Interstate Practice of Dental Teleradiology in the United States: The Effect of Licensing Requirements on Oral and Maxillofacial Radiologists' Practice Patterns.

BACKGROUND: In the United States, each state has independent licensing standards. Dentists wishing to practice in more than one state must apply to each individually. The goal of this study was to assess whether board-certified oral and maxillofacial radiologists interpreted images taken outside the states in which they were licensed and whether coverage provided by the malpractice insurance plans to which they subscribed affected their behavior. MATERIALS AND METHODS: An electronic survey was sent to all current members of the American Board of Oral and Maxillofacial Radiology, with a response rate of 74%. Descriptive statistics were calculated. RESULTS: The majority of respondents (54.6%) indicated they write reports for patients in states for which they do not have a dental license. An even larger majority (80.0%) do not know whether their malpractice insurance protects them in these cases. Qualitative responses indicate that there is confusion among practitioners as to what is legally permitted pertaining to teledentistry of this nature. CONCLUSIONS: Much of the work in which oral and maxillofacial radiologists engage may be considered teledentistry. In other settings, teledentistry has been proposed as a means to improve access to care for vulnerable populations, yet current licensure laws may make this more difficult to implement. Based on the results of our survey, many oral and maxillofacial radiologists in practice may be considered to be practicing without a license. Portability of diagnostic images may make it more difficult to enforce geographic practice boundaries. A national licensure system would be easier to enforce while maintaining high levels of patient safety.

Increasing Access to Dental and Medical Care by Allowing Greater Flexibility in Scope of Practice.

In recent years, advocates for increasing access to medical and oral health care have argued for expanding the scope of practice of dentists and physicians. Although this idea may have merit, significant legal and other barriers stand in the way of allowing dentists to do more primary health care, physicians to do more oral health care, and both professions to collaborate. State practice acts, standards of care, and professional school curricula all support the historical separation between the 2 professions. Current laws do not contemplate working across professional boundaries, leaving providers who try vulnerable to legal penalties. Here we examine the legal, regulatory, and training barriers to dental and medical professionals performing services outside their traditional scope of practice.

Supreme Court ruling may determine the future of state-based professionai licensing.

The U.S. Supreme Court heard oral arguments this fall in a case involving the North Carolina State Board of Dental Examiners that could have a dramatic impact on how states license and regulate professionals in America. This paper briefly describes the facts of the case and the history of professional licensing in America and then discuses and evaluates the potential impact of the various legal arguments presented by the parties in the case.

Conebeam computed tomography: legal considerations.

With the introduction of conebeam computed tomography (CBCT) in the early 2000s, oral and maxillofacial radiology fully entered the modern world of 3-dimensional (3D) radiographic imaging. Although conventional or medical computed tomography (CT) had been available since the 1970s, with few exceptions, it had not been widely used in dentistry. In the early days of conventional CT, the machines were limited in number, restricting their use to only the most beneficial of purposes--for example, imaging of the brain. The cost of a CT examination was also prohibitive. For these reasons, the modality in dentistry was used almost exclusively in oral and maxillofacial surgery and sparingly at that. Even as the limitations of access and cost disappeared, the cost-benefit ratio when the x-ray dose was compared in relation to the information to be gained was generally considered to be unfavorable for the use of CT scans in most dental applications.

Medical grounds for suspending the professional licence of physicians and dentists by Regional Medical Councils between 1990 and 2014. / Przyczyny zdrowotne zawieszenia prawa wykonywania zawodu przez okregowe rady lekarskie w latach 1990­2014.

OBJECTIVES: The professions of physician and dentist are associated with multiple health risks. The aim of this study was to identify the medical conditions that caused limitation or suspension of the professional license of Polish physicians and dentists, and to assess their return to professional activities. METHODS: We analyzed documentation of Regional Medical Registers concerning the procedure for suspending medical licences or limiting certain medical activities, and decisions of Regional Medical Councils in 1990-2014. RESULTS: The data on 65 decisions suspending the professional license, 8 decisions limiting the license and 1 revoking the right to practice have been obtained from 8 Councils. The most frequent cause of limiting or suspending the professional license was drug and alcohol dependence (54.1%). There was no correlation between the underlying medical condition and gender or profession (physician/dentist). Among doctors aged 42-57 and 58-67 whose licence had been suspended or limited, more than 60% suffered from substance use disorder (SUD). In the group of doctors aged 41 and younger, no such case was found. Among doctors older than 67, addiction was the cause of 37.5% of decisions suspending or limiting the professional license. In no case the medical condition causing limitation or suspension of the licence was an occupational disease. SUD was more frequent in surgical than nonsurgical specialties (76.5% vs. 46.9%, p < 0.05). The doctors suffering from addictions were more likely to return to their practice (57.5%) than those suffering from other illnesses (20.5%, p < 0.05). CONCLUSIONS: The most common medical ground for limiting or suspending the professional licence was substance abuse. Number of decisions suspending or limiting the licence is relatively small and indicates a need for more efficient procedures for identification of doctors and dentists incapable of practicing due to health problems and assessment of the capacity to practice in the case of individuals who do not undertake treatment themselves and therefore are unable to assure sufficient quality of care to their patients. Moreover, although few decisions were issued, there is a need for an active addiction prevention, particularly among surgical specialists.

Dental hygiene regulation: a global perspective.

Occupational regulation of health personnel is important to professional associations and their members, the public that relies on their services and the regulatory agencies responsible for their conduct. There is increasing interest in ensuring that dental hygiene regulation fosters the continuing evolution of the profession and its contribution to oral health. The keynote address for the 2007 Regulatory Forum on Dental Hygiene, this paper discusses the rationale for and issues pertaining to occupational regulation, outlines the evolvement of dental hygiene and identifies regulatory options for the profession. Professional regulation exists to ensure public safety, health and welfare. However, negative political-economic side effects coupled with environmental pressures have resulted in increased scrutiny for health professionals. One such profession is dental hygiene. Its evolution has been dramatic, in particular over the past few decades, as illustrated by its rapidly increasing numbers and broader distribution globally, gradual shift to the baccalaureate as the entry-level educational requirement and increase in postgraduate programs and expanding scope of practice and increased professional autonomy. Regulatory changes have been more gradual. Regulation is mandatory for the vast majority of dental hygienists. Of the options available, the practice act - the most rigorous type, is predominant. Globally, regulation tends to be administered directly by the government (n = 9 countries) more so than indirectly through a dental board (n = 4) or self-regulation (n = 3). Whether regulated directly or indirectly, dental hygienists increasingly are seeking a greater role in shaping their professional future. Self-regulation, its responsibilities, misperceptions and challenges, is examined as an option.

Professionalism by proxy: a case for the formal regulation of dental assistants in Australia.

Dental assistants are the most numerous member of the dental team in Australia, responsible for many clinical and non-clinical duties. Despite this, dental assistants are not registered and regulated in the same manner as their clinical colleagues within the dental profession. In this article, the authors argue that this is an unacceptable situation within the Australian dental context. In the examination of events within the profession both within Australia and overseas, it becomes apparent that this is an untenable position with regards to promoting the safety of the public. The current stance towards dental assistants is often perpetuated by a dental profession whose motives would not seem to be free from issues of professional dominance. Dental assistants may also be an essential division of the dental profession in providing culturally competent, economically viable and sustainable oral healthcare to those communities that are traditionally difficult to access.

Issues for the Traveling Team Physician.

This article outlines the value of having the team physician traveling with athletes to away venues for competitions or training sessions. At present, this travel presents several issues for the team physician who crosses state lines for taking care of the athletes. In this article, these issues and their possible remedies are discussed. A concern for the travelling team physician is practicing medicine while caring for the team in a state where the physician is not licensed. Another issue can be the transportation of controlled substances in the course of providing optimal care for the team athletes. These two issues are regulatory and legislative issues at both the state and federal levels. On the practical side of being a team physician, the issues of emergency action plans, supplies, and when to transport injured or ill patients are also reviewed.

Current licensure for acupuncture in the United States.

This article reviews current licensure and certification standards for the practice of acupuncture in the United States. It serves as a current reference for the regulation of the practice of acupuncture, the licensing of acupuncturists, and the certification and training of physicians, chiropractors, dentists, podiatrists, and naturopathic physicians to practice acupuncture. Two national accreditation bodies are responsible for certifying acupuncture training and practice. The Accreditation Commission of Acupuncture and Oriental Medicine establishes accreditation criteria and curriculum evaluation of acupuncture training programs. The National Certification of Acupuncture and Oriental Medicine certifies individuals to practice acupuncture in the United States. Although national standards have been established, regulations regarding training and the practice of acupuncture are determined individually by each state, and tend to vary widely. Typical acupuncture training curricula for physicians and chiropractors are discussed, and variations in training requirements by state for acupuncturists and each of the other 5 disciplines is provided.