NBDHE( law and ethics)

Purpose of the DH Code of Ethics

To achieve high levels of ethical consciousness, decision making, and practice by members of a profession.

DH core values include:

Veracity

Autonomy

Beneficence

Justice

Non-maleficence

Confidentiality

Societal trust

Veracity

Truthfulness

Autonomy

-Deals with the PATIENT, not the practitioner.

-Right to privacy; freedom of choice

The patients have rights to informed consent, full disclosure, privacy, freedom of choice, etc.

Beneficence

-Do what benefits the patient (promotes their well-being)

-Example: Doing dental screening

Justice

Fairness

Non-Maleficence

Do no harm. Deals with the PRACTITIONER.

Example- providing protective eyewear to the patient

Confidentiality

The act of holding information in confidence, not to be released to unauthorized individuals

Societal Trust

Value patient trust.

Based on our actions and behavior.

Civil offense

-A crime against an INDIVIDUAL but not against society.

-Satisfaction is sought (usually money)

-Most dental cases fall under this category.

-Common lawsuits are dental injections, adverse drug reactions related to contraindications to medical history, or failure to diagnose

-Best way to avoid lawsuits is through documentation, charting, and communication

What is the best way to avoid lawsuits

Best way to avoid lawsuits is through documentation, charting, and communication

Civil Law: Contract Law

-2 main types: implied and expressed

-Involves the practitioner and patient

-Can involve termination of patients and abandonment of patients

Implied contract

An agreement made through inference by signs, inaction or silence

Expressed contract

A written or oral agreement in which all terms are explicitly stated

Abandonment in contracts

Dismissal of a patient without ample and proper notice

Civil Law: Tort Law

Wrongs against a person or property: damages can be sought by injured party.

Intentional Torts (civil law: torts) includes:

-Assault

-Battery

-Deceit/Misrepresentation

-Defamation

-Breach of confidentiality

-Invasion of property (patients body is the property)

Assault

-A type of intentional tort

-Intention to cause bodily harm WITHOUT actually doing it (threatening)

Battery

-A type of intentional tort

-Intention to cause bodily harm WITH touching them

Defamation

-A type of intentional tort

-Act of harming or ruining another's reputation

-2 types (libel and slander)

Libel

-A type of defamation (which is an intentional tort)

-WRITTEN defamation

-Think L=Library > Libel

Slander

-A type of defamation (which is an intentional tort)

-Verbal defamation

-Think S=Spoken > Slander

Unintentional Tort (Civil law: torts) includes:

Negligence and malpractice

Negligence

-Failure to do what a reasonable person would do

-Includes Standard of Care and duty

-Example: breaking instrument tip in periodontal pocket and neglecting to tell the patient

4 essential factors in negligence:

1. Acceptance of the patient by the provider

2. Breach of duty (harm does not have to happen to be a breach)

3. Causal relationship between the breach and damage

4. Damage or harm to the patient

2 main types of law

Civil and criminal

2 main branches off of civil law

Contract law and tort law

OSHA

Occupational Safety and Health Administration

-Responsible for developing universal/standard precaution protocols for employees to prevent them from contracting disease through blood and/or other body fluids

-Protects the employees

-Pertains to clinics and facilities

-Includes Blood-Borne Pathogens and MSDS

HIPAA

Health Insurance Portability and Accountability Act of 1996

-Maintains patient confidentiality

-All health care entities that electronically process, store, transmits or receives medical forms, claims, or remittances

-Office has to provide the patient a copy of HIPAA policy every 3 years

How frequently does a HIPAA form need to be signed?

Only one time unless..

1. Changes are made and the patient needs to add or remove an individual from a previous form

2. The government has made changes to HIPAA policy

CDC

Centers for Disease Control and Prevention

-Recommends infection control protocol and conducts research to determine how diseases are transmitted

-Provides guidelines for disease prevention/transmission

-Located in Atlanta, GA

COBRA

Consolidated Omnibus Budget Reconciliation Act

-Law to provide terminated employees or those who lose insurance coverage because of reduced work to be able to buy group insurance for themselves and their families (spouse and children) for a limited amount of time (for 18 months)

Informed Consent

-AUTONOMY

1. Presented in an understandable language

2. Nature and need of procedure

3. Benefits and risks of procedure

4. Prognosis

5. Alternatives to recommended procedure

6. Patient is allowed to ask questions

Malpractice

Professional negligence where harm results

To prove there must be:

1. Act of omission or commission

2. Failure to satisfy standard of care

3. Harm or injury to the patient

Statute of Limitations

-Time frame (limitation period) within which legal action must be taken

-Varies from state to state and the type of lawsuit

-Because dental lawsuits vary from state to state and type of offense, there is NO definite time for a universal statute of limitations

Dental records

-Documentation of complete data

-Additional information (radiographs, referrals, prescriptions, OHI, etc.)

Ownership:

-Dentist owns paper on which information is printed

-Patient owns information

-It is ok for dentist to charge reasonable fee to transfer records (even if there is a balance on the account)

Another term for the employer (dentist)

Respondent Superior

Statutory Law for Dental Professionals

-Licensure requirements, examination, and eligibility requirements

-Licensure by endorsement

-Approval of educational programs

-Examination and disciplinary authority

-Scope of practice

-Supervision requirements

-Continuing education requirements

Utilitarianism

The consequentialist principle that one should choose the course of action that creates the most good for the greatest number of people

Deontology

-The study of the nature of duty and obligation.

-Right or wrong regardless of the consequences.

-Kant's approach

Fat soluble vitamins

A- All

D- Dieters

E- Eat

K- Kilocalories

Infection control measures consist of:

-Regulated biohazard waste

-Safety Data Sheet (SDS)

-Personal protective equipment (PPE)

-Disinfectants

-Sterilization

Regulated biohazard waste

-Must be disposed of properly

-Examples include: sharps, items that drip of saturated blood and/or saliva, hard and soft tissues removed from the patient's mouth

Safety Data Sheet (SDS)

Sheet that provides information on the safe use of and hazards of chemicals, as well as emergency steps to take in the event chemicals are splashed, sprayed, or ingested

Personal Protective Equipment (PPE)

Protective barrier that blocks exposure to a pathogen or a hazardous material.

-Mask (change when it becomes wet/moist and with every patient

-Examination gloves

-Protective eyewear

-Protective (impervious) clothing

PPE provides barriers to minimize exposure to:

1. Aerosol- invisible airborne particles; remain in air for awhile

2. Spatter- visible airborne particles of blood and/or saliva; drop quickly to a surface

3. Direct contact- occurs through direct touching of an infectious agent (blood, saliva)

4. Indirect contact- through a contaminated object (hand mirror)

Disinfectant purpose

Kill or inactivate MOST pathogenic microbes. However, NOT spores

Qualities of a disinfectant include:

-Rapid, broad spectrum antimicrobial (bactericidal, fungicidal, tuberculocidal, virucidal)

-Odorless, easy to use, fast acting, and economical

-Compatible to environment and surfaces

-Residual effect- continues to work after it is dried

-Non-toxic to touch or inhalation

-EPA registered

-Cleans and disinfects

Types of disinfecting agents

1. Chlorine-based compounds

2. Iodophors

3. Phenols (water or alcohol based)

4. Quaternary compounds

Chlorine-based compounds

Corrosive to metals

Strong odor

Iodophors

Can discolor some surfaces yellow

Phenols (water or alcohol based)

May leave a film or residue on surfaces

Quaternary Compounds

Not corrosive but have a lower kill spectrum; limited efficacy

Gluteraldehyde

-Should not be used as a surface disinfectant because of the toxic effects of the fumes

-Also, it is corrosive

-Immersion sterilant for 10 or more hours

Levels of surface disinfectants

1. High- used in surgical areas

2. Intermediate- used in dental offices; must kill TB organisms.

3. Low- generally used at home; not acceptable for use in a dental office.

Sterilization purpose

To kill ALL pathogenic microbes, including spores

Chemical sterilization (conditions, considerations & materials)

Conditions:

-Recommended minimum temperatures -273 F for 20 minutes with a pressure of kPa/25psi

Considerations:

-Ventilation is necessary

-May damage rubber and plastic items

-Spore test= Geobacillus (formerly Bacillus) stearothermophilus

Dry Heat Sterilization (conditions, considerations & materials)

Conditions:

-340 F for 1 hour

-or 320 F for 2 hours

Considerations:

-Recommended for metal instruments

-Avoid paper products

-May damage rubber and plastic items

-Not recommended for handpieces (think DRY HANDS)

-Spore test= Bacillus atrophaeus

Steam Sterilization (conditions, considerations & materials)

Conditions:

-Recommended minimum sterilization parameters are 250 F with 15 or 20 lbs. per square inch (psi) for 30 minutes

Considerations:

-Corrodes non-stainless (carbon) steel instruments

-Dulls instruments and burs

-Ok for SOME plastics (cotton rolls/gauze)

-Paper packages come out wet and tear

-Spore test= Geobacillus (formerly Bacillus) stearothermophilus

Preparation for sterilization

1. Clean instruments in ultrasonic cleaner > reduces risk of puncture wounds from manual scrubbing

2. Avoid overloading instruments in autoclave > place in a single layer (using cassettes helps prevent overloading)

3. Use proper ventilation

Sterilization packaging materials

-Cassettes and wraps

-Plastic/paper pouches

-Nylon clear tubing

-Paper

External indicators (on packaging materials or tape)

Color change indicates that the instruments have been heat processed (reached temp)

Biological Indicators (Spore Testing)

-Should be conducted weekly

-Determine if the sterilization cycle is reaching proper temperature, time, and pressure to kill ALL microorganisms

Spore test for chemical sterilization

Geobacillus stearothermophilus

Spore test for dry heat sterilization

Bacillus atrophaeus

Spore test for steam sterilization

Geobacillus stearothermophilus

G.V. Black Class I

Pits and fissures on lingual surfaces of anterior and on occlusal, buccal, and lingual surfaces of posterior teeth

G.V. Black Class II

Proximal surface of posterior teeth; commonly involves occlusal surfaces

G.V. Black Class III

Proximal surfaces of anterior teeth; does not involve the incisal edge

G.V. Black Class IV

Proximal surface of anterior teeth; involves the incisal edge

G.V. Black Class V

Cercial (gingival) 1/3 of the facial or lingual surfaces of any tooth. (Root caries)

G.V. Black Class VI

Incisal edge of anterior or cusp tips of posterior teeth

Class I Occlusion (describe and draw)

(Mesognathic) Normal

-Mesiobuccal cusp of the maxillary first molar is positioned in the buccal groove of the mandibular first molar.

-Maxillary canine occluded with the distal half of the mandibular canine and the mesial half of the mandibular first premolar

-Malposition of individual teeth or groups of teeth

Class II Occlusion (describe and draw)

(Retrognathic)

Molar Relationship: Buccal groove of the mandibular first permanent molar is distal go the mesiobuccal cusp of the maxillary first permanent molar by at least the width of a premolar.

Canine Relationship: Distal portion of the maxillary canine is mesial to the mesial portion of the mandibular canine by at lease the width of a premolar.

Division I-retruded mandible with one or more maxillary anterior teeth protruded facially.

Division II- retruded mandible with one or more maxillary anterior teeth inclined lingually.

Class III Occlusion (describe and draw)

3=P (Prognathic)

Molar Relationship: Buccal groove of the mandibular first permanent molar is mesial to the mesiobuccal cusp of the maxillary first permanent molar by at least the width of a premolar

Canine Relationship: Mesial portion of the maxillary canine is distal to the distal surface of the mandibular canine by the width of a premolar

Malocclusion includes:

-Overbite

-Overjet

-Open-bite

-Cross-bite

-Midline shift (deviation)

-Edge-to-edge

-End-to-end - cusp-to-cusp

Overbite

Vertical overlap of the maxillary incisors to the mandibular incisors

Overjet

Horizontal distance between the lingual of the maxillary anterior incisors and the facial of the mandibular anterior incisors.

Openbite

Teeth not in occlusion between the maxillary and mandibular teeth or arch.

Crossbite

Maxillary teeth are positioned lingual to or totally facial to mandibular teeth.

Midline shift (deviation)

Midline of maxillary central incisors does NOT align with midline of mandibular central incisors

Edge-to-edge

Incisal edge to incisal edge of the maxillary anterior to mandibular anterior teeth

End-to-end - cusp-to-cusp

Relationship of the posterior teeth

Class I Furcation

early evidence of bone loss; instrument can enter the depression leading to the furcation

Class II Furcation

Moderate bone loss; instrument can enter furcation, but cannot pass between the roots

Class III Furcation

Evidence of severe bone loss in between roots; instrument can pass through entire furca; tissue is covering furca

Class IV Furcation

Same as Class III with exposure resulting from gingival recession

Mobility- N

Normal

Mobility Class 1 or I

Involves slight horizontal mobility less than 1 mm

Mobility Class 2 or II

Involves moderate horizontal mobility; greater than 1mm- with no vertical displacement

Mobility Class 3 or III

Involves severe mobility with possible combined horizontal and vertical movement

Write furcation symbols Class I-IV

Calculus

Mineralized plaque; provides an irritant for the gingiva

Types of calculus and the nutrient source?

Supragingival- Nutrient source is saliva

Subgingival- Nutrient source is cervicular fluid and inflammatory exudate

Detecting calculus

Calculus-detecting explorers: posterior includes 11/12 and pigtail; anterior & cervical 1/3 of posterior teeth includes orban-type

Dry teeth with compressed air

Radiographs

Extrinsic stain

A stain that can be removed from tooth surfaces by polishing or scaling

Intrinsic stain (and causes)

Endogenous- not removable

Causes- pulpal necrosis, internal resorption, excessive systemic fluoride and/or tetracycline use during tooth development.

Origin of black-line stain

-Gram positive bacteria

-Typically located on cervical 1/3 of facials and linguals

Origin of brown stain

Associated with poor oral hygiene and/or drinking dark-colored beverages (coffee, tea, fruit juices and red wine)

Origin of dark brown and black stain

Associated with tobacco use

Origin of orange stain

-Chromogenic bacteria in plaque

-Associated with poor oral hygiene

-Typically located on anterior teeth