[Changes in court practice in cases of poor quality of dental care]. / Izmeneniya sudebnoi praktiki po delam, kasayushchimsya nekachestvennogo okazaniya stomatologicheskoi pomoshchi.

The study objective is to analyze changes in court practice over a 10-year period (from 2013 to 2022) including the quantitative and qualitative composition of complaints for conducted dental treatment, considering legislative changes in the procedure for the provision of dental service and formalization of the relationship between patient and medical organization. An investigation of 1800 legal cases containing complaints, forensic reports and court decisions allowed to identify tendencies in increasing the number of cases in which patients' demands were fully or partially satisfied, from 54% in 2013-2017 up to 61% in 2018-2022. At the same time, the amounts of payments determined by the courts increased by 14 times. In addition, the percentage of claims against medical organizations providing care under the CHI program increased significantly (from 5% in 2013-2017 to 15% in 2018-2022). A significant impact of changes in normative legal documents regulating the provision of dental care on the qualitative composition of complaints and the issues formed for medical experts by court has been noted.

[Organizational and legal aspects of implant dentistry according to the analysis of judicial practice]. / Organizatsionno-pravovye aspekty okazaniia stomatologicheskoi pomoshchi s primeneniem implantatov s uchetom analiza sudebnoi pravoprimenitel'noi praktiki.

The aim of the study was the analysis of complex forensic examinations and decisions of civil courts in cases related to poor-quality provision of implant care in 2013-2016. It determines specific features and algorithms for optimization of legislative protection system for dental surgeons and prosthodontist by provision of implant-related dental care.

[Legislative framework and legal regulation of dental care organization to patients with infectious diseases]. / Zakonodatel'naia osnova i normativnoe pravovoe obespechenie okazaniia stomatologicheskoi pomoshchi infektsionnym bol'nym.

The existing normative legal framework does not fully correspond to modern requirements for the organization and delivering dental care for adult population with various infectious diseases. The authors basing on the analysis of regulatory guidelines consider that in order to provide timely, high-quality and affordable medical care to patients in the infectious diseases departments and clinical hospitals, it is necessary to update the normative legal framework and develop criteria for monitoring the quality of dental care for infectious patients at the stages of its delivering.

Operator-related aspects in endodontic malpractice claims in Finland.

OBJECTIVE: We analyzed operator-related differences in endodontic malpractice claims in Finland. MATERIALS AND METHODS: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses. RESULTS: Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists. CONCLUSIONS: Operator-related factors had no impact on endodontic malpractice claims.

Opioid Use Disorder in Dental Patients: The Latest on How to Identify, Treat, Refer and Apply Laws and Regulations in Your Practice.

Opioid use disorder is a persistent problem in the United States and has become an important issue to medical and dental professionals. Americans are the largest users of opioids by a large margin. The importance of knowing how to identify, handle, refer, and treat patients with opioid use disorder cannot be understated. This article attempts to educate dental professionals on the current epidemiology of opioid use, explain the physiology of addiction, teach practitioners how to identify chronic opioid users, gives options for treating dental pain, establishes criteria for referring to an addiction specialist, and describes the laws, regulations, and resources available to practitioners. With this article, practitioners should have a greater understanding of the current problem of opioid use disorder and be able to develop a protocol for treating these patients.

Oral Health Care in Rural America.

(1) Rural Americans are twice as likely to lose their adult teeth as their urban counterparts. (2) Seventy-two percent of the country is classified as rural, but is home to only 15 percent of the population (46.2 million people). (3) According to the Pew Center on the States, rural residents are more likely to use emergency departments for their oral health needs because of a lack of dental insurance and a shortage of dental providers.

[Legal aspects of providing medical care to patients with intolerance of dental materials]. / Iuridicheskie aspekty okazaniia meditsinskoi pomoshchi patsientam s neperenosimost'iu stomatologicheskikh materialov.

The paper presents an analysis of legal documents describing the legal side of dental care to patients with intolerance of dental materials (IDM). The features of dental treatment from the point of view of the risk of IDM are described with the examples of real court cases in precedent as well as the conditions for the onset of strict liability and exemption from liability in relation to the practice of treatment of patients with IDM.

[The clinical and expert evaluation of the unfavourable consequences of the provision of the dental implantation treatment]. / Kliniko-ékspertnaia otsenka neblagopriiatnykh posledstvii okazaniia stomatologicheskoi implantologicheskoi pomoshchi.

The clinical and expert evaluation of the unfavourable consequences of the provision of the inadequate dental implantation treatment has demonstrated the ever increasing number of justified complaints and civilian lawsuits instituted annually in connection with the infringements of health associated with the poor quality of the medical care provided to the patients. The authors present the results of commission forensic medical expertise performed on account of the civilian lawsuits instituted by a 74 year-old patient K. against a private stomatological polyclinic. It was shown that the medical personnel of the polyclinic disregarded the objective contraindications for the surgical treatment of the patient on the day of her application for the medical assistance. It is concluded that the advanced age of the patient and well apparent atrophy of the alveolar part of the lower jaw required preliminary substantiation of the necessity of the surgical intervention. However, the diagnostic and treatment errors in the form of incomprehensive examination and the application of the inadequate implantation technique resulted in postoperative complications including severe disturbances of the masticatory function and painful sensations. The commission forensic medical expertise reported in the present article has failed to reveal any objective factors that might have been responsible for the above diagnostic and treatment errors and established the immediate cause-and-effect relationship between them and the resultant unfavourable consequences of the treatment. The opinion of the commission was recognized to be well-substantiated by the court and provided a basis for the judicial judgement in favour of patient K.

What's new in ... The Process of Consent.

An understanding of mental capacity is fundamental to the process of obtaining valid consent. This article looks at the processes of both consent and capacity assessment, and highlights the importance of fully informed consent following recent changes in the law.

Review of the peer review process.

Discussions of dental law, ethics, and risk management often center around what a dentist should do to reduce the risk that an upset, litigious patient will seek out an attorney to address the problem. There is a very useful option for the dentist and patient to pursue that eliminates the adversarial stance associated with a lawsuit. The peer review resolution process has been shown to be a positive, professional way to end certain dentist-patient confrontations, and the results normally are upheld in most jurisdictions.

The Francis Report--dento-legal implications.

This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms. Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.

Regulators and regulations: who will guard the guards? (or 'Quis custodiet ipsos custodes' as old Juvenal used to say).

Overbearing regulators with their various labyrinthine regulations have had adverse impacts on dentists and their teams' behaviours. This has produced the perverse outcomes of demoralizing dental teams as well as reducing their capacity and/or desire to deliver compassionate oral healthcare. These adverse outcomes do not seem to have benefited patients, or dentists, or their teams, in any sensible or measurable way. CPD/CLINICAL RELEVANCE: The vastly increased burdens on the UK dental profession of intrusive, bullying regulations, emanating from the various UK agencies, such as the supposedly fair and independent GDC, but including the increasingly politically controlled NHS and the CQC, have had unfortunate, perverse, effects on many dentists' clinical practices and affected dental teams' desires, or willingness, to be as compassionate as they used to be about helping to solve some patients' dental or oral problems.

Oral Healthcare Implications of Mass Migration.

Population movements, whether voluntary or forced, are an integral part of an increasingly globalized society and, while the health needs of migrant populations cannot be generalized, some migrants can have worse oral health outcomes compared with their host-country counterparts, with their first dental contact typically being for emergency care. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998. CPD/Clinical Relevance: NHS dental services need to evolve and address the challenges inherent in caring for vulnerable migrants. Education and appropriate training needs to be developed for the dental profession in order to enable new ways of promoting intersectoral care and community engagement.

Analysis of Nigerian dentists' opinion and consequences on expanded function dental auxiliaries.

OBJECTIVE: To examine Nigerian dentists' opinion on expanded function dental auxiliaries. METHODS: This cross-sectional study of Nigerian dentists attending a dental conference was conducting in 2012 using self-administered questionnaire. The data were analyzed using Statistical Package for the Social Sciences version 16.0. P < 0.05 was considered statistically significant. RESULTS: The majority of the 82 dentists that participated in this study were male, aged 31-40 years, either specialist or specializing (residents), practiced for < 10 years, teaching hospital and urban practitioners. Of the participants, 22 (26.8%) reported favorable opinion towards expanded duty dental auxiliaries. The mean scores on consequences, of expanded function dental auxiliaries ranked redundancy of dentist as highest. Males and non-specialist significantly reported expanded function dental auxiliaries would lead to redundancy of dentists. Practitioners working in other hospitals other than teaching hospital significantly reported that appropriate legislation are necessary before expansion of duties of the dental auxiliaries can be done. The dentists with favorable opinion significantly reported that expanded duty dental auxiliaries would not cause redundancy of dentist and the task are not too difficult for dental auxiliaries with necessary training but will increase service delivery and efficiency, increase job satisfaction, lead to dental auxiliary specialization with legislation. CONCLUSION: Data from this study revealed overall unfavorable opinion of Nigerian dentists on the expanded duty dental auxiliaries. However, those with favorable opinion were significantly supportive of expanded function dental auxiliaries. This information would serve as a useful tool for Nigerian oral healthcare policy formulators.

[Legal state of dental service in Ryazan region].

Analysis showed that the organizational-legal basis of dental service of the Ryazan region consists of limited liability companies (50.2%) and government budgetary institutions (40.3%).

[THE NORMATIVE LEGAL SUPPORT OF ORTHODONTIC CARE OF POPULATION AT THE LEVEL OF SUBJECT OF THE RUSSIAN FEDERATION].

The article contends that in stomatology actual normative legal support does not handle all problems of both organization of orthodontic care of children population and control of quality of orthodontic treatment. It is assumed that in. conditions of updated federal health legislation additional efforts are to be made to enhance quality and accessibility of orthodontic care. Thereafter in the area of normative legal support procedures of organization of orthodontic care of population at the level of subject of the Russian Federation in conditions of orthodontic medical organization are to be developed additionally. The standards of curative diagnostic measures, standards of quality control, target indicators, and mechanism of audit of evaluation of effectiveness of orthodontic care at the stages of its provision.

Knowledge, attitudes and practice of healthcare ethics and law among dental graduates at the RV dental college, Bengaluru.

OBJECTIVE: To assess knowledge, attitudes and practices among the dental graduate in relation to healthcare ethics and law. MATERIALS AND METHODS: A cross-sectional study design was employed using a self-administered questionnaire. A 15 item questionnaire about law and ethics was devised; tested and made available to all levels of graduates including teaching staff, postgraduates and intern at dental college in Bengaluru. A total of 116 graduates participated, with a response rate of 96.5% (n = 112). RESULTS: Seventy-six percent of the participants said that they are legally bound to treat all the patients who approach them for the treatment. Nearly 32% of the participants have mentioned the various other reasons for the rejection apart from the reason like HIV+, poor patients and patients with the contagious disease. CONCLUSION: The study points to the need for appropriate training among graduates including the professional staffs and other graduates, and to devise means to sensitize them to issues of law and ethics in the workplace.

The roles of federal legislation and evolving health care systems in promoting medical-dental collaboration.

Recent federal health care legislation contains explicit and implicit drivers for medical-dental collaboration. These laws implicitly promote health care evolution through value-based financing, "big data" and health information technology, increased number of care providers and a more holistic approach. Additional changes--practice aggregation, consumerism and population health perspectives--may also influence dental care. While dentistry will likely lag behind medicine toward value-based and accountable care organizations, dentists will be affected by changing consumer expectations.

International rescue? Managing the dental tourist.

UNLABELLED: The concept of dental tourism can be considered two-fold. On one side it is a term used to describe non-UK residing patients who visit, requesting NHS dental care whilst here in the U.K. Alternatively, it also encompasses patients who travel to destinations outside their residing countries to receive care. The latter has become an ever-growing issue in the U.K.; one that warrants appropriate management and knowledge of current legislation amongst dental professionals. CLINICAL RELEVANCE: Clarity and guidance on who is eligible for care under the NHS when visiting the U.K. and who, if anyone, is ultimately responsible when treatment abroad fails.