Some health and lifestyle events that might lead to more frequent taking of dental x -rays include (but are not limited to): In most adults, we cannot examine the contact areas in between the teeth visually or with our dental instruments.
Dental problems in an early state often DO NOT have symptoms such as pain or swelling that will signal something going on. But dental problems are most easily treated in an early stage, BEFORE symptoms develop.
Note: Information in this article is not meant to replace the clinical judgement of your healthcare professionals. Dr. Jennifer Rob sees adults and children at her General Dentistry practice at 1612 Cooper Foster Park Rd., Lorain, OH 44053.
Dear Dianne, One of the problems I have been experiencing more and more lately is patients who refuse to allow me to take X -rays. Dear Delaware, First, we need to establish that radiographs are a necessary part of good patient care.
Since we can see only about one-third of the actual tooth, radiographs provide valuable information that we cannot visualize otherwise. What’s that about?” While the patient was responding, he reached into his back pocket, took out a handkerchief, and began tying it around his eyes like a blindfold.
The patient started laughing, but she got the point when he told her that treating her without radiographs was like asking him to work with a blindfold. The point is, it’s our duty to provide competent care, and radiographs are vital to proper diagnoses.
However, you stated that the rule in your office is “bite wings on every patient once a year.” I take issue with the wisdom of such a mandate. In some cases, there are extenuating circumstances that make exposing radiographs prudent, such as implants, endodontics, and pathology.
If Joe protests, the hygienist should say, “There has been a history of cavities in the past, and tobacco-chewing places you at a higher risk than nonusers. The usual concerns expressed by patients are fear of radiation, cost, and discomfort.
I heard a doctor tell a patient once that people get more radiation exposure from their color televisions than from dental X -rays. The point the doctor was trying to make was that we receive radiation from many environmental sources, not just dental X -rays.
There are probably instances when the real cause for objection of X -rays is fear, but the patient just uses finances as an excuse. Each case calls for special efforts from us to make the experience easier.
Some clinicians report that having the patient rinse with a mouthwash, such as Scope or Listerine, can eliminate gagging long enough to expose radiographs. While this practice may seem rather inflexible and even harsh, it may be the wisest policy from a legal standpoint.
If a radiograph is not taken when it is needed for proper diagnosis and later a serious dental problem arises, the doctor could become entangled in a legal mess. However, doctors cannot provide care for patients based on an incomplete diagnosis without becoming subject to liability for failure to diagnose or treat existing conditions.
When the doctor decides that a patient should be dismissed from the practice for refusing radiographs, some risk-management courses recommend that the dismissal letter contain the phrase that failure to treat could result in “permanent, irreversible damage to your dental health.” When patients understand how taking radiographs will directly benefit them, there is less likelihood for an objection.
The bottom line is that we should use sound judgment and common sense in deciding when patients need X -rays, not some arbitrary standard that says everyone gets them every year or at six-month receive intervals. The next time your patient either questions or refuses X -rays, don’t take it personally.
Dianne D. Glass, RDS, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md.
We in the dental field know the importance of accurate and complete documentation. If your practice has implemented dental-medical cross coding, then the medically necessary reasons for treatment must also be documented.
It is accepted that verbal consent is often times sufficient for less complex dental procedures. Verbal consent can also be given over the phone, but it must include all the elements mentioned above and be thoroughly documented.
Major dental procedures are best handled with a written consent. In either case, the information must be presented in clear language that all patients can understand.
These forms should be dated, timed, and signed by the patient, dentist, and witness. In addition, parties with power-of-attorney for health care for those patients who are not mentally able should be the ones to give consent when it applies.
Dentists should discuss the risks of no treatment to be sure that the patient understands the consequences. If this fails to change the patient’s mind, then a refusal of treatment form that details the risks of no treatment needs to be given to the patient and handled in the same manner as the informed consent form.
Both consent and right to refusal forms may include various procedures, from smile makeovers, veneers, dentures, crowns, bridges, and partial reconstruction and complete reconstruction, to nonsurgical periodontal therapy and dental X -rays. “In the courtroom, medical records are witnesses whose memory never dies.” Pub med and other sources provide this quote as a reminder of the importance of thorough documentation of patients’ medical and dental records.
INFORMED REFUSAL FOR PERIODONTAL THERAPY I have been informed by ________that I have periodontal disease, a gum condition that if left untreated can progress and lead to further jaw bone destruction and tooth loss. I have been encouraged to ask questions pertaining to my gum condition and was informed of the strong correlation between periodontal diseases and other systemic diseases and total body health.
The ADA, in collaboration with the FDA, developed recommendations for dental radiographic exams to serve as an adjunct to the dentist’s professional judgment regarding treatment protocols. Radiographs can help the practitioner evaluate and definitively diagnose many oral diseases and conditions.
Improper diagnosis due to a lack of x -rays leaves the practice in a state of liability. You have the power to frame the conversation in a manner that opens further dialogue and reduces resistance.