The Standard of Care in Dentistry

Managing Professional Risks | Clinical Practice Risk Management

The standard of care in dentistry cannot be easily defined, especially in relation to managing professional risks. You undoubtedly believe you are treating each and every patient within the standard of care, but where is that bar set?

How is the standard of care defined? Is it:

  • Doing treatment the best you can in a particular situation?
  • What the majority of dentists do in their practices?
  • Doing what the normal, average dentist does?
    • Does “what the normal, average dentist does” vary from community to community?
    • Is it based on where – and when – you went to dental school?
  • The same in all states?
  • What you were taught in dental school?
    • Or what’s being taught in dental schools today?

The best answers to those questions are “Maybe,” “Possibly,” and “Not necessarily.”

While there is no single definition for standard of care, it can be influenced by the legal definition of negligence that are alleged in professional liability lawsuits filed in your community.

The legal definition of the standard of care depends upon the current jury instruction in your state. Most states define this standard as what a reasonably prudent dentist would do under the same or similar circumstances. A customary practice may constitute the standard of care only if such practice is also a reasonably prudent practice.

Generally speaking, most malpractice cases typically allege that the dentist, through an act or omission, failed to provide appropriate quality care or failed to take reasonable precautions when providing care. Charges usually go on to assert that the dentist’s action harmed the patient, usually during dental treatment, and resulted from the failure to treat the patient in accordance with the standard of care. Be sure to notify your professional liability carrier right away if you anticipate that a claim or lawsuit might be filed against you; failure to do so could result in the carrier denying the claim.

The outcome of a malpractice case often rests on whether the dentist followed the standard of care. But since there’s no true definition of standard of care, it’s usually left to a judge or jury to listen to the facts, determine what they believe to be the standard of care based on the evidence, and decide whether or not the treatment provided by the dentist was within the standard of care.

So how can you know what the standard of care is and whether you’re practicing within its parameters? A few tips include:

  • Consider what another reasonable dentist would do under the same or similar circumstances.
  • Follow the literature, but also understand that evidence-based dental practice should consider the quality of the literature/evidence. In today’s practice environment, the standard of care may well be based on the evidence presented by a dental expert and not simply their expert opinion.
  • Stay up-to-date with the latest innovations, treatment techniques and materials.
    • Make sure that you and your team are sufficiently trained before introducing new elements into the practice. Additionally, consider the previous point: does evidence support the latest innovation, or is it manufacturer/marketing hype?
  • Participate in continuing education, which is required in many states.
  • Consult a qualified attorney in your area who can provide guidance regarding what constitutes standard of care in your state.
    • Standards of care can vary by state and different standards may apply within a given state depending upon the particulars of the situation.
    • The standard of care reflects what is minimally required for prudent and reasonable treatment; anything less could be considered negligence and a failure to meet the standard of care.
    • A mistake is not necessarily outside the standard of care if the dentist has provided the minimum level of care that the patient is entitled to receive.
  • Be aware of the potential ramifications of making promises about treatment outcomes and guaranteeing your work or any devices or materials used.
    • A better approach may be to reassure patients about planned procedures and reiterating that you will act in their best interest to reach a good result through ordinary and reasonable care.
    • Align patient expectations with the realities of what you can reasonably provide in treatment.
      • Providing ordinary and reasonable care should satisfy your patient’s goals and desires for the results and allow you to assert that you practiced within the standard of care if a lawsuit is filed against you.

While policies, clinical guidelines, recommendations and position statements of the American Dental Association (ADA) may be used in a court of law as evidence of standard of care, they are not intended to set any standards for dentists to meet. The ADA maintains that recommendations for treatment are left to the treating dentist’s professional judgment and that you, as the treating dentist, should do what’s in the best interests of the patient.