11.1 Discussing Another Dentist's Work, and When to Report Other Professionals

Talking about a previous dentist's treatment (K2041)

A new patient says, "My last dentist put in this crown two years ago, and it hurts." The radiograph shows an open margin and recurrent decay. What you say next is governed by ADA Section 4.C (Justifiable Criticism):

Patients should be informed of their present oral health status without disparaging comment about prior services.

Advisory Opinion 4.C.1 explains the reasoning:

• Patients depend on the dentist's expertise, so comments must be truthful, informed, and justifiable.
• Where possible, and within the law, consult the previous treating dentist to learn the circumstances. The crown may have been a temporary compromise the patient chose, or recurrent decay may reflect two years of poor home care.
• A difference of opinion about preferred treatment should never be presented in a way that implies mistreatment.
• Unjustified disparaging comments can themselves lead to discipline.

The CDA Code matches this. Advisory Opinion 1.F.1 requires finding out from the previous dentist "under what circumstances and conditions the treatment was performed" and forbids disparaging differences of opinion. Section 10C puts the burden on a dentist who comments publicly to show the evidence would lead a reasonable dentist to believe the comment is true.

Expert witnesses: a dentist may testify when it is essential to a just outcome (ADA 4.D), but may not accept a contingent fee (4.D.1). Under the CDA Code (10A), a dentist giving an expert opinion about a person may not accept that person as a patient until the litigation ends.

When a dentist must or should report another professional (K2141)

California has no general statute requiring dentists to report a colleague's substandard work to the Board. The duties are a mix of legal mandates and ethical obligations:

Reports that others must make

• Insurers must report to the licensing agency any professional liability settlement or arbitration award over $3,000 within 30 days (B&P § 801).
• A licensee without insurance must report such settlements, judgments, or awards over $3,000 themselves within 30 days (§ 802).
• Licensees must report a patient's death during treatment, and hospital transfers, within seven days (§ 1680(z)).

Protection for people who report

It is unprofessional conduct to threaten or harass a patient or licensee for providing evidence in a disciplinary or legal action, or to fire an employee for trying to comply with the Dental Practice Act (B&P § 1680(q)). The Board also defends people who report to its diversion program against defamation claims (§ 1699).

How peer review works

Organized dentistry's peer review process, run by component societies with the CDA, is the "reviewing agency" the ADA Code has in mind. A patient or dentist can ask that a dispute about the quality or appropriateness of care be reviewed by trained dentist volunteers, who examine the patient and records and may recommend a refund or corrective treatment. Peer review supplements, and does not replace, a patient's right to complain to the Dental Board, which protects the public by licensing and discipline. A dentist who encourages the patient to use either route, and who documents findings objectively, meets both the ethical duty and the duty of veracity.

Putting it together

A patient presents with extensive recurrent decay under crowns placed by the same dentist over the past year, several with open margins, and says other patients from that office have similar problems.

1. Treat the patient honestly and without disparaging comments (ADA 4.C).
2. Consider contacting the prior dentist to understand the history, with the patient's permission.
3. If the pattern suggests gross or continual faulty treatment, the ethical duty is to report to the appropriate peer review body. The patient may also file a complaint with the Dental Board, and the dentist may explain how.
4. Document findings objectively in the chart.