You may have heard someone at the dental office talk of this item or that item being “the standard of care”. So what is the standard of care, anyway?
In the part of the world where we live, there have evolved certain expectations that our regulatory bodies have concerning treatment. The regulatory body for dentists in Ontario is the Royal College of Dental Surgeons of Ontario (RCDSO). These expectations of all phases of dental care from infection control to placement of fillings to diagnosis of dental problems in the first place are termed the “standard of care”. You will find minimum expectations in most other fields of endeavour as well. For example, there are standards in construction, or in the area of safety for autos, or in handling of foods at a restaurant.
A fair amount of time is spent in dental school and in continuing education courses and printed materials from the regulatory body after getting out of school regarding what the standard of care is for each procedure and how to achieve it. We in the dental field are required to perform our diagnosis and treatment at the standard of care. Every procedure has associated with it what is accepted as the standard of care for that procedure.
There can be quite a bit of pressure to perform below the standard of care. And here is the strange thing: The pressure to perform below the standard of care is often applied by the patient. As an example, it is the standard of care for a dentist to have a radiograph (x-ray) of a tooth before it is extracted. This seems reasonable, but some patients have financial limitations that cause them to put pressure on the dentist not to get a radiograph before a tooth is removed. Not getting an accurate view of the way the roots are formed increases the risk of complications like breaking a root off when the extraction is attempted. As another example, let’s look at lab work. A dentist uses a lab to make crowns and dentures and other items, and that lab must be approved by the regulatory body over the province where the dentist is delivering the care to the patient. The work can be sent to a lab that is not approved (often in places like Costa Rica and the Philippines) for a lot less money. Some patients will push for the work to be sent to an unapproved lab. Here again as in the example before, often nothing negative would come of using the unapproved lab, but the treatment results could be disastrous. In Ontario, work done at an unapproved lab is according to our regulatory body, below the standard of care, and it is the patient pushing for the substandard work. Dental cleanings are another item where patients often push for substandard work to be done. For example, it is the standard of care to do periodontal probing (measuring the depth of the gums around each tooth) at least once per year on every patient. The cost for this service is about $42. Some insurance plans cover the cost and others do not. To not receive the service is performance below the standard of care. Not knowing the depth of the gums around the teeth can lead to undetected bone loss, loose teeth, and even tooth loss. However, to save the $42 per year, many patients will push pretty hard to omit the required service. Some will even leave the practice and find somewhere else to have their teeth cleaned where the standard of care is not adhered to.
Standards of care are put in place to make sure every patient receives quality care. Trying to get your health professional to perform work below the standard of care puts you, the patient, at risk of poor treatment outcome. If you have questions about the standards of care, you should ask your dentist.
- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)