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19 Standard Of Care




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This article is from the Amalgam and Mercury-free Dentistry FAQ.

19 Standard Of Care


Dental board charges are brought on the basis that a defendant dentist
has failed to act in conformity with the ''standard of care.'' This
standard obligates a dentist to act in a manner consistent with the
actions of other dentists in the community. If the board determines
that a dentist's actions departed from the standard of care, he or she
many be disciplined. In other legal settings, defendants are required
to prove that they acted in a manner that is consistent with the
actions of a ''reasonably prudent person.'' The legal distinction
between these two standards is significant. The ''standard of care''
subjects an innovative and/or scientifically informed dentist to
claims that he/she failed to act in conformity with the practices of
other dentists and should therefore be sanctioned. Such claims expose
the dentist to sanctions even though he/she acted reasonably and
prudently.

It has been said that the clinical practice of dentistry lags at least
ten years behind science. Yet, if a dentist utilizes practices that
are scientifically advanced or innovative -but not used by other
dentists -the dentist can be disciplined for failing to conform to the
standard of care. Indeed, this is the situation in the mercury amalgam
controversy. Conversely, the ''standard of care'' protects those
dentists who are utilizing scientifically obsolete methods in their
practice, even though such methods would not be considered reasonable
or prudent in light of recent scientific evidence. For example, it is
scientifically well established that the use of metal retention pins
or root canal posts encourages root fracture. Yet, the use of these
materials is widespread in dental practice, thereby protecting those
dentists that utilize them. Another clear example relates to the use
of bonded composite restorations in posterior teeth. Again, it has
been well established scientifically that the use of ''bonding'' with
composites strengthens and preserves remaining tooth structure and
equally well established that the ''creep'' and ''flow''
characteristics of amalgam contribute to tooth fracture. Yet the
''standard of care'' is to use amalgam in posterior teeth, thereby
protecting the advocates of this practice, whereas dentists that are
mercury-free can be disciplined for using a material and procedure
scientifically proven to be beneficial in preserving tooth structure.

As a pronounced roadblock to progress, depriving the public of
advances in dental care, the folly of the ''standard of care'' concept
is obvious. It may very well be anticipated that this concept may be
challenged in the very near future, with the dental amalgam
controversy being the spearhead. If it is scientifically established
that mercury exposure from dental amalgam is a health risk to
patients, and government standard supports that position, the
''standard of care'' position becomes extremely tenuous. The use of
lead in gasoline, asbestos, DDT and silicone breast implants were all
''standard of care (or use)'' at one time.

Regarding the conduct of Dental Boards, and mindful of their statutory
obligations to the public health, the ''standard of care'' argument
becomes even more hazardous. Can Dental Boards discipline, with
impunity, mercury-free dentists on the sole basis of the position and
dictates of a dental trade organization? That question may be answered
before long.

 

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