Dental Healthcare Team Chapter 2-5 Notes PDF

CHAPTER 2 - THE DENTAL HEALTHCARE TEAM The Dental Health Team the dentist healthcare team consists of the following professions ◦ dentist(generalized or specialty) ◦ dental assistant ◦ dental hygienist ◦ dental laboratory technician Dentist = licensed practitioner, qualified in preventative, diagnos...

CHAPTER 2 - THE DENTAL HEALTHCARE TEAM The Dental Health Team the dentist healthcare team consists of the following professions ◦ dentist(generalized or specialty) ◦ dental assistant ◦ dental hygienist ◦ dental laboratory technician Dentist = licensed practitioner, qualified in preventative, diagnostic, and tx of disease, injuries and malformations of teeth, mouth and jaw Roles and Responsibilities ‣ legally responsible for the care of the pt ‣ assesses the pt's oral health needs as related to physical and emotional well-being ‣ diagnosing diseases ‣ promoting oral health and disease prevention ‣ creating tx plans to maintain or restore oral health of pt ‣ interpreting radiographs, and uses up to date diagnostic tests ‣ ensuring the safe administration of anesthetics ‣ monitoring growth and development of the teeth and jaws ‣ preforming dental procedures on teeth, bone, and soft tissues of oral cavity ‣ provide legally required supervision for dental team Dental Specialist licensed dentist who has pursued additional training in a specific area dental anesthesiology dental public health endodontics oral maxillofacial pathology oral maxillofacial radiology oral maxillofacial surgery oral medicine orofacial pain orthodontics pediatric dentistry periodontics prothodontics Types of Dental Practice Settings transitioning from solo practices to group practices with multiple locations Classification of Dental Practice Settings dentist owned and operated group practice - single practice dental management organization affiliated group practice - dentist owned that contracts with a management agency insurer-provider group practice -part of an organization that cover's a person's health care government agency group practice - associated with national and local agencies, infrastructure includes public health departments, hospitals and military settings not-for-profit group practice - providing tx for the disadvantaged population or training for health care professionals Dental Assistant RDA is a valuable member of the dental team, works closely with and under the supervision of a dentist education is between 1-2 years Roles and Responsibilities preparing pts for clinical care collecting and recording medical and dental history and the pts vital signs assisting the dentist in managing medical and dental emergencies providing pt information on oral health care assisting in a range of preventive, restorative, and specialty procedures preforming advanced skills after proper training and education preparing and delivering dental materials throughout a dental procedure providing post-op instructions managing infection control throughout office including instruments preforming radiographs preforming lab duties (pouring impressions and creating diagnostic cast greeting pts answering the phone scheduling + confirming appointments ensuring pt privacy overseeing pt relations Registered Dental Hygienist education between 18 months to 4 year undergrad degree Roles and Responsibilities preform oral health assessment, including reviewing pt history, chart, oral cancer screening and evaluation of gum disease educate pt on proper oral hygiene techniques preform dental prophylaxis remove plaque and calculus above and below gum line apply cavity preventative agents expose, process and interpret radiographs assess periodontal status of pt Laboratory Technician Education is 2 years diploma Roles and Responsibilities work with a variety of materials, waxes, plastics, alloys, stainless steels, porcelains, composites and polymer glass fabricate partial and full dentures fabricate fixed bridges fabricate implants fabricate veneers and crowns fabricate ortho appliances CHAPTER 3 - THE PROFESSIONAL DENTAL ASSISTANT Dental Assisting as a Profession personal rewards - diversity, job satisfaction, opportunity, for service and financial reward competency in skills gained through certification, advanced skills, using appropriate infection control and safety measures professional goals - dedication, personal responsibility, integrity and commitment to CPE Characteristics of a Professional Dental Assistant professionalism - having a positive approach in everything you do and say, distinguishes those that have a job vs. pursuing a career Qualities of a Dental Assistant dedication ‣ proactively take steps to expand knowledge and professional development attitude ‣ willingness to get along by avoiding gossip, or criticizing others responsibility and initiative ‣ knowing what is expected of you and being willing to support those that are over extended ‣ learning additional skills by asking questions and observing others ‣ finding tasks to perform without being asked ‣ calling the office when ill or unavoidably late ‣ not discussing personal problems in the office with other staff or pts ‣ not using cell phone during work hours for personal use teamwork ‣ Together, Everyone, Achieves, More Dental assistants role in Office Chair-side Assistant four handed dentistry prepares pt for tx, readies set up for procedure, assists during and keeps pt informed and comfortable/ relaxed Circulating Assistant "floater" used for six handed dentistry common in specialty offices with complex procedures Sterilization Assistant effectively and safely processes all instruments and manages bio-hazardous waste Administrative Assistant "receptionist" primary responsibility is to have a smooth and efficient operating business side of the dental office scheduling appointments, communicating on the phone, coordinating financial arrangements with pts and handles insurance claims Professional Appearance good health - adequate rest, well balanced diet, and being active to keep mind and body fit good grooming - paying attention to the details of appearance as you're working is very close proximity to others appropriate dress - wearing clothes appropriate for position, infection control standards must be considered with selecting clinical attire Standards for Professional Appearance specific dental office measures should include: uniform or scrubs be cleaned and in good repair shoes and laces be clean and in good condition hair styled back and out of face and the mouths of pts avoid jewelry fingernails clipped short and kept clean keep make up subtle and natural avoid tattoos and tobacco, body piercings perfumes and body scents should not be worn bathe daily and use deodorant maintain good oral hygiene implement procedures for infection control and prevention of disease transmission CHAPTER 4 - ETHICS AND CODE OF CONDUCT IN DENTISTRY Principles of Ethics ethics = moral discipline concerned with good and bad, right and wrong, includes values, high standards of conduct, and personal obligations reflected in our interactions with other professionals and pts ethical standards - always of a higher order than the minimum standards established by law Sources of Ethics basic instinct parents teachers religion peers Ethical Standards in Dentistry Patient Autonomy Autonomy = a person's choice to think, judge and act independently without unwarranted influence, basis for informed consent confidentiality = pt have the right to their privacy concerning healthcare and tx choices. everything said or completed in the dental office must remain confidential Advisory Opinions on Autonomy ‣ patient involvement ‣ providing copies of pt records ‣ confidentiality of pt records Nonmaleficence means do no harm refrain from harming the pt includes legal delegation of pt care to the DA of DH Advisory Opinions for Nonmaleficence ‣ second opinion ‣ use of auxiliary personnel ‣ personal impairment ‣ ability to practice ‣ post-exposure, blood borne pathogens ‣ patient abandonment ‣ personal relationships with patients Beneficence idea of doing good for others as a moral obligation includes providing dental care in a competent and timely period, putting their pts welfare first Advisory Opinions for Beneficence ‣ community service ‣ government of a profession ‣ ‣ ‣ ‣ research and development patents and copyrights abuse and neglect professional demeanour in the workplace Justice treating people fairly and giving people that they deserve and are entitled to receive Advisory Opinions for Justice ‣ patient selection ‣ emergency service ‣ justifiable criticism ‣ expert testimony ‣ rebates and split fees Veracity telling the truth in the best interest of the pt to know the truth about dental conditions Advisory Opinions for Veracity ‣ representation of care - not be false or misleading ‣ representation of fees - being charged for care should not be provided in a false or misleading manner ‣ disclosure of conflict of interests ‣ devices and therapeutic methods ‣ professional announcements ‣ advertising ‣ name of practice ‣ general practitioner announcement of services Professional Code of Ethics for Dental Assistants CDAA Code of Ethics ◦ to be a multi-skilled professional with a diverse knowledge base, application of clinical skills, administrative principles, and practitioner ◦ be responsible to pts by following: confidentiality, informed consent, dental jurisprudence, accountability, comfort and welfare ◦ be responsible to the public and community through the following: human rights, environmental protections, community participation ◦ be responsible to the profession: equality among professionals, representation, professional conduct, independent fxning and autonomy, collaborative relationships, contributions, technological advances and continuing education ◦ research Applying Ethical Principles Ethical Dilemmas occurs when one or more ethical principles are in conflict Steps for Solving Ethical Dilemmas ‣ identify the alternatives ‣ determine the professional implications ‣ rank the alternatives ‣ choose a course of action CHAPTER 5 - DENTISTRY AND THE LAW The Law Statutory Law Criminal Law ‣ felony - major crime, such as insurance fraud or drug abuse. conviction may result in imprisonment ‣ misdemeanour - lesser offence that may result in a variety of penalties, fines, loss or suspension of the license to practice, mandatory education, counselling or community service ‣ infraction - minor offence that usually results in a fine Civil Law ‣ involves crime against an individual with legal suits over wrong doings against an individual or company Contract Law - binding agreement between 2 or more people expressed contract - established through a written word or verbal agreement, commonly used when the required tx is extensive or take longer time to complete implied law - established by actions, not word. most dental contracts are implied Tort Law - civil wrong , intentional or unintentional acts that bring harm to a person or damage to properties Board of Dentistry Licensure purpose of licensure is to protect the public from incompetent and unqualified practitioners reciprocity - agreement between 2 or more states at allow a dentist and hygienist who is licensed in one state to receive without further education / action license by credential - allows individuals licensed in one state to become licensed in another state is certain requirements are met state board has authority to revoke, suspended or deny renewal of license Expanded Functions and Supervision direct supervision - dentist has delegated a specific procedure to be performed for a pt of record by a legally qualified dental auxiliary, dentist required to be physically present in operatory at time of procedure indirect supervision - supervision which the dentist is not only required to be in the office when a procedure is provided by a legally qualified dental auxiliary general supervision - supervision where dentist not required to be in the dental office when procedure is provided Legal Practice of Dental Procedures ‣ legally perform only fxns that have been delegated to you under the dental practice act Standard of Care level of care at which the average provider with similar training and experience would practice in the same area or similar locality Due Care means effort made to avoid harm to another, with proper and sufficient care and the absence of negligence dentist has legal obligation to provide due care in treating pts dentist may not refuse to treat pt based on race, colour, or creed Abandonment refers to discontinuation of care after tx has begun, but before it has been completed dentist may not dismiss or refuse to treat a pt of record without giving pt written notice of termination Patient Responsibilities pt has legal duties to dentist pt legally required to pay a reasonable and agreed-on fee for services pt expected to cooperate and follow instructions regarding home care for tx Malpractice professional negligence = failure to provide due care/ lack of care. occurs when dentist fails to provide reliable, safe, and effective tx in accordance with standard of car the 4 D's present to have a malpractice suit ◦ Duty of care - not a formal dentist - pt relationship ◦ Dereliction - dentist not providing pt with care and tx needed ad expected ◦ Direct cause - negligent act by dentist was the direct cause of injury ◦ Damages - pt must show actual suffering of harm, physically, mentally or both Acts of Omission and Commission act of omission = failure to preform an act 'reasonable and prudent profession' would preform act of commission = performance of an act that a 'reasonable and prudent professional' would not preform Doctrine of Res Ipsa Loquitur act speaks of itself therefore, expert witnesses no necessary for a malpractice suit Risk Management practices and procedures to avoid lawsuits: ◦ excellent communication with pts ◦ maintaining accurate and complete records ◦ receiving informed consent ◦ doing everything possible to maintain highest standards of clinical excellence Avoiding Malpractice Lawsuits prevention and good communication is the best defence against malpractice Silence is Golden ‣ idiom means it is often better to remain silent than to speak ‣ concept res gesture statements made spontaneously by anyone a part of the dental team at the time of an alleged negligent act are admissible as evidence and may be damaging to dental team in a court of law Informed Patient Consent informed consent = dental tx is based on information provided by dentist, dentist must give pt accurate info about condition and all available tx options implied consent = action of pt displaying their consent by scheduling an appointment or sitting in tx chair for examination written consent = preferred means of obtaining and documenting the pts consent to and understanding of course of tx Informed Refusal ‣ pt refuses proposed tx, dentist must inform pt about consequences and obtain pt's informed refusal and record in pts record Informed Consent for Minors ‣ parent, custodial parent or legal guardian must give consent for minor children Documenting Informed Consent ‣ pt record should indicate that pt received information about risks, benefits and tx alternatives ‣ tx is extensive, invasive or risky, a written informed consent document is recommended ‣ pt should receive a copy and original kept in pt record Content of Informed Consent forms ‣ informed consent is a process, not a form ‣ involves face to face discussion, where time is available for all questions or concerns the pt has ‣ informed consent forms should include: nature of proposed tx benefits and tx alternatives risks and potential consequences associated with not performing tx other necessary information for the case ‣ clinical situations requiring written informed consent: new drugs being used experimentation or clinical testing is involved pt identifiable photograph is used general anesthesia is administered minors are treated in a public program tx takes longer than 1 year to complete Patient Referral dentist refer pt when case or medical condition is out of their scope of expertise dentist must inform pt that tx cannot be provided by said dentist properly and that the service of a specialist is required Failure to Refer ‣ many malpractice suits occurs from a general dentist not referring a pt when they require special attention ‣ important for general dentist to establish a pt baseline of oral health conditions and record changes overtime ‣ important to make an entry each time the pt is informed of a condition and need tx or a referral ‣ documentation of the referral should include problem, reason for referral, name of specialty of the referral dentist and if the pt has agreed to the referral Guarantees ‣ outcomes of dental care cannot be completely predicted ‣ no dental staff should make a promise or a claim about an outcome of care Contributory Negligence occurs when a pts actions/ lack of actions negatively affect the tx outcome pt records should notate broken appointments or last minute cancellations documentation of contributory negligence helps protect the practice from legal recourse Patient Records pt of record is a pt who has seen the dentist, had an examination done and has a tx plan Ownership of Patient Records and Radiographs the dentist owns all pt records and radio graphs pts have the right to access and retrieve records original records and radiographs cannot be taken from the practice without the dentists permission Reporting Abuse and Neglect Dental professionals may be the first to recognize abuse and be instrumental in enhancing the victims chances of getting assistance mandated reporters - legal obligated to report abuse suspected if reasonable suspicion: ◦ physical abuse resulting in injury ◦ emotional abuse ◦ emotional deprivation ◦ physical neglect or inadequate supervision ◦ sexual abuse or exploitation Child Abuse defined as any act of omission or commission that endangers/ impairs a child's physical or emotional health and development primary intent on reporting is to protect the child warning signs = repeated injuries, unusual sites of accidental injury (neck, cheeks) neglected appearance of pt, strict and overly critical parents, extremely isolated families Domestic Abuse describes battering, abuse or control over an individual within same household spousal abuse should be reported with the consent of the abused spouse, behaviour starts with controlling then become aggressive Elder Abuse when a relative or health provider abuses an elderly pt. abuse can be physical, sexual, or emotional consisting of passive neglect, willful deprivation and most commonly financial exploitation Dental Neglect willful failure of a person or guardian to seek and obtain appropriate tx for caries and oral infection Health Insurance Portability and Accountability Act Purpose of HIPAA: Ensure portability of health benefits for employees who change jobs and whose eligibility for benefits may have changed because of a change in health status provide tax credits for employers to encourage employee medical savings accounts reduce fraud and abuse encourage administrative simplification in healthcare, maintaining pt confidentiality