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Standards

The standards of practice in dentistry: what does that mean?

Originally published in Dispatch 2017 Vol. 31 No. 2

Sometimes, despite a dentist’s best efforts, an undesirable or unfavourable treatment outcome can lead to patient dissatisfaction, which may subsequently trigger a formal College complaint and/or legal action.

In determining whether a particular complaint or lawsuit has merit, the fundamental question often boils down to: did the dentist meet the standards of practice or the standard of care of the profession? The terms refer to a benchmark that is used to assess the performance and conduct of a dentist in a particular situation in a regulatory or civil court process.

The Practice Advisory Service often fields questions from patients inquiring about whether or not the treatment performed by their dentists was adequate, and from dentists, asking about the accepted practice relating to a particular clinical situation. These inquiries come in different forms, but they are all generally variations of the basic question “what is the standard of practice in this circumstance?”

At times, attempting to define standards of practice is like trying to aim at a moving target or a constantly changing benchmark, as knowledge, expectations, materials, technologies and procedures continually evolve.

REGULATORY AND PROFESSIONAL LIABILITY PERSPECTIVE:

Under the Regulated Health Professions Act, 1991, the College is charged with the responsibility to develop, establish and maintain programs and standards of practice to ensure the quality of the practice of the profession.

Contravening a standard of practice or failing to maintain the standards of practice of the profession can be considered professional misconduct under the Dentistry Act, 1991.

The standard of care stems from the legal definition of negligence and is defined as the degree of care that a reasonable and prudent dentist would exercise under the same or similar circumstances. A practitioner who fails to meet the standard of care with respect to any part of a dental treatment and who causes injury as a result can be found liable of negligence.

HOW ARE THE STANDARDS MEASURED?

A dentist must demonstrate a reasonable degree of skill and knowledge, and exercise a reasonable degree of care. The conduct of that dentist should be consistent with the expected conduct of any other normal, prudent practitioner in the community or profession.

The standards may vary from one jurisdiction to another. In Ontario, whether a dentist is a new graduate or a seasoned practitioner, whether the dentist practices in a rural area or an urban setting, the dentist will be held to the same standards of practice as their peers in terms of their professional education, technique, diligence and judgement.

Specialists have advanced training and can make this expertise known to the public. As a result, they are held to higher standards of practice, consistent with the knowledge and skill of a reasonable member of their specialty.

Although a minimum level of competence or judgement might be expected from a reasonable practitioner, every situation or circumstance is different and each patient is unique. For each condition that a dentist has assessed and diagnosed, there are most likely a few different approaches to treatment that could be taken. Just because treatment was not successful does not mean the standards were not met. Therefore, each case can and should be considered by a College committee or court of law on a fact-specific basis and evaluated on its own merits.

WHO DEFINES THE STANDARDS OF PRACTICE OF THE PROFESSION?

It is not possible to conclude that one individual, institution, organization or group of experts can set the standards of practice in dentistry, but is it safe to assume that we, as a profession, can have an influence in determining the standards.

  • Faculties of Dentistry, whether in Ontario or other provinces, are known as nurturing cradles for scientific research that foster constant evolution of knowledge in the field of dentistry. Current teaching at dental schools determines baseline clinical standards for dentists entering the profession.
  • Evidence-based literature, such as clinical research findings from rigorous university-led studies, scientific articles published in peer-reviewed journals, as well as current dental textbooks used for reference in dental schools and authored by academic faculty members and specialists in their field, may all be considered credible and authoritative sources of information that set the standards of practice.
  • In a regulatory process or malpractice lawsuit, an expert witness may be called upon to testify or produce an expert opinion to help the committee or the court better understand the clinical issues in dispute. The expert must have special skills, education, and training in their area of expertise to be considered an authoritative voice in their field and accepted as qualified to comment on a particular topic.
  • The College has established standards of practice on several topics by publishing standards of practice, guidelines, practice advisories and other documents. They all contain practice parameters and standards which should be considered by Ontario dentists in the care of their patients. These publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.

IN THEIR EVERYDAY CLINICAL DECISION-MAKING PROCESS, DENTISTS CAN ENSURE THEY MEET THE STANDARDS OF PRACTICE OF THE PROFESSION BY:

  • Familiarizing themselves with, and having a clear understanding of, the College’s standards of practice, guidelines, practice advisories and other publications.
  • Keeping their clinical skills sharp and their knowledge base up-to-date through continuing education courses and review of current evidence-based dental literature. The College regularly provides Ontario dentists with copies of key articles on clinical and nonclinical topics from the dental literature around the world through PEAK (Practice Enhancement and Knowledge).
  • Being an active participant in the dental community by engaging in ongoing consultation with specialists and other colleagues, and joining study clubs and professional organizations where sharing of ideas and collaboration can provide dentists with a barometer to gauge the current standards in their community.
  • Reaching out to the Practice Advisory Service, which points dentists towards pertinent clinical resources and provides clarifications on particular College publications, documents or position statements.
CONCLUSION:

The current standards of practice are the minimum requirements that all dentists must meet. In today’s dynamic environment, dentists must strive to achieve excellence. Dentists must ensure they are up-to-date with the latest knowledge resources, as what is considered the standard today may not be the standard tomorrow. In fact, the bar for the standards of practice is continually being raised by the vast majority of highly skilled and competent dentists, who are committed to the advancement of the profession. That is undeniably a good thing for the patients they serve.

For useful links to websites for reliable evidence-based research:

The Centre for Evidence-Based Dentistry in the UK: www.cebd.org 

American Dental Association Center for Evidence-Based Dentistry: http://ebd.ada.org

The Canadian Dental Association’s Oasis project: www.jcdaoasis.ca

The Canadian Agency for Drugs and Technologies in Health (CADTH): https://www.cadth.ca/evidence-bundles/evidence-on-dental-and-oral-health

Centers for Disease Control and Prevention: https://www.cdc.gov/publications/