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.

A study of 1000 malocclusions selected by the HLD (CalMod) Index.

The purpose was to study the results of applying the HLD (CalMod) Index to a very large population of patients. The materials were the study models of 1000 cases that had already been measured and approved for treatment. Each model was remeasured and studied. The average age of the patients was 14.138 years of age; 55% were females and 45% were males. Fifty-six percent were approved on the basis of a score of 26 or more, and 44% were approved as one of the exceptions in the index. Fifty-eight percent of the patients were Class I, 35% were Class II, and 7% were Class III. Surprisingly, 26% of all the approvals (19% adjusted for overlap) were for overjets greater than 9 mm. Reverse overjets occurred at the rate of 2% of approvals. Deep impinging overbites with tissue destruction comprised 12% of all approvals and crossbites of individual anterior teeth with tissue destruction 4%. Only 4 cleft palate cases were recorded, as they do not routinely enter the system through the index route. No traumatic deviations were found. The HLD (CalMod) Index has been field tested under a very heavy load. This study demonstrated that it selects a very wide range of malocclusions.

The standard of care for oral diagnosis as it relates to oral cancer.

The periodic oral examination of patients must be performed by the dentist as standard procedure. As a physician of the mouth, the dentist must also be able to recognize abnormalities or lesions and then provide, or refer patients for, diagnosis, treatment, and surveillance of the condition. With prompt and decisive action, the dentist can save lives and influence the morbidity of oral cancer. Conversely, inadequate diagnostic skills and improper documentation techniques can incur legal consequences.

A case for diagnoses.

It is common practice to record treatment rendered, but not the diagnostic basis for these treatment decisions. This practice appears to undervalue diagnosis, as well as hamper feedback to practitioners and the profession about the effectiveness of treatments relative to specific diagnoses. It also leaves dentists open to liability for litigation and impedes research. A case is made that dentistry should follow medicine in exploring the use of standardized computer-codable diagnoses as part of record keeping. A two-step process is suggested to promote initial acceptance.

Current status of tests for periodontal disease.

The methods applied to the diagnosis of periodontal disease are changing. Historically, static clinical and radiographic parameters have formed the basis of the periodontal evaluation. As the limitations of these traditional procedures became clear, several new techniques have been proposed as diagnostic tests for periodontal disease. These tests are based on improved understanding of the pathogenesis of periodontal disease, and can be considered in three categories: assessment of physical changes in the periodontium, the bacterial infection, and the host response to the infection. Several technical questions must be addressed before these tests can be widely utilized. These specific concerns include such matters as the information available from the tests (e.g., Does the test provide a measure of disease severity or identify the site, region, or patient experiencing active disease?), the most appropriate test configurations, the statistical analysis of data from trials examining the accuracy of the tests, and selection of patients who would benefit from these procedures. Last, several important practical issues must be examined before these tests can be expected to gain widespread acceptance. These include familiarization of dental practitioners with the use of diagnostic tests and the medical laboratory, the role of regulatory agencies in determining the claims made by these tests, and the medical/dental insurance benefits provided for these services.

Forensic and legal issues in oral diagnosis.

The forensic odontologist has assumed a more visible role in the last decade, having been called upon repeatedly to assist both law enforcement agencies and the judicial system. It has become quite common for dentists to establish the identity of unknown bodies; to quickly and positively identify the victims of mass disasters such as airliner crashes, floods, and earthquakes; as well as to provide testimony in court concerning bite marks or other matters that require dental expertise. Litigation directed at dental defendants for failure to diagnose, properly treat, or obtain valid consent from plaintiff patients is also on the rise. In each of these fields, dentists who have been specially trained in or who have devoted their practices to the dental diagnostic sciences have been looked to widely as experts. This article discusses in detail these areas and others that affect the dental diagnostician.