1) Patient Records
2) Reporting
3) Laser Technology
4) Prescribing and Elective Cosmetic Procedures
5) Mercury Free Dentistry
6) Practice Abandonment
7) Dental Clinical Exams
8) Failure to Renew on a Timely Basis
9) Record Keeping
10) Dentistry in ND by Guest Clinicians
11) Sargenti Paste
1) Policy Regarding Patient Records
The purpose of this policy is to clarify the Board's position regarding the ownership and release of patient records.
The American Dental association calls upon dentists to follow high ethical standards who have the benefit of the patient as their primary goal. To that end, the Board adopts the following policy regarding patient records.
It is the Board's position that a dentist must release a copy of the patient record upon request of the patient or the patient's parent/legal guardian. Failure to do so is grounds for discipline pursuant to North Dakota Century Code § 43-28-18 and NDCC § 23-12-14.
Record, defined:
A patient record includes any document or combination of documents that pertains to a patient's medical/dental history, diagnosis, prognosis, or medical/dental condition, and that is generated and maintained in the process of the patient's dental treatment. Patient records include:
1. Medical/dental history.
2. Written progress notes.
3. Radiographs.
4. Models.
5. Billing information
6 Insurance claims
A patient record should not include:
1. Care related to another patient.
2. Peer review/quality assurance information/documents.
3. Correspondence/notes from attorneys.
4. Aberrant/deviant statement.
Ownership: Patient records belong to the treating practitioner; however, the patient has an absolute right to a copy of his/her patient records.
Costs:
This obligation to provide a copy of records exists whether or not the patient's account is paid in full. Since the patient has an absolute right to a copy of his/her records, a dentist may not ignore a request for records due to an unpaid balance for services rendered. Further, a dentist cannot demand payment for copies up front. The dentist may add the fee for copies to the unpaid balance, and include this in any claim for reimbursement, but records cannot be held hostage for payment of any kind.
Disclaimer:
Nothing in this policy supercedes the confidentiality requirements outlined in the Health Insurance Portability and Accountability Act. Further this policy does not apply to records subpoenaed for the North Dakota State Board of Dental Examinations investigation/enforcement purposes as those requests are exempted from the protections under HIPPA.
2) Policy regarding reporting
Conduct related to professional competence which could adversely affect the health or welfare of a patient or unprofessional/unethical conduct during the delivery of dental services or errant behavior should be reported to the NDSBDE. Reports may be related to conduct of another dentist, dental hygienist or dental assistant, or may be self-reported. By self-reporting an incident to the NDSBDE, the practitioner may avoid the imposition of formal disciplinary action by the Board of Dental Examiners. Failure to report is a violation of N.D.C.C. § 43-28-18.1
3) Policy regarding laser technology
It is the position of the Board that any services provided by a licensee, regardless of the devise used, must be within the scope of practice for each licensee. Whenever a new treatment modality is brought forward, it is the Board’s policy that the dentist must have equal or greater proficiency and training in the technology. Licensees utilizing the new technology must maintain documentation of the satisfactory completion of the formal continuing education or training. The particular technology utilized does not alter the fact that the dentist is ultimately responsible.
4) Policy regarding prescribing and elective cosmetic procedures
The issue is governed by the definition of dentistry as found in NDCC §43-28-01.6 wherein the term “practice of dentistry” includes examination, diagnosis, treatment, repair, administration of local or general anesthetics, prescriptions, or surgery of or for any disease, disorder, deficiency, deformity, condition, lesion, injury, or pain of the human oral cavity, teeth, gingivae and soft tissues, and the diagnosis, surgical, and adjunctive treatment of the diseases, injuries, and defects of the upper and lower human jaw and associated structures. In North Dakota dentistry is further defined by the qualifications required for application of license to practice dentistry, NDCC § 43-28-11 and scope of practice for dentistry, NDCC § 43-28-10.
Currently, cosmetic surgical procedures and cosmetic drug or chemical enhancements of the face for purely aesthetic purposes are being marketed to dentists as an adjunct to the treatment of facial pain syndromes (temporomandibular joint, myofascial pain dysfunction syndrome, fibromyalgia, etc.). Some providers and/or marketing messages have suggested that, in addition to the use of these procedures in the context of a dental treatment plan, a secondary gain of aesthetic enhancement could be realized and that this cosmetic outcome alone should be marketed.
The board is aware that dental curricula and the residency curricula in Oral and Maxillofacial surgery accredited by the American Dental Association Commission of Dental Accreditation requires the performance of and proficiency in the treatment of conditions of the entire craniofacial complex, including treatment of facial trauma, cleft and craniofacial surgery, surgical reconstructive treatment of maxillofacial skeletal deformities and cosmetic/aesthetic procedures.
The Board recognizes that hospital credentialing standards established by the Joint Commission of Accreditation of Hospital Organizations, based on education, training and experience, also permit Oral and Maxillofacial Surgeons (OMS) to perform cosmetic/aesthetic procedures including the administration of chemical facial enhancements for cosmetic purposes.
Any licensee who lacks the requisite qualifications and nevertheless performs cosmetic surgery or by any method applies drug or chemical facial enhancements for purely cosmetic purposes shall be subject to discipline by the Board. Such conduct shall be considered outside the scope of the practice of dentistry.
The prescription, dispensing or administration of drugs or materials or the delivery of services by a licensed dentist for purposes other than those required for accepted dental therapeutic purposes shall be considered unprofessional conduct with the exception of those services for which advanced specialty training recognized and accredited by the ADA has been acquired.
5) Policy regarding mercury free dentistry
There are no rules or regulations in place that would prohibit a licensee from discussing the pros and cons of specific filling materials with a patient. The Board does not regulate the filling materials used as long as the treatment rendered conforms to the standard of care and is the appropriate treatment for the diagnosis. As is the approach of this Board regarding mercury-free dentistry and other professional practice related areas, the Board makes determinations within its disciplinary jurisdiction on a case-by-case basis. This is consistent with the mandated mission of the Board, which is to assure that licensees practice in an ethical and competent manner that is appropriate to preserve the health, safety, and welfare of the public.
What should a dentist do if a patient asks him or her to remove their serviceable amalgams?
A dentist is not ethically obligated to remove serviceable dental amalgams from the non-allergic patient at the patient’s request or even the recommendation of the patient’s physician. The dentist has the professional obligation to use his or her independent judgment about the dental treatment that is best for the patient. The dentist is free to suggest that the patient seek dental care elsewhere.
If a dentist agrees to remove serviceable amalgam restorations from the non-allergic patient at the patient’s request:
The dentist should clearly state that he or she promises no health benefits to the patient by removing serviceable amalgam restorations. The dentist should take special care to obtain the patient’s informed consent to the procedure and thoroughly document that consent in the patient’s records. The patient should be informed of the risks involved in replacing amalgam restorations, including potential damage to healthy tooth structure and the loss of sound tissue in the process and the costs.
Review with the patient the current scientific data on the safety of dental amalgams – that there is no evidence that amalgams pose a significant health risk to non-allergic patients and that no known health benefits result from the removal of dental amalgams. Provide the same data for the alternative materials suggested for use.
6) Policy regarding practice abandonment.
What constitutes “patient abandonment” in a dental setting?
A dentist who discontinues his services to a patient before the need for those services has ended and without giving that patient notice and an opportunity to procure the services of another dentist. Administrative rules have been adopted for the purpose of avoiding practice abandonment. (Administrative Rule Chapter 20-02-01-08. Discontinuance of Practice)
7) Policy regarding dental clinical exams
Clinical exams accepted by the NDSBDE for the purposes of dental licensure will be those clinical exams, designed to test the practitioner’s clinical skills and knowledge administered by a regional testing agency which is determined by the board to be not less than equivalent to the clinical examination developed by the American board of dental examiners. (Chapter 20-02-01-04) Clinical exams taken after January 1, 2008 that are not ADEX exam format or equivalent will not be accepted.
8) Policy on Failure to Renew on a Timely Basis
The licenses of individuals who fail to renew by January 1st of the renewal year will be considered in default. Procedures for renewal and reinstatement following license default are outlined below. When a licensee is believed to have practiced without a current license, the Executive Director will forward the licensees name and license number to the Board for further investigation and processing as follows:
Failure to renew by January 1 of biennial renewal:
The option for online renewal is not available on or after January 1 of the renewal year. A Licensee applying to renew his/her license after January 1 of the renewal cycle must provide the following documentation to the Board for its review and approval:
1. Complete Renewal Application (as issued by the Board)
2. Payment of renewal fee
3. Payment of late fee
4. Documentation of Continuing Education Requirements for
renewal cycle (32 CEUs for Dentists, 16 CEUs for Dental
Hygienists, 16 CEUs for Registered Dental Assistant)
Failure to renew after 30 days notice (NDCC §43-28-17):
1. The Board may cancel the license, notify the dentist/hygienist of the
cancellation and record the cancellation.
2. Payment of the biennial fee and late fee within the thirty-day period will
excuse the default.
3. Licensee may request to have the license place on inactive status upon
expiration of the license.
4. Licensees whose licenses are cancelled may reinstate by application to
the Board (Administrative Rule Chapter 20-02-05-01.1 Reinstatement
requirements).
9) Policy on record keeping
Although no statute or rule is currently in place for record keeping, laws outlining transferring of records and retention of records do exist in the Administrative Rules (Chapters 20-02-01-08 and 20-02-01-09). It is unlawful, and the ADA considers it unethical, for a dentist to refuse to copy and transfer records, even if the patient owes money for previous treatment or does not agree to pay in advance the costs of duplication. (NDCC §§ 43-28-18.1, 23-12-14).
A good record protects the patient and the provider. A dentist’s recollection of events is not likely to be adequate for a subsequent provider, review by the NDSBDE, insurance claims, or a jury. Common record keeping errors seen by the NDSBDE during it’s administrative processes with licensees include:
*Comprehensive informed consent includes treatment options (including no treatment), scheduled treatment, costs, risks, benefits, and mechanism of delivery. Information provided to patients should contain all treatment options, benefits and risks of each, prognosis of each, and all costs involved. The information given should not be limited to only those treatments provided in that dentist’s practice or what that dentist personally thinks is appropriate.
10) Practice of Dentistry in ND by Guest Clinicians
North Dakota statute (NDCC § 43‑28‑02, sec. 4) provides that certain duly licensed practitioners may engage in the practice dentistry in North Dakota as a clinician or lecturer without obtaining a license. It is the policy of the North Dakota state board of dental examiners to facilitate whenever possible the exchange of scientific and clinical information among dentists and other practitioners in this state and thereby provide means to further the clinical competency of our state's dental practitioners. This policy reflects the board's application of specific provisions of state law whereby an already duly licensed practitioner may serve as a guest lecturer or clinician. This policy does not apply to instances whereby a licensed or unlicensed practitioner seeks to participate in a residency or post graduate training program.
11) Sargenti Paste
The NDSBDE refers to the American Association of Endodontists position statement concerning paraformaldehyde-containing endodontic filling materials and sealers, frequently known as Sargenti pastes, which states that these materials should not be used for endodontic treatment because those materials are unsafe. The position of the AAE is backed by extensive scientific research, which has proven unequivocally that paraformaldehyde-containing filling materials and sealers can cause irreversible damage to tissues and bone.