The dental profession differs from the medical profession due to the general lack of professional oversight. This can, and many times does, result in patient injuries due to a breach of duty. Solo practitioners in an office setting, by and large, make up the majority of the dental profession; precluding formal quality assurance by peers. In a hospital-based medical practice, for example, formal review of patient complications occurs at regular intervals, is discussed, and recorded in an open and transparent manner among multiple physicians and staff. Thus, improvements in patient care can be proactively introduced by the facility.
Very little research or data exists in the scientific literature on dental patient injuries; however, it is much more common than the public would believe. As a practicing surgeon, dental specialist and dental educator for over 20 years, I have been secondarily involved in the treatment of hundreds of patients in which dentists performed procedures in which they had no formal training.
This differs significantly from the medical profession. For example, a Dermatologist cannot perform Neurosurgery procedures because a hospital credentials committee reviews the training of that applicant. Without formal training, hospital surgical privileges would not be granted to the individual. The public is thereby protected from un-trained or otherwise under-qualified practitioners.
State dental boards are not involved in the credentialing of procedures for dentists in most states; except for the delivery of advanced anesthesia techniques (e.g. IV sedation). Anesthesia techniques are treated differently than other procedures due to the significant risk of office-based anesthesia in un-trained hands.
However, special state board permits for other advanced techniques (e.g. dental implants) that were not learned in dental school do not exist. This lack of oversight contributes to dental patient injuries in the US.
Most state dental boards will hold licensees to the standard of a care of a dental specialist in disciplinary matters involving advanced techniques; such as the previous example of implants. The “minimally competent practitioner in the same field” who sets the standard for these procedures is the specialist. He is not the general family dentist.
However, this policy does not protect the public proactively from un-trained practitioners performing procedures in which they have no formal training. Since general dentists can still choose to perform these advanced procedures. This is in a sense just putting the “cart before the horse,” and contributes to negligence. In addition, Dental Boards in the US are overwhelmingly comprised of general dentists, not specialists. So any restrictions on the practice of generalists will not be looked upon favorably.
Frequently, dentists will take weekend courses to add new techniques to their private practices. The American Dental Association’s Commission on Dental Accreditation (CODA) certifies dental schools. It also certifies dental residency training and the student curriculum in the US. They do not certify these weekend courses as being adequate training to produce competency. A specific technique that may have taken me 4 years of residency training cannot be mastered in a weekend course. These are highly technical and difficult procedures that may take years to develop competency.
Dental specialists can also become complicit in the making the breach of duty problem simply “go away” in many communities. In my state, a mandatory state board reporting duty exists if we “have personal knowledge that another dentist has engaged in illegal, unlawful, incompetent or fraudulent conduct in the practice of dentistry” (828 IAC 1-1-23, Sec 23 (a)). In practice, this rarely, if ever, happens.
While occasional bad outcomes are to be expected after any procedure, and you can never guarantee a successful outcome, negligence is quite easy to define by experienced individuals. My advice to those dentists who are thinking of performing procedures in which they have no formal training is to reconsider. A good rule is to treat your patients the way you would want your family members treated. This is my definition of a duty to your patient.
If you cannot deal with all the potential complications of the procedure and are unsure of your abilities, don’t do it! On the job training can just as easily be viewed as human experimentation from another viewpoint.
Attorneys who deal with the dental profession should critically review the training and experience of those practitioners involved in the case. In my experience, lack of training and experience is the root cause of most dental negligence. Voir dire should not be limited to just the experts in the case. Bad outcomes can be expected with surgery on occasion – negligence is not. It’s vitally important to differentiate between the two if tort law is to be a successful deterrent in limiting patient injuries from poor judgment and care. State dental boards should mandate stricter credentialing for new graduates. This should exactly reflect the training and experience of the individual in the same manner as a hospital credentials committees do on a regular basis.
