The ensuing conversation was robust. Last week, I attended a dental society dinner meeting where the speaker delivered an engaging presentation on implant dentistry. He reiterated that since dental patients "carry" the work of a previous dentist with them, a unique ethical dilemma often occurs. The subsequent treating dentist may not agree with the previous treatment, resulting in a "loaded" conversation with the patient.

During dessert, the dentists at my table discussed the ethical considerations of criticizing a patient's previous treatment. Yes, the new dentist must be careful broaching previous, substandard treatment. They don't know the circumstances under which the previous treatment took place.

Although the ethical issues concerning such conversations are critical and important, what can matter more are the legal strings attached to it.

Depending on the treatment circumstances and the outcome of that conversation, either one or both dentists may become drawn into the stress of a State Board complaint or the weight of a malpractice lawsuit.

Because of changing licensing requirements, Continuing Education courses for Dental Ethics are required in New Jersey during the biennial period. To present a realistic, comprehensive course that closes the gap on dental ethics, it is best presented by a dentist attorney or an attorney who understands what dentists do and experience during the course of their professional day. Why?

Because of:

• Accountability
• Professional Knowledge
• Source of Assistance

Accountability

The American Dental Association's Principles of Ethics and Code of Conduct provides ethical guidelines in areas that include: protecting the patient's welfare, delegating and referring, abandonment, insurance, truth in advertising, Informed Consent, and not disparaging another dentist's treatment.

While no dentist seeks to overstep an ethical guideline, limited accountability exists for doing so. If a dentist is called before Peer Review (which is a branch of the American Dental Association), and the decision is in favor of the patient, the dentist may not be accountable for not adhering to that decision. The State Board may not have a rule or regulation that enforces that decision without a complaint. Of course the ethical lapse may incur harm to the dentist's reputation, which in turn may be financially consequential.

What will make the dentist accountable is how that ethical guideline dovetails with the law. Accountability appears in the form of a state or federal law violation, a State Board complaint or a lawsuit.

Examples of how a dentist may be held accountable, legally, for ethical lapses are: Health Department violations, HIPAA violations, State Board complaints, Insurance and Banking violations, advertising fines, a malpractice lawsuit, and in rare cases, a lawsuit for defamation.

Professional Knowledge

An attorney familiar with dental ethics will understand the ethical lapse in terms of malpractice, the State Board and any other type of relevant lawsuit. If the attorney does not know the answer, similar to the dentist who will formulate the best treatment plan, the attorney will know where to find the answer and know when it's correct, based on their knowledge, experience, research and network.

Source of Assistance

If a dentist faces an ethical dilemma and is concerned about the consequences, a dental colleague may give advice based on their experience. However, the advice will be anecdotal and not based in law. The dental colleague will not be accountable for that advice, as an attorney who hires a client will be. An attorney who is familiar with the dental profession can advise their client on what to do next, and what possible consequences exist.

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Dr. Gilman, Esq. is available for presentations to Component Societies and Study Clubs to speak about Dental Ethics and other dental-legal related matters.