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Professional responsibilities for managing dental emergencies

Originally published in the February/March 2015 issue of Dispatch

Dentists have a legal, professional and ethical obligation to provide or arrange for dental emergency treatment for their patients.

Section 2(18) of the professional misconduct regulations made under the Dentistry Act, 1991 (Ontario Regulation 853/93) defines professional misconduct as “failing to make arrangements for emergency dental services for the member’s patients or to advise a patient how to obtain emergency dental services.” Failure to do so may also expose a dentist to allegations of patient abandonment.

Patients may require emergency services either during or after regular office hours, or when a dentist is out of the office. An emergency protocol should be developed so that patients who have a dental emergency during regular office hours may be attended to in a timely fashion. Such patients may be seen by the dentist of record where possible, or another dentist in the same office, and should be accommodated either the same day or the next day at the latest.

When the office is closed or no dentist is available, arrangements must be made for patients to be directed to another practitioner or to a facility where emergency dental services can be offered. In many instances, dentists may elect to participate in a private on-call group which is often organized by a component dental society. Regardless of the system that a particular dentist decides to implement, patients who contact the dental office must be informed of how they may obtain emergency services. This may involve a telephone message with specific instructions, or the patient’s call may be redirected to an answering service who will then advise the patients accordingly.

Dentists who choose to participate in a group on-call service and who are on-call for a period of time have an obligation to provide appropriate emergency management for all patients who are directed to the service, regardless of who their primary care provider might be. When participating dentists are not on call but are available during office hours, they should see their own patients of record and not automatically refer their emergency patients to the on-call service.

Those dentists who choose not to belong to such an on-call group are obligated to manage their emergency patients at all times. If they choose not to participate, they must not rely on the group service to look after their patients of record, whether during or after regular office hours.

The College recommends that on-call dentists offer patients the same terms of payment as those offered by the patients’ regular dentists; for example, by accepting payment by assignment or from specific social services plans. It is not appropriate to require a deposit as a condition of receiving emergency care. In addition, the patient’s inability to pay should not be a barrier to appropriate palliative treatment of true emergencies (such as trauma, significant infection, prolonged bleeding or pain which cannot be managed by over the counter medications).

Although a dentist is not obligated to provide treatment for every new patient who contacts the dental office, a patient with a dental emergency should be assessed and either provided treatment or referred to another practitioner or facility capable of treating the patient. Following the provision of emergency care, the patient should be referred back to the regular dentist with a report indicating the treatment that was rendered.