Posted by & filed under Featured, Malpractice Coverage.

By Dr. Lindsay Compton

Dentists don’t practice alone or in a bubble. That would be boring and I personally feel that I would be missing out on a lot of fun and comradery. I consider my hygienist leader in my dental team and sometimes an appendage of my body. For me and my practice philosophy, I wouldn’t practice without a hygienist.

As an important practitioner in the dental office, does the hygienist need malpractice insurance? The oversimplified answer is no. In most instances, the dentist’s professional liability or malpractice insurance will cover the employed dental hygienist. You’ll notice that I said the words “in most instances,” which means not always. Which means there probably was a time when the hygienist was liable. Which means there exists a situation when the hygienist needs their own malpractice insurance.

Let’s look at an example of this. Let’s say that your hygienist was placing sealants on a patient. Unfortunately the etch tip was not securely placed on the tube. As they were carrying it from the patient tray to the patient, the tip popped off and etch was expressed all over the patient’s face and eye. Did I say they patient was not wearing eye protection as well? To make matters worse, the patient had a horrible reaction between their face cream and the phosphoric etch and their face became scarred. The patient not only needed emergency treatment for their eye, but they also needed cosmetic facial and reconstructive surgery to cover up the scar created from the unsecured etch tip. In this instance, the dentist and the hygienist were both listed on the civil law suit. The legal fees and medical fees were over the required state coverage. Therefore both the dentist and hygienist were responsible for the difference in damages because both were listed on the case.

Could just a hygienist be named in a law suit? Yes they can. It would look something like this next example. An elderly patient gets up from a patient visit and uses the back of the patient chair to steady themselves as they exit the operatory. Unfortunately as they reach for the headrest on the chair, they instead only grab the headrest cover that wasn’t secure enough for the needs of the patient. The patient falls and hits their head on the counter top. They end up needing stitches in their head and sue the hygienist, not the dentist, because it was their responsibility for the upkeep of the operatory. Since only the hygienist was named on the law suit, the dentist’s malpractice insurance will not cover the hygienist.

Outside of the scope of this blog is the hygienist that practices independently. Without the direct supervision of a dentist, the hygienist is the sole care provider and is solely liable and must carry their own professional liability insurance.

If your hygienist is weary of the threat of a lawsuit, he or she may purchase professional liability insurance that would cover them if any of the above examples, or situations like them, become true. A resource in Colorado to find out more would be the Colorado Dental Hygienist Association.

Posted by & filed under Dental Anxiety, Featured.

By Dr. Sarah D. Parsons

Many patients report to our offices with PTSD. These patients have undergone perceived severe mental or physical abuse that elicits mental, physical, or combined responses. It can be challenging to treat these patients due to their fear and intolerance of pain and anxiety. Often times we seek additional sedation measures such as nitrous, minimal, moderate, or even deep/hospital sedation.

Profound local anesthesia is the cornerstone to management of any dental case in general but is especially important to any successful management of PTSD. The more that we as clinicians can deliver successful and profound anesthesia, the better outcome our cases achieve. Never as a clinician should we dismiss a patient’s reporting of discomfort or pain during a procedure. Rather in these instances, we should consider and evaluate our anesthesia.

Sedation of any form is not a replacement for profound local anesthetic but rather an adjunct to help ease the anxiety of the dental patient. Prior to additional doses of sedatives, profound anesthesia should be confirmed. Many patients tolerate more complicated procedures and sedation cases are more successful, if profound anesthesia is achieved.

Adequate interviewing of a patient with PTSD is helpful prior to any dental procedure performed. This can also aid us in the decision of what sedation level is appropriate. Many clinicians believe that only moderate to deep sedation will be useful to treat a PTSD patient. However, this is not always the case and a comprehensive examination and treatment plan should be performed prior to any dental procedure.

Here are some questions you may want to consider in your interview with a patient that has PTSD prior to any dental treatment:

  1. May I inquire the reason for your PTSD diagnosis
  2. Are there any specific lights, sounds, or situations which trigger your PTSD?
  3. During your procedure, there will be clinicians whom will be female/male or both. We will be over you and looking down at you during the procedure. Will this trigger your PTSD? Would you be more comfortable with an all male or all female team?
  4. What are some calming measures you use during a PTSD episode? If you are triggered during this procedure, what measurements would you like me to use to help you through your episode?
  5. Do you feel you should be more sedated or more awake for your procedure?

Management and treatment of PTSD patients can be successful in your dental practice. These patients can become loyal and long term great patients. If you manage your treatment of these patients successfully with profound anesthesia and appropriately sedate to the level they require, they will return and become some of your practice’s biggest fans and cheerleaders.