As the communication editor of CDPA (Canadian Dental Protective Association) I am involved with the analysis of data from cases that place dentists at risk. One such area of particular interest is the interrelationship of dentists working in conjunction with denturists. In the RCDS(O) publication Dispatch1 this issue has been highlighted three times since 2002.
The RCDS(O) views the levels of responsibility shared between a dentist and a denturist to be different. A referral to a denturist carries with it the same level of due diligence as is implicit with any other health care provider referral, whether in office or out. As the patient moves back and forth in the treatment sequences between the dentist and denturist, the dentist must never lose sight of his/her overall responsibility for the prosthetic component of treatment. Denturists are allowed to perform assessments and treatment plan under the Denturism Act (1991) and to communicate the findings of their assessments to the patient as they relate to full and partial dentures.
It is imperative for dentists to remember that they are the only dental health professionals who are authorized to communicate a diagnosis that identifies a disease or disorder of the oral-facial complex as the cause of the patient’s symptoms. In recommending denture treatment and referring the patient to the denturist (whether as an in house employee or an independent practitioner located in or outside your office), the dentist still has the obligation to obtain informed consent regarding the proposed treatment and referral. The dentist may not delegate obtaining that consent to the denturist who may have his or her own professional consent obligations that are separate from the dentist’s.
It is essential that even though the patient is about to be referred in house so to speak, the process i.e. the diagnosis and treatment planning decisions must be documented. Do not blur the areas of responsibility especially if practicing together! Dentists must perform all tooth preparations for partial dentures and take the impressions and fasten or cement any fixed overdenture hardware, any single crown or locator type attachment to be used as an overdenture abutment.
From a business perspective the RCDS (O) prefers the separation of the dentist and denturist if practicing together; which means separate charts and most importantly independent billing. The denturist may not bill the patient at the dentist fee and should submit all claim forms utilizing their own provider numbers and procedure codes.
The best arrangement is for the denturist to pay rent in order to work in the dentist’s office. Associate arrangements or “fee splitting” are not permissible business relationships with denturists. In Ontario, dentists are permitted to employ denturists (Denturism Act 1991) but each province is unique and our readers should check with their own College. If the denturist is an employee there would be a single set of patient records (as with hygienists) and the dentist would bill using appropriate procedure codes taken from his or her provincial schedule. A note under the appropriate section would identify by name the denturist who completed the procedure.
It is in the best interest of all concerned to remain independent with separate records, fee schedules and billing procedure codes. In this way if the patient wishes to file a complaint or initiate a civil suit against the denturist, issues relating to professional responsibility, standards of care and liability are more easily sorted out. oh
1 Dentists/Denturists Working Together Under One Roof. Dispatch Feb/Mar Pages 32-33 2009.
