Dentaltown July 2020 - 52

What is the "standard of care"? That's
the elusive question every dentist in the world
really wants to know. I've spent more than
three decades figuring out this question and
the amazing thing is, the answer changes.
Every time there's a lawsuit or a dental board
case has a ruling, we change the standard of
care and up the ante for every dentist. The
only constant in life is change.
So, the definition of the standard of care
is what a reasonable and prudent dentist
would do in a like or similar situation, in a
like or similar locale. The standard of care
is more like a bell curve, as seen in Chart 1.
If you really examine malpractice cases
and dental board cases, you begin to realize
that breaking the standard of care requires
you to be negligent.
The most common standard of care
breach involves record-keeping. How many
times do I hear from attorneys that the
dentist "normally" does this but was remiss
in putting it into their records? Don't be that
dentist who didn't put the information in
the patient chart.

if we have done that job correctly, we must
ask ourselves some basic questions when we
do our exams. Below is a list of questions
to assist in determining if a dentist met
the standard of care for the four blanket
allegations.

Guidelines for determining
the standard of care

*	 Was a full-mouth X-ray series
or equivalent taken?
*	 Are the X-rays clinically acceptable?
*	 Do any other X-rays exist?
*	 Are the X-rays clinically applicable
to the diagnosis?

First, we must examine the basics.
What do I mean? The basics would include
what used to be called the "four blanket
allegations," a term used for decades by the
Arizona State Board of Dental Examiners.
The categories of the four blanket
allegations are:
*	 History/clinical.
*	 Radiographs.
*	 Diagnosis.
*	 Treatment planning.
These really determine the outcome of
everything we do in dentistry; without this
basic information, we cannot determine the
health of the patient. We cannot determine
what was done or needed to be done. We must
have a diagnosis or differential diagnosis,
and we must have a treatment plan. We
also need X-rays to properly diagnose.
Without these basic elements, we cannot
do dentistry safely.
The health, welfare and safety of the public relies on us doing our jobs. To determine

52

History/clinical
*	 Does a signed and dated
health history exist?
*	 Is the health history
comprehensive?
*	 Do regular health history
updates exist?
*	 Does there appear to be
soft-tissue exam notes?
*	 Are full-mouth periodontal
probings present?
*	 Do regular periodontal
updates exist?
*	 Was a limited exam done?
*	 Are existing restorations charted?
*	 Does a TMJ/TMD evaluation exist?
*	 Is there an oral cancer screening?

Radiographs

Diagnosis
*	 Does a written documented
diagnosis exist?
*	 Is the diagnosis consistent
with the treatment plan?
*	 Is the diagnosis reasonable?

Treatment planning
*	 Does a written documented
treatment plan exist?
*	 Is the treatment plan supported by
the radiographs and diagnosis?
These are the questions you should be
asking before doing the procedure being
evaluated. Remember, if only a limited
exam was done, it is not expected to have
existing restorations, full-mouth periodontal
probing, etc.; the information listed can be

JULY 2020 // dentaltown.com

DT0520_Dovgan_Standards_AG.indd 52

6/22/20 12:20 PM


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Dentaltown July 2020

Table of Contents for the Digital Edition of Dentaltown July 2020

Dentaltown July 2020 - Intro
Dentaltown July 2020 - Cover1
Dentaltown July 2020 - Cover2
Dentaltown July 2020 - 1
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Dentaltown July 2020 - Cover3
Dentaltown July 2020 - Cover4
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