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COVID-19 Vaccines in the Dental Workplace FAQs for Practice Owners (via ADA)

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Dismissing a patient is sometimes the best option for the practitioner and the patient. However, it can be uncomfortable and challenging. Knowing when and how to correctly terminate the relationship is critical to avoid an issue such as abandonment.

Formal, written notice should be mailed to the patient (no email or text!). Under Colorado law, certain provisions must be met when dismissing the patient such as reason(s) for dismissal, advising patient of conditions requiring further treatment or evaluation, 30 days of dental emergency availability, as well as other requirements.  Each dismissal case is different and the letter should, therefore, be individualized.

Ultimately, the decision to dismiss a patient is the practitioner’s. For a more thorough discussion of Dismissing a Patient as well as guidelines visit the Resource Library for the full article, Dismissing a Patient (Breaking Up is Hard to Do…or is it?)

If you are not a member of the Trust and would like to be contacted about becoming a member please go to Contact Us on the Home Page banner or feel free to reach out to Dr. Candace DeLapp [email protected]

doctor dismissing a patient

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As dentists we understand the pro and cons of dental treatments, but rarely do our patients. Obtaining informed consent is the process of giving a patient enough information to make an informed decision and is the basis for all of our recommended treatment. Do all procedures require informed consent? Probably not all, i.e., oral exam. However, informed consent is considered standard of care and is strongly recommended for most procedures:  oral surgery, endodontic, prosthodontics, and Invisalign, etc. Our Colorado dental malpractice carrier (www.tdplt.com) the Dentists Professional Liability Trust, fields calls on a daily basis on the most effective way to present and maintain consent for the benefit of both the dentist and the patient.

Informed consent is “not” just a paper to sign. Sometimes the message is misconstrued that informed consent is just a sheet of paper to be signed quickly. This could not be further from the truth.  Informed consent provides a cognitive checklist of areas to review with patients prior to performing a procedure. Ultimately, the goal is to provide significant information about the procedure, allowing time for feedback (reflection), and clarification so a patient’s expectations can be managed. Providing time for the patient to make an informed decision increases patient autonomy and can help reduce the malpractice gap. Obviously, with certain procedures time is of the essence while not with others.  Deciding on having a root canal is much more time sensitive than deciding to do Invisalign or dental veneers.

informed consent

For more information on the Informed Consent process learn more in the Resource Library.

If you are not a member of the Trust and would like to be contacted about becoming a member please Contact Us or reach out to Dr. Candace DeLapp at [email protected].

The Dentists Professional Liability Trust of Colorado is a dental malpractice carrier and works in partnership with the Colorado Dental Association and seeks to provide our dental community with resources to help Colorado dentists and their patients by providing tools and information to improve the understanding of dental procedures.

Posted by & filed under Anxiolysis, Deep Sedation, Dental Anxiety, Featured, Minimal Sedation, Moderate Sedation, Sedation.

A Quick Review of Sedation Related Definitions

Anxiolysis – To mitigate anxiety. Usually accomplished in the clinical setting by administering a medication the night before and the morning of the procedure to reduce anxiety.

Minimal Sedation – Lightly depressing a patient’s level of consciousness with agents to produce a level of light or minimal sedation. The patient’s cognition level may be slightly impaired but respiration and cardiovascular functions should not be adversely changed or affected.

Moderate Sedation – Mildly depressing a patient’s level of consciousness with agents to produce a level of moderate sedation. The patient’s cognition level will be impaired but the patient should be able to respond to commands and light stimulation. The patient’s respiration and cardiovascular functions should not be adversely changed or affected.

Deep Sedation – Heavily depressing a patient’s level of consciousness with agents to produce a level of deep sedation. The patient’s cognition level will be greatly impaired and the patient will have great difficulty in responding to very simple commands or stimulation. The patient’s respiration and ability to maintain an airway may be adversely affected but cardiovascular functions should not be adversely changed or affected.

Level of consciousness from anxiolysis through sedation to general anesthesia needs to be thought of as a smoothly flowing continuum. The levels outlined for clinical and academic purposes are actually smoothly flowing and interconnected. A good source of information for this can be found in The Colorado Dental Practice Rule XIV, The Anesthesia Continuum.

Brent E. Virts, DDS

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SB19-079 Electronic Prescribing of Controlled Substances

On April 8, 2019, Governor Jared Polis signed SB19-079 Electronic Prescribing of Controlled Substances. This law requires that all podiatrists, dentists, physicians, physician assistants, advanced practice nurses, and optometrists that prescribe a schedule II, III, or IV controlled substance do so electronically, with certain exceptions. The law does not require pharmacists to verify the applicability of an exception to electronic prescribing and pharmacists may dispense the controlled substance pursuant to an order that is written, oral, or facsimile-transmitted that is valid and consistent with current law. For most prescribers, the requirement begins July 1, 2021. For dentists and prescribers who work in a solo practice, or in a rural area, the requirement begins July 1, 2023.

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Cosmetic medicine is not an exact science, and patients occasionally have less than perfect outcomes with dermal fillers. Less experienced providers are more likely to make mistakes such as overfilling and asymmetry. Other side effects such as infection and allergic reactions can occur. Hyaluronic acid fillers such as Juvederm and Restylane products can be partially or completely removed with an enzyme called hyaluronidase. When injected into the affected areas, hyaluronidase dissolves the hyaluronic acid particles and may help in the event of vascular compromise, lumpy or irregular texture, infection in the treatment area, overfilling and dissatisfying results. Hyaluronidase isn’t perfect, and since products tend to be made from animal derivatives, certain patients may be at higher risk for allergic reaction and therefore not good candidates for the treatment. Make sure your patients know to call you immediately if they are experiencing pain, or unusual swelling, or the area feels warm to the touch. These are signs of infection that need to be addressed swiftly. Calcium based fillers can NOT be reversed with hyaluronidase. Each dermal filler product is unique and a wide variety of products are available. If this is a procedure you rarely provide, you might want to consider whether the possible complications are worth it. -Berkley Risk Complications with Dermal Filler Procedures. Is it worth it?

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No Child under the age of 12 should snore. If they do, they me be suffering from obstructive sleep apnea. Children can be misdiagnosed with ADHD when in fact they have OSA. Common symptoms of OSA in children are: Sleep in abnormal positions, snore loudly and often, stop breathing, sweat during sleep, behavioral problems. Restless sleep. Headaches in the am and bed wetting. As a dentist some of the oral signs you may notice are: mouth breathing, chapped lips, exaggerated gag reflex and dark circles around their eyes. We as dentists, see our patients more frequently than MD’s do so we can screen and refer to sleep specialists. We can CURE KIDS with OSA with early treatment (tonsillectomy and max expansion with forward maxillary growth) but adults we can only treat. So, Keep your eyes open!!!

Posted by & filed under Malpractice Coverage.

By Dr. Lindsay Compton

I knew when I left school I needed a few necessities to practice dentistry. I needed to have passed boards. Check. I needed to apply for my state license. Check. I needed to have malpractice insurance. Sure? Maybe? Kinda?

Myself and my classmates set out on the mad dash to get malpractice insurance, and true to dental student fashion, I needed the best deal. The only problem was that I had no idea what the words in the malpractice policy even meant. Seriously! How could I have endured the trials and tribulations of dental school and not know what the composition or the key terms in my malpractice quote. Further, how am I going to judge if what’s in my policy is what I really need?

Let me simplify your life and give you the skinny on the components and meaning of your malpractice insurance. First, don’t get caught up in terminology. Malpractice insurance and professional liability insurance are the same thing. It’s also the same as errors and omissions insurance. It protects you against a claim that the dentistry you provided was done in error or an omission of treatment. If a claim is made and brought to trial, it will pay for your defense and damages whether the claim was unfounded or not. Keep your auto, home, life, and umbrella insurance. These don’t overlap. It will only cover you in civil matters in the practice of dentistry.

Next up are the really large numbers that the State Dental Board asks for you to have covered. It looks like this: Effective July 1, 2010, the law requires a minimum indemnity amount of $1,000,000 per incident and $3,000,000 annual aggregate per year, or an acceptable alternative as set forth in Board Rule 220.

Let’s break that down. Minimum indemnity amount is the maximum amount an insurance company will pay out for any one claim in one year. At this time, Colorado asks that you have $500,000 of minimum indemnity. An example of this would be if a patient claimed that you failed to diagnose their periodontal disease and therefore they are losing all their teeth. When the insurance company acts to defend you by retaining an attorney and acquiring testimony and other needed items in a civil court case, the most they will pay out is $1,000,000 per case. 

Taking that a step further is the annual aggregate per year. This is the total amount an insurance company will spend on defending you in one year. So if you have multiple claims in one year, the insurance company will stop covering the costs at $3 million. You may ask, “What if legal fees are greater than $1 million for one case or $3 million in one year?” In that situation you would then be responsible for the rest of the bill.

As a new dentist myself, I have a couple of words of advice despite the grim topic. Get malpractice insurance from a company where you can talk to a real live person. If something were to happen, you don’t want to be encouraged to send an email or chat online. You will be panicked and you need a voice on the other end of the phone. Sign up with a company that has dentists on their board and is run by dentists. Don’t rely on statisticians and historians to comb through legal cases to see if your claim can be won or not. Have a group of dentists that are on your side and looking out for your ability to practice dentistry. Unfortunately we live in a litigious society and some patients believe that a malpractice payout could secure their financial future. Practice with confidence and only practice with The Trust.

Posted by & filed under HIPPA.

by Dr. Candace DeLapp

Texting has become more common as a means of communication. It’s easy and convenient for all parties. However, it is not without pitfalls. Below are a couple of situations you need to know about texting and malpractice claims.

  1. A patient texts you or your office with “a quick question.”  Avoid the quick answer back. Maybe have the patient in for a face-to-face conversation or let them know you want to investigate further and will get back with them. Patients can and will use text messages against you!
  2. Do not conduct business via texting. Your office should not be texting billing statements (balances due) or any private information via a text. A personal phone call or statement should be sent. Speak with the patient in person (don’t leave a detailed message) and ask them to return your call. HIPPA and privacy issues come in to play here. Have you ever dialed the wrong number?
  3. Appointment reminders are acceptable via texting, but no personal information should be included. Just the day and time of the dental appointment. No details as to what is to be performed. Again, this is a privacy issue. You don’t know who has access to the text.

It’s important to remember that anything stored on a phone can be retrieved and used as evidence.

Be careful what you text!

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By Dr. Todd Pickle

I am sure you have never had a situation where two or more implants are either too close together or angled into each other to the point that you cannot get the metal impression copings on at the same time.  But if this ever does happen, I have found the best thing to do is use a plastic version of the impression coping if your implant company makes one, which many do.  This will allow you to cut the copings so that they all fit and you can pick them up in one closed-tray impression. 

Plastic impression copings are single-use anyway, whereas metal copings that you have to cut are usually not usable again.  They are not accurate enough for multi-use and the plastic components deform during use beyond their elastic ability to accurately be used again.  But if you cannot find a plastic version of the impression coping, you should try to find a plastic TEMPORARY coping.  These can be customized with resin ‘blobs’ so that they will pick-up in the impression and serve the same purpose. 

Make sure you decide if you need engaging or non-engaging copings before you make the impression.  Some companies call these parts “bridge copings”.  Only single unit crowns need engaging copings, so stick with non-engaging components for everything else, including impressions.   

Use this tip to make a good impression!