Are Dentists Liable for Lead in Dental Products?

Dentists Must Do Their Due Diligence

With recent news that some dental prostheses may be contaminated with lead, a lot of dentists are wondering if they’re legally liable for the quality of their dental lab work.

Unfortunately, there’s no simple answer to that question. However, one thing is clear: if you, the dentist, haven’t done your due diligence in selecting a reputable dental lab, you could be held responsible for the quality of their products.

“The liability situation is the same as it has always been, each party, the dentist and the dental laboratory must do their due diligence to comply with existing laws and regulations,” said Bennett Napier of the National Association of Dental Labs (NADL). “The liability exposure is different in each case specific scenario depending on a number of factors.”

But what exactly does “due diligence” mean? Well, it definitely means that you’re not choosing a dental lab on the internet because they have the cheapest crowns available. It does mean that you’ve researched your lab. Ideally, you’ve talked to the owner, visited the premises, and heard good reviews from other customers. If not… well, just be prepared for the possible consequences.

We at The Wealthy Dentist have been investigating what dentists may be able to do to protect themselves.

1. Make your dental lab tell you where the work is coming from and what it’s made of. Remarkably, most dental labs are NOT required to pass this information on to the prescribing dentist.

Florida and South Carolina have recently passed legislation that would require such disclosure, and other states are likely to follow suit soon. The NADL is working on a universal form for dental laboratories. Ohio has a similar form; the state’s dental board recommends but does not currently mandate use of these forms.

Highlights from the Ohio State Dental Board Laboratory Prescription & Point of Origin Form

Type of Restoration: _______

Materials:
– Porcelain to High Noble
– Porcelain to Noble
– Porcelain to Base Metal (NP)
– Full Metal High Noble
– Full Metal Noble
– Full Metal Base (NP)

This case will be:
– Fabricated by technicians at our own dental laboratory.
– Sent to another laboratory in the U.S. to be fabricated (Lab Name & Location)
– Sent to an overseas/foreign laboratory to be fabricated (Lab Name & Location)

See the full Ohio dental lab form

2. Make sure you’re giving your dental lab a full prescription.

An alarming number of dentists don’t actually give their dental labs all the information a technician needs to formulate a dental prosthesis. When information is missing (for example, what specific metals should be used), the technician is left to make an educated guess.

A checklist form can help ensure that dentists are giving their labs all the necessary information.

The Ohio State Dental Board has also released prescription guidelines. This form outlines the minimal information that should be included in a dentist’s prescription.

  1. Form must include basic information on patient, dentist and dental lab, as well as type of prosthesis.
  2. Crowns and bridges: Shade prescription, shade mapping, and material prescription.
  3. Partial and complete dentures: Shade prescription. tooth material prescription, tooth mold (shape) prescription, design of partial denture framework.
  4. Orthodontics or occlusal splints: explicit definition of type of prosthesis and instructions.
  5. Any additional explicit instructions from the dentist.
  6. Point of origin information should be included.

See the full dental lab prescription guidelines

3. Check your lab’s credentials.

The NADL’s Napier offers the following advice to dentists: “Dentists as part of minimizing their liability risk exposure can look at working with dental laboratories that are Certified Dental Laboratories or DAMAS accredited dental laboratories where third party validation occurs to ensure the lab’s quality system includes material traceability of lot and batch numbers of materials used for a specific dental restoration.”

The National Board for Certification in Dental Laboratory Technology (NBC) has developed a form for use by Certified Dental Technicians (CDTs).

Dental Restoration Disclosure Form
This case was manufactured by:
CDT Name: ___________________
CDT Number: ___________________
at ___________________(Dental Laboratory),
in ___________________(City, State, Country)
using the following FDA registered materials in the final restoration:
____________________________
____________________________
[Place Identalloy/IdentCERAM Sticker Here]

See the complete CDT dental restoration form

4. Stay current. It’s quite possible your state is considering new legislation for dentists and dental labs. You might consider setting up a Google News Alert to keep you informed of the latest news; just use “dental lab” and your state as keywords.

Can you suggest any additional resources? We’d love to see what forms you’re using with your dental lab. Just send us an email at DrWeeklyNewsUpdate@TheWealthyDentist.com!

Dental Retirement Age? No Way, Say Dentists

Dentists veto mandatory dental retirement ageDentists shouldn’t have to retire just because they’ve reached a certain age, say doctors. This survey found only 1 dentist in 10 supporting a mandatory retirement age for dentists.

A mandatory dental retirement age was recently in the spotlight when the European Court of Justice ruled in favor of Germany’s law mandating retirement for dentists and firefighters past a certain age, finding it does not constitute age discrimination. [Read more]

Here are some thoughts from dentists:

  • Dental continuing education should be required. Patients know when a practitioner’s abilities are diminishing, as do dentists themselves. Liability concern should prevent dentists from procedures for which they no longer have the skills.” (Mississippi dentist)
  • “In Germany and in Europe, there is a mandatory retirement age for workers/employee, so why not for dentists? I do not think it has to do with competence, but rather with social economy and spot for young dentists to practice.” (California orthodontist)
  • “I am approaching my 76th birthday and 48th year in practice. I still am able to deliver superb dentistry including full-mouth and cosmetic dentistry cases, but I just see patients three days a week. To me, retirement is a nasty word.” (California prosthodontist)
  • “I am about to turn 70 this year, and I feel my skills are better than they have ever been. I take lots of continuing dental education and feel I know so much more about dentistry than most younger recent grads.” (New York dentist)
  • “A simple evaluation of current work is very easy to do today. Just have a dentist present pictures and radiographs of current work as a competency report.” (New York prosthodontist)
  • “There maybe should be some additional testing in those dentists over 75-80. We have one in our city that I believe is 88… His patients are not getting proper periodontal care and I’m concerned about the dentistry provided.” (California dentist)
  • “The doctor should know when it is time to hang it up.” (Texas pediatric dentist)
  • “If you can be US president in your 70’s, why not a dentist?”
  • “Not only do people’s skills vary, different aspects of dentistry demand different levels of skills. In addition to orthodontics, I practice dental sleep medicine (oral appliances for snoring and obstructive sleep apnea). I could practice the latter until they take me out on a stretcher.” (Oregon braces dentist)
  • “We all know dentists that should have ‘retired’ at the age of 30! Some of us can go to 70 with no problems. It depends on the individual.” (Nevada dentist)
  • “Dumb idea. Who would make that decision — some governmental bureaucrat? Should there be a mandatory retirement from life itself, too?” (California dentist)
  • “The wealth of knowledge and experience an older dentist has would be a loss to our profession if he/she could not mentor a new associate in a clinical environment.” (Pennsylvania dentist)
  • “Specialties vary. People vary. It’s insane to consider seriously.” (Colorado orthodontist)

Read more: Dentist Retirement: Dentists Say ‘No’ to Mandatory Retirement Age

Root Canal Dentist Uses Paper Clips in Surgery

Root canals with paper clipsA Massachusetts dentist accused of using paper clips in root canal procedures has been indicted on 13 charges.

The dentist pinched pennies by using pieces of paper clips instead of stainless steel posts – though that didn’t stop him from billing Medicaid for the more expensive materials he didn’t bother to use.

The charges against him include assault and battery, larceny, submitting false Medicaid claims (using other doctors’ provider numbers), and illegally prescribing drugs (Hydrocodone, Combunox and Percocet).

Between 2003 and 2005, he is estimated to have submitted at least $130,000 in fraudulent Medicaid bills. But it’s his use of office supplies in root canal therapy that’s garnered the most attention. (This root canal treatment is definitely not endodontist-approved!) In fact, some of his root canal patients still have paper clips in their mouths.

Read more about how NOT to cure root canal pain: Charge: Paper clips used in root canals

Discover What Dentists Are Saying About Dental Lasers (video)

Discover What Dentists Are Saying About Dental Lasers  (video)Dental lasers are quite literally cutting-edge technology.

Some dentists find them an amazing tool for fighting gum disease. Others find them highly over-priced and not particularly useful, while others want to buy them, but can’t afford them yet.

Speaking of a dental laser, one dentist said, “It is the best thing to come along in dentistry in the past 20 years!” While another complained, “The laser I paid so much for isn’t a comfortable part of any treatment I do. It’s not paying its own bills!

The Wealthy Dentist conducted a survey asking dentists if they use lasers on soft tissue for the treatment of gum disease. Watch the video to hear how the dentists responded —
 

 
Are you using dental lasers in your dental practiceWhat do you think?

Dental Care: Are Mid-Level Practitioners a Threat to Dentists?

Dental Care: Are Mid-Level Practitioners a Threat to Dentists?Can mid-level dentist practitioners give the same quality of dental care as a dentist?

This question is being raised in the Northwest where a Washington state dental practitioner bill passed through the Senate Health Committee.  The Senate version of this legislation moves out of committee and can potentially be considered by the full Senate.

If this bill passes in the Senate, Washington will be the next U.S. state to adopt a mid-level dental provider model to create both dental hygiene practitioners and dental practitioners, who will be supervised (offsite) by a dentist.

These practitioners will be allowed to provide various levels of dental care “pursuant to a written practice plan with a dentist.”

Dental hygiene practitioners would expand the scope of practice of the state’s hygienists, who can now place fillings after a dentist has done the prep work. They would receive specialized training to do extractions, handle medical emergencies, and administer some drugs.

Dental practitioners would be permitted to do everything that hygienists can do except scaling and cleanings. They could also do restorations, administer anesthesia, and extract primary teeth as well as loose permanent teeth (+3 to +4 mobility).

Both types of practitioners could work with offsite supervision if approved by their supervising dentist, but neither could do dental crowns, bridges, or complicated procedures. (Dr Bicuspid)

The Washington Academy of General Dentistry and the Washington State Dental Association oppose this bill siting, “insufficient training for diagnosis and a lack of direct supervision.”

What are your thoughts on mid-level dentist practitioners? Are they bad for dentistry?

For more: Washington Lawmakers Mull Dental Therapist Bills

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