Lawrence Freedman

As a result of its investigation of a formal complaint, the Inquiries, Complaints and Reports Committee decided to caution Dr. Freedman as follows:

•    He must practice dentistry only in accordance with recognized, evidence-based, peer-reviewed scientific literature.
      -	It is not appropriate to inject ozone into patients, whether into bone, dental canals or otherwise.
      -	It is also not appropriate to inject other substances, such as B12, folic acid or other vitamins or minerals, into patients, and the use of any other supplements must be justified by scientific literature.
      -	While ozone is an antibacterial, chemotherapeutic agent that may be applied topically as a surface disinfectant in conjunction with comprehensive conventional dental treatment, if providing ozone in the treatment of periodontal disease, it must be done as part of a complete plan for periodontal management, including such components as regular periodontal scaling, regular reassessment of the patient’s condition, and referrals to specialists for assessment and/or treatment.
      -	Muscle testing and/or motor reflex testing outside of the oral-facial complex are not appropriate methods for diagnosing dental issues or confirming dental diagnoses.
      -	Thermography is not an accepted tool for dental diagnosis or treatment.
      -	Dr. Freedman must comply with the College’s Practice Advisory on the 
Use of Complementary and Alternative Therapies in Dental Practice on an ongoing basis, including ensuring that his practice remains rooted in conventional diagnoses and scientifically-founded treatments.

•    He must provide treatment, recommendations and/or products only within his scope of practice as a dentist holding a certificate of registration in Ontario.
      -	It is not appropriate to use ozone for non-dental purposes in the dental office.
      -	It is not appropriate to dispense ozone for non-dental uses outside of the dental office.
      -	It is not appropriate to give or sell supplements, remedies or other products unrelated to dentistry to patients in association with a dental office.
      -	It is not appropriate to discuss conditions unrelated to the oral maxillofacial complex with patients beyond simply noting a concern and referring a patient to the relevant health care practitioner.
      -	It is not appropriate to recommend or make comments that may imply a recommendation about the use and/or provision and/or sale of naturopathic remedies, products or tools in the dental office. Patients may perceive any approving comments about non-dental products or treatments as recommendations. Dr. Freedman may refer patients to other practitioners, but he should not assess the merits of other modalities of care or provide information that may be taken as a recommendation for any particular product or service.

•    He must ensure that his patient records reflect the College’s Guidelines for Dental Recordkeeping.
      -	Dr. Freedman must ensure that his clinical records contain detailed documentation of examinations, case work-ups, diagnosis, treatment planning, treatment, and so on.
      -	Dr. Freedman must maintain all records pertaining to the treatment provided to and/or discussions he has with patients as part of the dental record.
      -	Dr. Freedman must document his informed consent discussions with his patients. If he proposes complementary or alternative therapies, the details of those discussions should be documented in the patient record, including the risks and benefits of the proposed therapies. If a patient’s case is complicated, that should be disclosed to the patient and documented in the record. If he seeks to charge fees higher than those recommended in the ODA fee guide, he must document discussions with his patients about those proposed fees and the reasons why he seeks to charge them.
      -	Dr. Freedman must ensure that what is billed corresponds with the treatment that is provided and that is documented.

•    He must improve his informed consent protocols. In order for consent to be informed, the dentist must provide the patient with certain information: the diagnosis or problem noted, nature and purpose of the proposed treatment along with the risks and benefits of such treatment, the treatment alternatives available along with the associated risks and benefits, the likely consequences of not having the treatment, and the cost of each treatment option.
      -	Dr. Freedman must always provide factual, thorough, balanced and impartial information about the proposed treatment options, including conventional treatment options when a complementary or alternative treatment option is being presented. It is inappropriate to malign conventional treatment options on the basis of inaccurate information, incomplete information, or information taken out of context.
      -	Dr. Freedman must disclose to patients that complementary and alternative proposed treatments are in fact alternative forms of treatment, outside of the recognized norms for dentistry in Ontario.
      -	When a patient’s condition is severe or the treatment required is complex, one of the options should be a referral to a specialist for consultation and/or treatment.
      -	Regardless of whether the patient consents in writing or orally, the dentist should keep a record of the nature of the conversation, the information provided, and the patient’s decision.
      -	In order to obtain informed consent with respect to the cost a proposed treatment option, Dr. Freedman must discuss with his patients any proposed fees that are above those recommended in the ODA fee guide and explain his reasons for charging higher fees and document the patient’s consent in the record.

•    He is responsible for managing and overseeing billing and financial practices in his dental office.
      -	It is inappropriate and a conflict of interest to sell products for a profit in the dental office.
      -	It is inappropriate to sell any products in the dental office that are unrelated to dental treatment.
      -	It is usually inappropriate to bill for materials required for dental procedures for which procedure fees are being charged. In exceptional circumstances, any such additional fees must be discussed explicitly with the patient.
      -	There must be proper documentation in the patient records for any treatment for which Dr. Freedman bills.
      -	Dr. Freedman must avoid conflicts of interest in his billing and financial practices. It is not appropriate to facilitate business and/or to complete transactions for a business owned by a family member via his dental practice.

•    He must perform complete case work-ups, diagnoses, and treatment planning, especially for comprehensive treatment. It is not appropriate, for example, to treat periodontal disease without a well-founded treatment plan or to begin orthodontic treatment without a full case work-up.