Standard of care: the legal view.

The standard of care is a legal construct, a line defined by juries, based on expert testimony, marking a point where treatment failed to meet expectations for what a reasonable professional would have done. There is no before-the-fact objective definition of this standard, except for cases of law and regulation, such as the Occupational Safety and Health Admintration (OSHA). Practitioners must use their judgment in determining what would be acceptable should a case come to trial. Professional codes of conduct and acting in the patient's best interests are helpful guides to practicing within the standard of care. Continuing education credit is available for this and the following article together online at www.dentalethics.org for those who wish to complete the quiz and exercises associated with them (see Course 22).

The ethics of social media in dental practice: challenges.

This is the first of two essays written to consider several important trends in dental practice that result from innovations in digital and social media. This essay reviews ethical and legal implications of the use of websites, Facebook, review sites, email and other digital innovations in dental practice. The second essay provides ethical tools for analysis, illuminates areas of ethical concern in today's practice environment and offers recommendations for future practice.

The ethics of social media in dental practice: ethical tools and professional responses.

This article considers several important trends in dental practice that result from innovations in digital and social media. It provides ethical tools for analysis, Illuminates areas of ethical concern in the current practice environment and offers recommendations for future practice. A summary in the form of a checklist is posted at the end of this essay for dentists considering the use of social media in their practice.

The law and dentoalveolar complications: trends and controversies.

Complications are an inherent part of oral and maxillofacial surgery. A risk in surgery is a complication that occurs despite treatment that meets or exceeds the professional standard of care. When treatment fails to meet the standard of care, a complication may be considered the result of malpractice, resulting in claims for compensation. Whether a surgical procedure meets the standard of care is determined by expert witnesses evaluating the evidence. This article reviews legal issues and cases where complications have resulted in claims of malpractice. Recommendations for patient communication and documentation to reduce or eliminate such claims are presented.

Legal issues of perinatal oral health.

Every dental health care provider will inevitably be faced with perinatal oral health issues involving patients or staff members. The legal issues involving perinatal dental care are reviewed including the laws of malpractice claims by patients, employment claims involving staff, and Dental Board of California investigations involving patient care, and the administration of the business of dentistry. Recommendations are made for record keeping.

Cone beam CT--anatomic assessment and legal issues: the new standards of care.

Until the recent introduction of cone beam computed tomography scanners, standard 2-D imaging provided a moderate contribution to overall treatment planning when considering the diagnostic potential, costs of study and risks to the patient. Cone beam computed tomography-dedicated maxillofacial imaging scanners provide broader imaging tools for anatomic assessment and have become widely available. This article discusses the uses and benefits of 3-D imaging, as well as the impact on the standard of care. Many phases of patient care involve imaging to assist with diagnosis, treatment planning, risk assessment and treatment. Techniques employing X-rays, visible light, ultrasound, lasers and magnetic fields have been used in medicine and dentistry to create images. All forms of imaging require a coupled system of emitters and sensors. For example, a cephalometric image is produced using an X-ray emitter and film sensor. Imaging systems can be categorized in many different ways based upon emitter or output type (examples; film-based, digital, 2-D and 3-D images). The resultant images can be used to evaluate the anatomy of interest, including surface and subsurface. The ultimate quest of all forms of imaging is to reveal the anatomic truth; that is, to portray the anatomy as it exists in nature. Thoughtful clinical application of image acquisition requires matching the uses and limitations of the available imaging choices to achieve the desired diagnostic information (imaging goal) while keeping the risks and costs to the patient as low as possible. Imaging data must provide a benefit at an acceptable cost and risk. Two-dimensional representation of 3-D anatomies creates images that have poor spatial accuracy, are static in space and time, and contain information voids. These 2-D measurements have propagated legacy databases of inaccurate morphometric measurements. Current development in imaging technology for dentistry includes digital imaging and improved sensor technology. Multidimensional anatomical reconstruction can be performed through software applications. The ultimate reward of technological imaging advancements is the 3-D representations (digital volume) of anatomy as it exists in nature (anatomic truth). Analysis of the accurate digital volume can provide clinically relevant spatial information or data. Visualization and analysis of 3-D information can benefit a dental practice by providing data that will improve diagnosis, risk assessment, treatment outcome and treatment efficiency, and reduce treatment complications. This article discusses the uses and benefits of 3-D imaging (cone beam CT, CBCT) for diagnosis, treatment planning and the legal issues affecting the standard of care, as well as offering risk management tips and use guidance.

The business of dentistry.

There are many reasons why someone chooses to become a dentist: a family member was in the profession, they have a proclivity for the sciences of health care, or they like the autonomy of having their own practice. Mark Gonthier, assistant dean for admissions of Tufts University School of Dental Medicine, offered this description of the ideal dental school applicant, "We are looking for mature, well-rounded students capable of handling the rigor of the basic sciences curriculum and are equally adept and committed to providing quality comprehensive patient oral health care" Few dentists will report that they chose their profession because they wanted to run a small retail business.

Cone beam CT--anatomic assessment and legal issues: the new standards of care.

Until the recent introduction of cone beam computed tomography scanners, standard 2-D imaging provided a moderate contribution to overall treatment planning when considering the diagnostic potential, costs of study, and risks to the patient. Cone beam computed tomography-dedicated maxillofacial imaging scanners provide broader imaging tools for anatomic assessment and have become widely available. This article discusses the uses and benefits of 3-D imaging, as well as the impact on the standard of care.

Prevention of wrong-site tooth extraction: clinical guidelines.

Wrong-site tooth extraction can be defined as the extraction of a tooth other than the one intended by the referring dentist. This adverse event continues to be one of the major reasons for filing malpractice claims against oral and maxillofacial surgeons. Most cases of wrong-site tooth extractions are preventable and can be minimized by the development of an educational program, an informative, unambiguous referral form, a pre-operative check list, and incorporation of the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery into daily clinical practice.

The leqal standard of care.

Standard of care is a legal concept of establishing, on a case by case basis, the minimal quality of care that must be met to defend against a claim of negligence in a lawsuit. Unlike other "standards," it is not prescriptive, but it does encompass diagnosis and overall management of patients, not just treatment. The standard is determined by assessment of the credibility of expert witnesses, the appropriateness of written evidence, and pertinent laws and regulations. Although the burden of proof rests with the plaintiff, only a preponderance of the evidence, not certainty beyond doubt, is required. Practice, especially diagnosis and informed consent, must be updated continuously.

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.