regarding the proposed treatment. This article describes precautions and obligations to observe by the practitioner in order to minimize the possibility of being sued by a patient. Various anamnestic question lists are provided in this article.

[Liability and prosthodontics]. / Responsabilité et prothèse.

The dentist is a full medical professional with all the rewards and risks that this entails. The patients' requirements from dental specialists are increasing, especially when prostheses are concerned. Practitioners are concerned with the desire to satisfy these requirements to the best of their personal abilities and the current scientific knowledge. This desire results in increased risks. The dentist's liability is proportional to these risks. This report consists in a reminder of the legal principles regulating this notion of liability in our profession, especially with regard to prostheses.

Informed consent for the prosthodontic patient with temporomandibular disorders. Report of the Committee on Temporomandibular Disorders of the American College of Prosthodontists.

The prosthodontic treatment of patients with a history of temporomandibular disorders presents unique risk-management problems because of the varied nature, uncertain prognosis, and frequent recurrence of these disorders. Patients with temporomandibular disorders frequently require managed treatment over extended periods of time and may complicate the delivery and outcome of prosthodontic treatment. Informed consent is needed to protect both the patient and the prosthodontist because it facilitates proper communication, goal setting, and cooperation. The purpose of this article is to discuss the essential elements of informed consent and to present an informed consent program useful in the prosthodontic treatment of patients with temporomandibular disorders.

Medico-legal aspect of dental implants.

The practising environment in health care is ever changing in both clinical and management areas. Within dentistry, two major changes have occurred with the development of implantology into a sound treatment approach and a burgeoning of dental litigation. There are medico-legal issues that relate to dental implant treatment with which clinicians must become familiar and there are medico-legal implications that impact on risk management by Medical Indemnity Organizations (MDOs) and the indemnity premiums they set for their members. The aim of this paper is to discuss these issues and highlight those areas of significance to clinicians.

Practice and malpractice expenses in maxillofacial prosthetics.

Recent changes in Medicare reimbursement methods have made the estimation of specific practice and malpractice expenses in maxillofacial prosthetics more important. New reimbursement models such as the resource-based relative value scale used by Medicare and an increasing number of private carriers require accurate and specialty-specific values for these parameters. The Health Care Financing Administration's estimates of practice expense values in all specialties of medicine are significantly lower than those suspected in maxillofacial prosthetics. There is concern that the assignment of erroneous values in maxillofacial prosthetics could lead to inadequate reimbursement. Because the American Dental Association provides only aggregate specialty values, a survey of the general membership of the Academy of Maxillofacial Prosthetics was undertaken to determine these values more accurately. Practice expense values were found to be significantly higher than those in medicine, whereas malpractice expense values were lower. In addition, practice expense values in the survey were found to be greater than the ADA's aggregate specialty calculations.