Dentist
Directory Frequently Asked Questions
What
records are my dentist required to give me upon written
request?
What
are standard infection control measures?
What
are dental assistants allowed to do when delivering
care to patients?
Are
dentists required to provide sign language interpreters
for the hearing impaired?
Do
I have to pay for a sign language interpreter?
What
if a disabled patient uses a seeing-eye dog? Does the
patient have the right to bring the animal into my office?
Are
dentists legally bound to disclose if they are HIV positive?
Under
what conditions can a dentist dismiss a patient?
What
is the Colorado Dental Association’s position
on the use of dental amalgams?
What
records are my dentist required to give me upon
written request?
The
Patient Records Law of Colorado requires health care
providers to provide a copy of a patient's treatment
record when requested in writing. In addition, the
American Dental Association's Principles of Ethics
and Code of Professional Conduct states, "a dentist
has the ethical obligation to furnish such records
whether or not the patient's account is paid in full.” Furthermore,
the Dental Practice Law clearly states that it is a
violation of the law for a dentist not to comply with
the Patient Records Law.
Colorado
rules that govern what a dentist or other health care
provider may charge for records state that charges may
"not exceed $12 for the first 10 or fewer pages
and $.25 for every additional page. Actual postage costs
may also be charged." In addition, if a patient
requests copies of radiographs or other items "which
cannot be reproduced without special equipment"
the dental office may charge "the actual cost of
such reproduction."
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What
are standard infection control measures?
Occupational Safety and Health Administration
(OSHA) guidelines require dental offices to follow
certain measures to control infections. Complete documentation
may be found through the Center for Disease Control
(CDC), www.cdc.gov.
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What
are dental assistants allowed to do when delivering
care to patients?
Only licensed dentists can perform procedures that
contribute to or result in a change of the oral anatomy.
A dental assistant MAY perform the following under
the personal direction of a licensed dentist:
- Smoothing
and polishing natural and restored tooth surfaces;
- Applying
fluorides and other recognized topical agents to
prevent oral disease;
- Gathering
and assembling information regarding patient history,
oral inspection, and dental and periodontal charting;
- Administering
topical anesthetic to patients in the course of
providing dental care;
- Administering
and monitoring nitrous oxide on a patient, under
the direct supervision of a licensed dentist;
- Any
other task or procedure that does not require the
professional skill of a licensed dentist.
A
dental assistant may also perform the following procedures
necessary to make dentures, under the general supervision
of a licensed dentist:
- Taking
preliminary and final impressions;
- Taking
bite-registration and determining vertical dimensions;
- Making
tooth selections;
- Administering
preliminary fitting of the trial denture, prior
to fitting and written approval by a licensed dentist;
- Adjusting
denture prior to the final examination of the denture.
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Are
dentists required to provide sign language interpreters
for the hearing impaired?
The Americans with Disabilities Act (AwDA) defines a
dental office as a public accommodation. Therefore,
dental offices cannot discriminate against individuals
with disabilities such as hearing loss. The AwDA requires
dentists to provide care for patients with disabilities
and to establish ways to communicate so they can understand.
There are a variety of ways to communicate with a deaf
or hearing-impaired patient. For example, using written
notes, pictures or models to discuss the patient’s
condition and recommended treatment. Office computers
are also useful in carrying on a conversation with a
hearing-impaired patient. Some hearing-impaired individuals
are very adept at reading lips and prefer to be spoken
to. The best approach may be to let the patient indicate
the form of communication he/she prefers. There may
be times when using a sign language interpreter is appropriate.
For example, it may be advisable to use an interpreter
when providing complex or extensive information to obtain
informed consent to a procedure that carries significant
risk.
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Do
I have to pay for a sign language interpreter?
You may not have to hire an interpreter. A member of
the patient’s family may be able to interpret
for you, or there may be a service organization in
your community that will provide an interpreter at
no cost. The local office of your state rehabilitation
services agency or health department may be able to
direct you to such an organization. It is important
that an interpreter accurately convey what both doctor
and patient are saying.
If
no other resource is available, and the patient is
unable to communicate and understand by any method
other than sign language, you may have to hire an
interpreter. Under the AwDA, you would have to pay
the cost of the interpreter and could not pass the
cost on to the patient as a supplemental charge or
increased fee for the dental treatment. Should you
determine an interpreter is not required, the disabled
person can file a complaint and you must be prepared
to justify your decision. For increased patient confidentiality
and/or to explain complex procedures, a professional
interpreter may be needed. Visit www.nad.org to learn
more about interpreters from the National Association
of the Deaf.
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What
if a disabled patient uses a seeing-eye dog? Does the
patient have the right to bring the animal into my office?
The regulations under the AwDA specifically state that
you must permit disabled people to bring service animals,
such as seeing-eye dogs and hearing dogs, into your
office. Nothing in the act requires you to allow service
animals into the operatory if the patient does not require
the service provided by the animal during the time the
dental procedures. Public accommodations, including
dental offices, are not required to supervise or care
for service animals. A staff member should remain with
the patient at all times and under all circumstances
while they are separated from the animal. The only exception
would be if a friend or relative accompanies them.
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Are
dentists legally bound to disclose if they are
HIV positive?
Dentists, dental hygienists and dental assistants who
are diagnosed as HIV positive are not currently required
to report their status to the State Board of Dental
Examiners or the Colorado Department of Health. However,
the health care provider who makes the diagnosis that
an individual is HIV positive is obligated to report
that finding to the Colorado Department of Health.
The department will review all new reports of HIV infection
and determine if the individual is a health care worker
(HCW). When a health care worker is identified the
department will “convene an expert advisory panel
to provide advice to the department...(and) make a
recommendation on whether the health care worker’s
current practice represents a risk to patients. If
a risk is determined, (the department) will counsel
the health care worker . . .(and) will monitor the
health care worker’s voluntary compliance with
the counseling message. If the health care worker disagrees
with the department’s recommendations, the matter
may become a mandatory proceeding where the department
would issue a public health order and the health care
worker may challenge the order in a judicial proceeding.”
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Under
what conditions can a dentist dismiss a patient?
According to the American Dental Association’s
Principles of Ethics and Code of Professional Conduct,
“once a dentist has undertaken a course of treatment,
the dentist should not discontinue that treatment without
giving the patient adequate notice and the opportunity
to obtain the services of another dentist. Care should
be taken that the patient’s oral health is not
jeopardized in the process.”
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To
avoid the abandonment of a patient, the Dentists
Professional Liability Trust recommends that all
emergency needs of the patient be addressed prior
to dismissing a patient. If the patient is at a non-emergency
point in their treatment and it is clear that a situation
has developed that prevents the dentist from practicing
quality dentistry to the level of the patient’s
needs, the dentist can terminate the patient from
their practice by sending a letter advising the patient
of the current situation. The patient should also
be provided with names of various clinics or clinicians
who might be in a position to assume their care.
It is also strongly recommended that the dentist
remains available for the following two weeks to
handle any emergencies until the transfer of care
can be arranged.
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What
is the Colorado Dental Association’s position
on the use of dental amalgams?
Dental amalgam, commonly referred to as “silver
fillings,” contains various metals such as silver,
copper and tin. Mercury chemically binds these components
together to form a hard, stable restorative material.
This material is a biologically inactive substance.
Under the pressure of vigorous chewing and grinding,
very small amounts of mercury vapor may be released.
There is no scientific evidence that this small amount
of mercury vapor has any adverse health effects.
Mercury
can be found in food, water and air. Consequently,
there is always a very low level of mercury present
in the human body. Most mercury in human blood is
from food intake. Dental amalgam has been used for
more than 150 years without any credible evidence
that it is responsible for any health problems. Dental
amalgam, one of the most effective and widely used
tooth restoration materials, serves the dental health
care needs of 100 million Americans. In extremely
rare cases, some individuals are allergic to amalgams
(fewer than 100 cases have been reported in dental
literature). However, more than 99 percent of the
general population should be able to have amalgam
fillings with no allergic response. In the absence
of allergic reactions, it is not advisable to have
amalgams removed. Removing amalgams can cause damage
to healthy teeth and can lead to further dental problems.
In
support of its position on the safety of dental amalgam,
the CDA points to the following studies:
- In
January 1993, a report from the U.S. Public Health
Service found: “There is no solid evidence
of any harm for millions of Americans who have
these [dental amalgam] fillings” and “(there
is) no persuasive reason to believe that avoiding
amalgams or having them removed will have a beneficial
effect on health.”
- In
August 1991, the National Institute of Health Technology
Assessment found: “There is no scientific
evidence that currently used restorative materials
cause significant side effects. Available data
does not justify discontinuing the use of any currently
available dental restorative materials or recommending
their replacement.”
- In
May 1991, the FDA’s Dental Products Panel
determined that “amalgam caused no direct
hazard to patients, nor was there any reason to
remove amalgam fillings.”
The
CDA supports the considerable research that has been
done on dental amalgam and encourages further scientific
inquiry and dialogue. The Colorado Dental Association
concurs with the American Dental Association’s
position on amalgams, which can be found on the ADA’s
Web site, www.ADA.org,
under “Research & Clinical Issues, Dental
Products & Procedures.
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