Implant maintenance in general dental practice: dento-legal considerations for the general dental practitioner.

Before implants are placed, the patient, as part of the consent process, should understand the risks of the treatment but also the importance of a lifelong maintenance programme. This is particularly important if the patient is at risk of periodontitis. There should be arrangements in place for the patient's ongoing care and general dental practitioners who look after the patient need to appreciate their duty of care in monitoring the implants. Excellent record-keeping and valid consent are important factors in delivering care and can also very much help assist a defence in the event of a civil claim or a regulatory investigation.

A general dental practitioner's responsibility for implants that have been placed by a different clinician.

A review of the management of implants in general practice in relation to the responsibility and liability for managing them when the dentist has not placed the implant themselves.

The incidence and nature of complaints against dentists for the treatment of children in Israel from 1992-2011.

OBJECTIVES: Medical literature lacks information about complaints against dentists who treat children. The present study aimed to evaluate the reports filed to Medical Consultant International (MCI) regarding paediatric dentistry in 1992-2011. BASIC RESEARCH DESIGN: Most dentists in Israel (85%) are obliged by their professional liability insurance policy to report adverse events to MCI. Reports were analysed using a structured form that included demographic details of the treating dentist, patients and parents, type of treatment, the result and the dentist's attitude. MCI dental consultants' decisions were evaluated by two specialists in paediatric dentistry. RESULTS: The number of complaints per year is increasing. Complaints involved maltreatment (33%), case mismanagement (25%) and complications that required additional treatment (26%). Communication was problematic in 60% of cases. Only 16.7% of complaints developed into an actual lawsuit. Most complaints were against female general practitioners and against dentists who worked in community dental clinics located in peripheral areas. Treating permanent teeth increased to 3.6 times the probability of developing into a lawsuit. 59% of event records had missing data. Seventy-five percent of the cases rose from elective treatments while 25% concerned emergency treatments. One third of the cases required additional treatment in a hospital i.e. abscess drainage, foreign body swallowing or other physical damages. CONCLUSIONS: Better case selection and documentation, better training of dentists who treat children and more appropriate attitude toward patients and parents, are likely to reduce the number of complaints.

[Dentists' judgement of the complaint procedure of the Royal Dutch Dental Association]. / De KNMT-klachtenregeling beoordeeld door tandartsen.

In 2013, to evaluate the functioning of the complaint procedure of the Royal Dutch Dental Association (KNMT), an anonymous, written survey was conducted among 955 dentists and dental specialists, for whom in the period mid-2008 to mid-2013 a complaint was handled. 413 (43%) participated in the study. 51% of them reported that the complaint was successfully mediated by the Regional Mediation Boards and the Specialist Mediation Board and 17% that the patient had withdrawn the complaint. For the remaining 32% the complaint was handled by the Central Complaint Committee, who determined that 13% was (partially) substantiated, 17% was not substantiated and 2% was settled. Generally, 79% of the dentists are (mostly) positive about the procedure of mediation, while 8% are neutral and 13% are dissatisfied about it. With regard to the complaints procedure this was 60%, 11% and 29% respectively. The judgment of the dentists about the Regional Mediation Boards and the Specialist Mediation Board and about the Central Complaints Committee is influenced by the success of the complaints procedure and by the impact of the complaint that was experienced. The emotional support of dentists during the complaints trajectory is one of the points requiring attention.

Perspectives of dental students and faculty about evidence-based dental practice.

OBJECTIVE: The study aimed at evaluating attitudes and perceptions of dental students and faculty toward evidence-based practice, integration of technology and social media, general practitioners' and specialists' scope of practice, and dental practice rewards and disadvantages. METHODS: A survey instrument was designed with 10 statements rated on a five-point Likert scale (strongly agree to strongly disagree) and an optional comment section. The survey instrument was delivered through SurveyMonkey, whereby 401 students and 182 faculty members from ten U.S. dental schools participated (16% estimated response rate). Null hypotheses regarding the equality between the responses of the two groups were statistically tested using Mann-Whitney U test. Statistical significance was set at .05. RESULTS: Evidence-based practice is positively perceived by both groups, but with significantly higher support by faculty than students (P = 0.002). Both groups agreed that technological advancements are advantageous (P = 0.95), but do not constitute good dentistry and cannot mask poor clinical skills. Students showed higher support for social media than faculty (P = 0.000). Both groups perceived group practices positively. Faculty members showed higher agreement than students toward limitation of dental specialists' practices to their specialties (P = 0.000). Both groups are aware of practice disadvantages, such as increased litigation, health risks, and detriment to the dentist's posture. However, they both perceive dental practice positively despite all these challenges. CONCLUSIONS: Students and faculty share generally comparable perspectives toward dental practice. They are both in agreement with evidence-based practice and adoption of technology. They both acknowledge practice limitations.

Extending dental nurses' duties: a national survey investigating skill-mix in Scotland's child oral health improvement programme (Childsmile).

BACKGROUND: Childsmile is Scotland's national child oral health improvement programme. To support the delivery of prevention in general dental practice in keeping with clinical guidelines, Childsmile sought accreditation for extended duty training for dental nurses to deliver clinical preventive care. This approach has allowed extended duty dental nurses (EDDNs) to take on roles traditionally undertaken by general dental practitioners (GDPs). While skill-mix approaches have been found to work well in general medicine, they have not been formally evaluated in dentistry. Understanding the factors which influence nurses' ability to fully deliver their extended roles is necessary to ensure nurses' potential is reached and that children receive preventive care in line with clinical guidance in a cost-effective way. This paper investigates the supplementation of GDPs' roles by EDDNs, in general dental practice across Scotland. METHODS: A cross-sectional postal survey aiming to reach all EDDNs practising in general dental practice in Scotland was undertaken. The survey measured nurses': role satisfaction, perceived utility of training, frequency, and potential behavioural mediators of, preventive delivery. Frequencies, correlations and multi-variable linear regression were used to analyse the data. RESULTS: Seventy-three percent of practices responded with 174 eligible nurses returning questionnaires. Respondents reported a very high level of role satisfaction and the majority found their training helpful in preparing them for their extended role. While a high level of preventive delivery was reported, fluoride vanish (FV) was delivered less frequently than dietary advice (DA), or oral hygiene advice (OHA). Delivering FV more frequently was associated with higher role satisfaction (p < 0.001). Those nurses who had been practising longer reported delivering FV less frequently than those more recently qualified (p < 0.001). Perceived difficulty of delivering preventive care (skills) and motivation to do so were most strongly associated with frequency of delivery (p < 0.001 for delivery of FV, DA and OHA). CONCLUSIONS: This study has provided insight into EDDNs' experiences and demonstrates that with appropriate training and support, EDDNs can supplement GDPs' roles in general dental practice in Scotland. However, some barriers to delivery were identified with delivery of FV showing scope for improvement.

Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners.

UNLABELLED: Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim. CLINICAL RELEVANCE: New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.

[Dentistry and healthcare legislation 10. The law governing complaints: readily accessible filing procedures]. / Tandheelkunde en gezondheidsrecht. 10. De Wet klachtrecht: laagdrempelig klagen.

The law promises patients a readily accessible means of filing complaints. Healthcare providers are therefore required to adopt regulations governing complaints which satisfy a number of conditions. Most dentists choose to adopt the regulations which have been established by their professional organization. In addition to handling complaints, there is also a provision for mediation, which is often used by patients. Mediation appears, then, to be a successful provision. Many complaints have their origin in insufficient knowledge of healthcare legislation and patients' rights legislation. This demonstrates that more attention should be given to these subjects in educational programmes and programmes in continuing education. The present law governing complaints is expected to be replaced this year by a new, more comprehensive law in which considerable attention will be devoted to the quality of care as well as to complaints. It seems likely, however, that the new law governing complaints will damage the effective manner in which patients' complaints are dealt with in dentistry today.

[Distribution of patients' complaints presented to the law court of the Israel Dental Association according to themes, dental area profession and the results].

The purpose of this study was to review the distribution of patients' complains presented to the law court of the Israel Dental Association in Tel Aviv district, according to their topics, dental areas and results. 260 complaint cases filed between 2000 and July 2008 were reviewed. only 186 cases, to which an arbitration proceeding conducted full appeal only, were taken into account . Dentists, who encountered many complaints, were classified according to their country of graduation, as specialists or general dentists. The complaints were classified according to their specific dental field, year of complaint, to the number of arbitrations each year, to the number of appeals each year, to the entity who submitted the appeal, to the difference between the verdict in the District compared to the national ruling, to the distribution of complaints by gender and to the frequency of complaints by anonymous doctors. The distribution of complaints in accordance with topics was as follows: 30% in oral rehabilitation 13.5% in Dental prosthesis, 12.4% in implants, in endodontics 5.3%, 3.7% in maxillofacial surgery, 3.2% on ethics, 2.7% in orthodontics, 1.1% in periodontology 0.5 % in pedodontics and 28% in combined dental domains. 92.5% of complaints filed against dentists who were not experts. 7.5% of the complaints were filed against s specialists. Specialists in the field of oral rehabilitation encountered the largest number of complaints, i.c. 30%. Approximately 35.2% of complaints filed against dentists who have completed their studies in Eastern European countries and 24.9% against the Israeli graduates. 63% of referrals to the Court from Tel Aviv district for which a full arbitration procedure / appeals were presented by women whereas only 37% were presented by men. An analysis of the findings in the difference between the verdicts in the District compared to the national ruling it showed a tendency to aggravation of punishment. (P = 0.003) The Greatest number of appeals was filed in 2001, mostly by patients. In 2004, the greatest number of appeals were filed mostly by dentists. Most appeals have been filed over the years by patients. Against a small number of doctors several complaints were filed. The majority of complaints that were filed in a specific period against one doctor was 6.

Risk management in the dental office.

This article is devoted to risk-management strategies regarding oral surgical procedures in the general dental office. Lawsuits are more likely to be filed following poor outcomes related to oral surgical procedures rather than after operative or prosthetic dental procedures. The article is not meant to discourage practitioners from performing oral surgical procedures if they have the experience, training, and appropriate skill set to complete the planned procedure. Rather, it advises clinicians as to the steps one can take to limit the chances of litigation from occurring, and avoid the emotionally and painful time-consuming process associated with a malpractice lawsuit.