RCDSO Dispatch_2013_v27_no4 – page 31 - PTIFA

ENSURING CONTINUED TRUST DISPATCH NOVEMBER/DECEMBER 2013

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DISPATCH Vol. 27, No.4 • November/December 2013Dispatch is the official publication of the Royal College of Dental Surgeons of Ontario (RCDSO). RCDSO is the regulatory body governing the practice of dentistry in Ontario. Dispatch is published four times a year. The subscription rate is included in the annual membership fee. The editor welcomes comments and suggestions from our readers.

MANAGING EDITOR Peggi Mace

SENIOR EDITOR Angelo Avecillas

ART DIRECTION AND PRODUCTION Roger Murray and Associates Incorporated

COVER DESIGN Public Good – www.public-good.com

REGISTRAR Irwin Fefergrad, CS, BA, BCL, LLB(Certified as a Specialist by the Law Society of Upper Canada in CIVIL LITIGATION and in HEALTH LAW)

Reprint Permission

Material published in Dispatch should not be reproduced in whole or in part in any form or byany means without written permission of the College. Please contact the editor for permission.

Environmental Stewardship

This magazine is printed on paper certified by the international Forest Stewardship Council ascontaining 25% post-consumer waste to minimize our environmental footprint. In making thepaper, oxygen instead of chlorine was used to bleach the paper. Up to 85% of the paper is madeof hardwood sawdust from wood-product manufacturers. The inks used are 100% vegetable-based.

PUBLICATION MAIL AGREEMENT #40011288

ISSN #1496-2799

FRONT & BACK

4 The President’s MessageAddiction help tailor-made for dentists now open to all of Canada

48 From the RegistrarWhere there is no openness, no airing of facts, there is no trust, no justice

DEPARTMENTS

Wellness6 Addiction in health care professionals

38 MOOD DISORDERS Psychiatric illness: Towards a successful dentist-patient interactionFinal Part of Four Part Series

Website Spotlight14 Dental firsts: A visual history

PART Quality Assurance18 The basics of searching for

information on the internet

Malpractice Matters20 Acting as an expert: Another way

of giving back

23 Dealing with unhappy patients and the threat of litigation

Practice Bites34 Allowing a patient to dictate treatment


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PRESIDENTDr. Peter Trainor

VICE PRESIDENTDr. John Kalbfleisch

Dr. Robert CarrollDr. David Clark Dr. Lawrence Davidge Dr. Sven GrailDr. John Kalbfleisch Dr. Lisa Mary Kelly Dr. Elizabeth MacSween Dr. David SegalDr. Joe StaskoDr. Peter TrainorDr. Flavio Turchet Dr. Ron Yarascavitch

Royal College of Dental Surgeons of Ontario6 Crescent Road, Toronto ON M4W 1T1

416-961-65551-800-565-4591fax: [email protected]

RCDSO COUNCIL MEMBERS

APPOINTED BY LIEUTENANT-GOVERNOR IN COUNCIL

Marianne Park WoodstockBeth Deazeley OakvilleManohar Kanagamany MarkhamKelly Bolduc-O’Hare Little CurrentTed Callaghan SudburyKurisummoottil Joseph Thunder Bay Catherine Kerr StevensvilleEvelyn Laraya Toronto Dr. Edelgard Mahant TorontoJose Saavedra WoodbridgeAbdul Wahid Scarborough

ACADEMIC APPOINTMENTS

Dr. David Mock University of TorontoDr. Richard Bohay Western University

DEPARTMENTS

Professional Practice25 Clarification of the advice on advertising

of dental fees and services

26 College draws clear distinction betweensupervision of an in-office dental laboratory and a commercial operation

28 Elaborate Health Canada safeguards protectagainst illegal or counterfeit dental materials

29 Educational requirements for theuse of botulinum toxin and dermal fillers by Ontario dentists

32 New Guidelines on educational requirementsand professional responsibilities for implant dentistry

41 College Mailbag

41 Calendar of Events

42 PEAKThe Importance of Ethics to the Dental Profession

NEWS

36 College appears before legislative committee on spousal exemption legislation

44 College President receives prestigious appointment

FEATURES

8 First international dentalregulators conference is ahuge success

10 Proposed RHPA changes would impact our operationsand members

16 Membership renewals online are the fast and easy way to go!

ISSUE ENCLOSURES

Discipline Summaries

PEAK: Dentists vs. Auto Mechanics: Are There Ethical Differences?

SSometimes there are things in life that are just worthfighting for. For me, one of those things is theCollege’s commitment to support our fellow dentistsand their families struggling withaddiction disease.

Almost a decade ago, theleadership of this College askedthe tough questions: Were wedoing the best we could to helpour colleagues in distress? Werewe doing our best to assistdentists in a progressive andcompassionate manner thatsupported their recovery?

It was clear that we could dobetter. So back in 2005 theCollege started to deal with thechallenges of answering thosequestions. We started small witha PEAK article inserted withDispatch magazine on dentists’use, misuse, abuse ordependence on mood-altering substances. Over thepassing years, our commitment to this important issuehas grown and grown.

In November 2008, Council unanimously passed amotion to authorize staff to take all necessary steps tomove forward on the implementation of a wellnessprogram.


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THE PRESIDENT’S MESSAGE

Addiction help tailor-made fordentists now open to all of Canada

PETER TRAINOR


One of our goals was to bring addiction diseaseout from behind closed doors. We learned thatdrug and alcohol addiction is a disease. Thereare effective treatments that can help peoplerecover and go on to lead productive lives.

We kept the issue in the forefront of dentistsacross the province. In 2009 alone there werethree major feature articles on addictiondisease in Dispatch magazine, written byleading specialists in addiction medicine fromCanada and the United States.

We tried to eliminate many of the barriers toappropriate treatment. That is why in themiddle of 2010 the College announced thecreation of a wellness support service forOntario dentists in crisis with addiction issues.

The College signed a special agreement withthree different treatment facilities to giveOntario dentists immediate access toevaluation and treatment. Each of thesecentres specializes in treating healthprofessionals in crisis who are dealing withaddiction diseases. The centres are The FarleyCenter in Williamsburg, Virginia; TalbottRecovery Campus in Atlanta, Georgia andHomewood Health Centre in Guelph, Ontario.

Then, in early 2011, the College brought onboard Dr. Graeme Cunningham as a specialwellness consultant to assist College membersin dealing with addiction or substance abuseissues.

Dr. Cunningham is uniquely suited to this role.He had a key part in starting the OntarioMedical Association’s Physician HealthProgram. As a former president of the Collegeof Physicians and Surgeons of Ontario, heunderstands the unique role of a regulator inbalancing protection of the public andsupporting an ill health care provider to getbetter. He is also the former Director of theAddiction Division at the Homewood HealthCentre in Guelph.


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Suite à la page 46Continued on page 45

DUne aide contre la toxicomanie spécialement conçue pour lesdentistes est désormais offerte partout au Canada

Dans la vie, certaines causes valent la peine qu’on se battepour elles. Pour moi, l’une d’elles est l’engagement du Collègeà soutenir nos collègues dentistes et leur famille aux prisesavec la maladie de la toxicomanie.

Il y a près d’une décennie, la direction de ce Collège s’est posécette question difficile : faisons-nous tout ce que nous pouvonspour aider nos collègues en détresse? Faisons-nous de notremieux pour venir en aide aux dentistes avec compassion etdes méthodes modernes pour favoriser leur rétablissement?

Il était évident que nous pouvions faire mieux. C’est ainsiqu’en 2005 le Collège a entrepris de relever le défi de répondreà ces questions. Nous avons commencé à petite échelle enpubliant dans la revue Dispatch un article du programmePEAK sur l’utilisation, le mauvais usage et l’abus dessubstances psychotropes et la dépendance de certainsdentistes à ces substances. Au fil des ans, notre engagementenvers ce problème capital n’a cessé de croître.

En novembre 2008, le conseil a adopté à l’unanimité unemotion autorisant le personnel à prendre toutes les mesuresnécessaires pour mettre en œuvre un programme de bien-être.

L’un de nos objectifs était d’étaler au grand jour la maladiequ’est la toxicomanie. Nous nous sommes rendu compte quela dépendance à l’alcool et aux drogues est une maladie etqu’il existe des traitements efficaces qui peuvent permettre derécupérer et de retrouver une vie productive.

Nous avons fait de cet enjeu une priorité pour tous lesdentistes de la province. Pour la seule année 2009, la revueDispatch a publié trois articles de fond sur la toxicomanierédigés par des toxicologues réputés du Canada et des États-Unis.

Une aide contre latoxicomanie spécialementconçue pour les dentistesest désormais offertepartout au Canada

WWhen it comes to addiction in healthcare professionals – including dentists– it is often the very skills they haveacquired that get in the way ofrecovery.

“They (health care professionals) aresuccessful people, so when they arefaced with an uncontrollable diseaselike addiction, it baffles them,” says Dr. Harry Vedelago, director of theaddiction division at HomewoodHealth Centre.

Homewood, a mental health andaddiction facility in Guelph, Ontario,treats approximately 100 health careworkers each year, and has done so forthe past 20 years. Having treatedaddicted health professionals for years,including a number of dentists, Dr. Vedelago is recognized for hisexpertise in this field, and haspresented at an internationalconference on the topic.

According to Dr. Vedelago, healthprofessionals believe that their successshould have prepared them to avoidthe risk of addiction, and preventedthem from becoming mired in thisinsidious disease.

Add to this the fact that most healthcare professionals, while experts intheir chosen disciplines, often lack anunderstanding of the disease becausethey receive little training in addiction.

This results in a punishing cycle ofrepeated attempts to control theaddiction, followed by repeated failureto do so.

Paradoxically, health care professionalsbelieve that if they work harder, put inlonger hours, they can manage thedisease. But this only serves toexacerbate the situation. They spiralinto a circuitous process of overwork,relapse, and renewed effort to controltheir substance use.

When an addicted health careprofessional finally comes totreatment, these barriers must beaddressed in order to achieve asuccessful recovery.

Dr. Vedelago says that health careprofessionals arrive at treatmentfeeling that they should have knownbetter. They are immersed in shame,and they struggle with the concept thattheir addiction is indeed a disease.

They use the same approach totreatment that served them so well intheir career. They are task-oriented,intellectual, and they see treatment asa continuing education course.

“They think that by learning a fewrules they can get better,” says Dr. Vedelago. “But they miss animportant step in the recovery process,and that is to shed the health


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Addiction in Health CareProfessionals

The College, in partnershipwith Homewood HealthCentre, is now offering anaddiction treatmentprogram tailor-made fordental professionals thatensures those who areaddicted have quick accessto effective treatment. This article, written by staff at the HomewoodHealth Centre, supportsthis program.

WELLNESS

professional persona and understandthat they are human beings likeeverybody else.

“When the health professional finallyacknowledges and accepts theiraddiction as a disease, and that itstrikes democratically – that is, it canaffect anyone – then the healthprofessional does well in recovery.”

In addition, the addicted health worker can begin to deal with theoverwhelming sense of shame, whichis a doubly significant issue to confrontfor these individuals.

“Their sense of shame is compoundedbecause they believe that they haveviolated a public trust by succumbingto an addiction andputting their patientsat risk,” says Dr. Vedelago. “Theyexperience theiraddiction as a moraldilemma.”

Once they recognize the addiction as adisease, then they can address theshame, according to Dr. Vedelago. Thepatient begins to work through theprocess, recognizing that they are notpersonally defective, and that thisviolation of public trust was not doneon purpose.

Still, this does not absolve the healthcare professional of personalresponsibility for seeking help in thefirst place. The addicted person mustseek the appropriate care andtreatment.

“Once they recognize this, they startgetting better,” says Dr. Vedelago.


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THEIR SENSE OF SHAME ISCOMPOUNDEDBECAUSE THEYBELIEVE THATTHEY HAVEVIOLATED APUBLIC TRUSTBY SUCCUMBINGTO ANADDICTION AND PUTTINGTHEIR PATIENTSAT RISK

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Help is just a phone call away for anyRCDSO member. If you have an addiction and need treatment, call thenumber below and a Homewood representative willassist you.

Realizing you have an addiction and need help is thefirst step; making that call to Homewood can put youon track to coping with an addiction.

The number to call is: 1.866.478.4230

AAt the end of the one-day meeting,there was unanimous agreement toinstitutionalize this dental regulatorsconference as an annual event. Aworking group was struck to organizethe 2014 meeting. Members includeRCDSO President Dr. Peter Trainorand Registrar Irwin Fefergrad fromCanada and representatives fromAustralia, Dubai, France, Ireland andNew Zealand.

The inaugural meeting featured HarryCayton, Chief Executive of theProfessional Standards Authority, asthe keynote guest speaker.Conference delegates came fromaround the world: Australia, Canada,Croatia, Dubai, France, Ireland,Malaysia, New Zealand, Poland,Singapore, and the United Kingdom.


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First internationaldental regulatorsconference is ahuge success

For the first time, dental regulators fromaround the world came together to discusscritical issues of common concern at the 1stInternational Conference of Dental Regulatorson Saturday, October 12 in Edinburgh,Scotland. Conference co-chairs were RCDSOPresident Dr. Peter Trainor and Marie Warner,Chief Executive of the New Zealand DentalCouncil. College Registrar Irwin Fefergrad actedas the conference organizer.

The conference addressedsuch pressing issues aslabour mobility,international accreditation,development of standardsand guidelines and therole of continuingeducation to ensurecontinued competency.

The dental regulatorsconference was followedthe next day by theannual conference of The

International Society forQuality in Health Care.ISQua is a non- profit,independent organizationwith members in over 70countries. Annually itorganizes the leadingscientific internationalconference in health carequality and safety. Thisyear ISQua’s conferencehosted over 1,000delegates. The scientificcontent had a record 1250

abstracts from 50countries, over 250speakers presenting and370 posters on display.

RCDSO President Dr. PeterTrainor made apresentation on challengesand systems aroundmutual recognition andlabour mobility.

RCDSO Registrar IrwinFefergrad participated in apanel discussion called“Do we need all theregulators” looking atopportunities to promotesafety and quality forpatients more effectivelyby bringing togetherlearning from institutionaland professionalregulation.


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Participants, including theCommission on DentalAccreditation of Canada andthe National DentalExamining Board, attend theinternational conference ofdental regulators inEdinburgh, Scotland. First row (left to right): IrwinFefergrad, RCDSO Registrar;Harry Cayton, ChiefExecutive, The ProfessionalStandards Authority forHealth and Social Care; MarieWarner, Chief Executive, NewZealand Dental Council; andDr. Peter Trainor, RCDSOPresident.


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Proposed RHPAchanges wouldimpact ouroperations and membersBill 117, the Enhancing

Patient Care and

Pharmacy Safety (Statute

Law Amendment) Act,

2013 received first

reading in the provincial

legislature on October 10,

2013, and continued with

second reading on

October 22, 2013.

WWhile largely focused on amendments to the Drug andPharmacies Regulation Act that relate to the regulation ofhospital pharmacies, Bill 117 also proposes severalamendments to the Regulated Health Professions Act,1991 that would impact the operations of all healthcolleges and their members.

The proposed amendments fall into four broad categories:

•appointing a College supervisor by the Minister ofHealth;

•mandatory reporting requirements for employers andothers;

•confidentiality and information sharing rules forcolleges;

•changes to the process for dealing with certaincomplaints against members.

Appointing a College SupervisorThe proposed amendments expand theability of the Minister of Health to appointa supervisor to take over the operations ofa health college. Under the currentlegislation, in order for a supervisor to beappointed, the Minister must hold theopinion that the council of the healthcollege failed to comply with a requirementthe Minister previously issued to thecollege.

The proposed amendments remove thisrequirement and permit the Minister toappoint a supervisor where she considersit to be appropriate or necessary to do so.

To date, the Minister of Health hasappointed a supervisor on one occasion,when in March 2012 she appointed asupervisor to take over the operations ofthe College of Denturists of Ontario and itsCouncil.

Mandatory Reporting Requirementsfor Employers and OthersUnder the current legislation, an employeror other person must file a report with theRegistrar when she terminates theemployment of or revokes, suspends, orimposes restrictions on the privileges of amember due to reasons of professionalmisconduct, incompetence or incapacity.The report must be filed within 30 daysand set out the reasons for the terminationor suspension.

This reportingrequirement continueseven if the member inquestion resigned orvoluntarily relinquishedhis or her privilegesbefore they could beterminated orsuspended.

Bill 117 expands this reporting obligationsuch that an employer or other personmust submit a report to the Registrarwhenever a member resigns or voluntarilyrestricts his or her privileges or practice,and the employer or other personreasonably believes that these actionswere related to the member’s professionalmisconduct, incompetence or incapacity.

For example, if a member’s associateresigns from practice and the member hasa reasonable basis to believe that thisresignation was due to a substance abuseissue, the member would be required toreport that fact to the College.

This proposed requirement applies to anyperson who employs a member, who offersprivileges to a member, or who associateswith a member for the purpose of offeringhealth services, whether in a partnershipor otherwise.

In particular, this reporting requirementapplies to all members in respect of theirpartners, associates, and employees whoare also members of a regulated healthprofession.


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PROPOSEDAMENDMENTSEXPAND THEABILITY OF THEMINISTER OFHEALTH TOAPPOINT ASUPERVISOR

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Confidentiality and Information SharingThe RHPA imposes a strict duty ofconfidentiality on all persons employed,retained or appointed by a College and onall members of a College Council and itscommittees.

This duty of confidentiality is balanced byvarious exceptions that permit a College todisclose information during theadministration of the College’s duties. Forexample, while complaint and otherinvestigations into a member’s professionalconduct are normally confidential, theRHPA permits information regarding theseinvestigations to be shared with the policeand other regulatory bodies.

Bill 117 would grant the Minister of Healththe authority to create regulations settingout additional circumstances in which acollege can share information regarding acomplaint against a member, or obtainedduring an investigation into a member’spossible professional misconduct,incompetence, or incapacity. Thisinformation could be shared with a publichospital that employs or grants privileges tothat member, or with any other person orclass of persons specified in the regulations.

Bill 117 does not set out the purposes forwhich this type of information could bedisclosed or outline the limitations on suchdisclosure. The details and any limitationswould be provided for in the regulationsmade by the Minister of Health, if any.Unless and until such regulations arepassed by the Minister of Health, nochanges to the rules regarding informationsharing under the RHPA are in effect.

Changes to the Complaints ProcessBill 117 also proposes changes to theprocess for handling complaints filed withthe College against members. Theamendments would allow the Registrar toevaluate a complaint when filed and tomake a preliminary determination as towhether it is reasonable to believe that theallegations in the complaint, even ifestablished, could constitute professionalmisconduct, incompetence, or incapacity onthe part of the member.

If the Registrar determines that it is notreasonable to believe that the allegations,even if proven, could constitute professionalmisconduct, incompetence, or incapacity,the Registrar must notify the parties withinthirty (30) days and no investigation of thecomplaint would take place.

In other words, this process would permitthe Registrar to perform a screeningfunction with respect to complaints overwhich the College has no jurisdiction.

It is important to note that this processwould apply in only very limitedcircumstances, as the Registrar must besatisfied that even if all the allegations in


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BILL 117 WOULD GRANT THEMINISTER OF HEALTH THEAUTHORITY TO CREATEREGULATIONS SETTING OUTADDITIONAL CIRCUMSTANCESIN WHICH A COLLEGE CANSHARE INFORMATIONREGARDING A COMPLAINTAGAINST A MEMBER...

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the complaint were true, they could still notresult in a negative finding against themember. As an example, a complaint madeagainst a dentist for publically supportingthe fluoridation of municipal drinking watercould be handled through this process,since such actions by a dentist could not beconsidered an act of professionalmisconduct.

Importantly, this process would not covercomplaints about subjects within theCollege’s jurisdiction, even if suchcomplaints are eventually proven to bewithout merit or frivolous. For example, acomplaint made against a dentist regardingtreatment he provided would not be caughtby this process, as the College hasjurisdiction over such conduct and theRegistrar must assume that all theallegations have been established.

These complaints would be dealt withaccording to the normal procedures andwould be reviewed by a panel of theInquiries, Complaints, and ReportsCommittee (ICR Committee) following aninvestigation.

Even if the Registrar determines to exercisethese proposed new powers, a complainantcan request a review of the Registrar’sdecision in writing within 30 days.

Any request would be reviewed by a panelof the ICR Committee, which woulddetermine whether to confirm theRegistrar’s decision or to direct that thecomplaint be investigated according tonormal protocols. If the panel confirms theRegistrar’s decision, there is no furtherappeal and the complaint is closed.

Although considerably limited, this newprocess would provide the College withgreater flexibility to better handlecomplaints made against members that areclearly outside of its jurisdiction and thattherefore could not reasonably be expectedto result in a finding of professionalmisconduct, incompetence or incapacity.

Bill 117 will be returning to the legislaturefor continuation of second reading in thecoming weeks. Until the Bill is passed andproclaimed into law, the current lawremains in force.


13COLLEGE CONTACT Irwin Fefergrad – Registrar416-934-5625 1-800-565-4591

[email protected]

THIS NEW PROCESS WOULDPROVIDE THE COLLEGEWITH GREATER FLEXIBILITYTO BETTER HANDLECOMPLAINTS MADEAGAINST MEMBERS...“


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Dentists in Ontario

are part of a long and

illustrious tradition

that stretches back

more than 140 years.

WEBSITE SPOTLIGHT

Dental Firsts: A Visual History

TTo help members and the public understand the evolutionof the College and the many achievements and milestonesreached by the profession, we created an online micrositethat takes visitors through a remarkable visual history ofdental firsts.

From information on the first dental act adopted anywherein the world to the launch of the quality assuranceprogram, the site spans decades of Ontario dental history.An interactive slideshow reveals significant dentalartifacts, including one of the first dental chairs, practicephotos and unique advertisements.

The site also provides details on several important figuresthat helped take the profession from two small rooms atthe corner of Church and Court Streets in Toronto to whereit is today.

You can access the microsite by going to history.rcdso.org,or by visiting our website, www.rcdso.org. The site designis optimized for smartphones and tablets, so you can surfusing any device.

Remember that we also have a microsite that providesinformation about College programs, including QualityAssurance and PLP. You can access this orienteeringmicrosite by going to orienteering.rcdso.org.


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Several dental firsts are explored

throughout the microsite,

including the first dental faculty,

dental school, military clinic and

first female practitioner.

This interactive slideshow takes

you through significant dental

artifacts, including one of the

first dental chairs, practice photos

and unique advertisements.

COLLEGE CONTACT Angelo Avecillas – Communications Specialist/Webmaster416-961-6555, ext 4303 [email protected]

WEBSITE SPOTLIGHT

http://orienteering.rcdso.org/Home

http://history.rcdso.org/Home

Do you need to have my e-mail address on file for me to register online?Yes, we do. Nearly 95% of the College membershiphas already shared their e-mail address with us.Once we have your e-mail address, you areautomatically signed up to receive any newsbulletins sent out by the College and can makechanges to your basic address information anytimeon your own, and access your e-Portfolio and theannual health human resources survey.

How do I formally give my e-mailaddress to the College?Just send us an e-mail message with your name,your e-mail address and your College registrationnumber. Within two business days of receivingyour e-mail, your records will be updated. Thenyou can easily renew your membership online.Send that e-mail to [email protected].


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Membership renewalsonline are the fast and easy way to go!

How do I get started?Go to the College website atwww.rcdso.org and click on theMember Resource Centre. Nowenter the members-only sectionof the website by clicking on theLog In button. Fill in your IDnumber. This is the four or fivedigit registration numberassigned to you by the College. If your ID number starts with 06,do not use those two digits.

I had a password but I haveforgotten it. Can I still renew online?Yes you can. Go to the MemberResource Centre accessible right fromthe home page of the website atwww.rcdso.org. Now enter the membersonly section by clicking Log In. Click on‘Forgot Password.’ Fill in your IDnumber. Automatically a newtemporary password is sent to the e-mail address you have on file with theCollege.

I used ‘Forgot Password’ butdid not get a new temporarypassword back. Whathappened?This happens from time-to-time.Usually it is because the speed of your internet service is too slow. Check your spam or junk mail foldertoo. As a last resort, e-mail us [email protected] to ensure wehave your e-mail address on file.

Are all the other documentsthat I need to fill in like theannual declaration for thequality assurance programand the conduct disclosureonline too?All these can quickly be completedonline. In fact, you need to answer allthese questions first before you canaccess the online payment portion ofthe renewal process. There are clearinstructions to lead you through theprocess step-by-step.

Can I complete the Health Human ResourcesSurvey online?Yes, in fact, this year, the HealthHuman Resources Survey is availableexclusively online.

I still haven’t received myrenewal package from theCollege. What do I do?The packages were mailed during thefirst week of November. However, evenif you don’t receive your package bypost, it is still your responsibility to payyour annual fee by the due date. Theeasiest solution is to renew online.

What happens if I mail in myrenewal and it gets lost?Any loss or delays due to problems like“lost in the mail” are not accepted asreasons for late payment. The easiestway around this scenario is to renewonline or to send your completedrenewal to the College by courierservice.

What if I opt to fax in my renewal?This is not the safest option. There is noguarantee that we have received it. Atrenewal time, our fax machine oftengets overloaded. That is why it is yourresponsibility to maintain a faxconfirmation slip to verify the date andtime your paperwork was sent.

I have decided not to renewmy licence. Do I have to doanything special?You need to complete the resignationform. It is available online and in yourmailed renewal package. It too mustreach the College by the due date.

I need some help. What do I do?Staff in the registration department arehere to help you. However, it will be nosurprise to learn that renewal time isvery busy. Between mid-November andthe beginning of January, staff processover 9,300 renewals. So we ask foryour patience and understanding. E-mail [email protected] or phoneat 416-961-6555 or 1-800-565-4591.


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Whether looking for information to share with patients or searching for themost up-to-date clinical information,several effective tools are readilyavailable that make the internet a valuable resource. There are a wide variety of options to source online scientific literature, but you may find what you need by using one or more of these options.

Many databases contain information of interest to dentists. One isMedline, compiled by the U.S. National Library of Medicine. It isthe largest and most widely available free health sciences andmedicine database in North America. Another is the CochraneDatabase of Systematic Reviews, which represents one of severaldatabases in the Cochrane Library. The Cochrane Collaborationconsists of a large group of volunteers, who review the effects ofhealth care interventions and prepare the reviews. These andother databases are searchable in many different ways, includingPubMed, Google Scholar and TRIP. These sites do not requireinstitutional access and are freely available.

The basics of searchingfor information on the internet

QUALITY ASSURANCE PROGRAM

PUBMEDPubMed - http://pubmed.gov

There can be many steps involved in acomprehensive literature search.However, for those who are just gettingstarted, a basic PubMed search servesas a good introduction to the widevariety of information that is available.

Once on the PubMed website, doing abasic search is similar to using a simplesearch engine. Enter your keywords andstart your search. The results will matchthe keywords and be displayed in orderof relevance, if those words appear inthe article record.

This kind of search frequently producesa very large number of citations andmany irrelevant results. For example, abasic search using the key word “aids”produces information related toAcquired Immunodeficiency Syndrome,plus information on hearing aids andmobility aids.

The PubMed user also has anopportunity to further limit the resultsby journal, author, date of publicationand other parameters by clicking on the“Advanced” tab or using the filters inthe left hand column.

The results of a search will usuallyproduce the abstract of an article, pluslinks to full text articles, if they arefreely available.

In fact, if full text articles are desired, itmay be helpful to use PubMed Central,available at http://www.ncbi.nlm.nih.gov/pmc/about/intro. It acts as aPubMed filter and limits access to fulltext articles.

A PubMed search can also be doneusing the MeSH (Medical SubjectHeadings) feature. This is the Medlineindexing system. It is available in adrop-down menu next to the search bar.It requires more steps, but it producesmore specific and contextual results. Itis analogous to looking up a term in theindex of a textbook. Once your topic ofinterest is found, MeSH permits an evenmore detailed and selective search.

For those who wish to use moreadvanced search strategies, you canview the online PubMed tutorial,available on the PubMed website.

Also you can find information on howto do searches on the University ofToronto Dentistry library website. Select“Research Guides” and then choose“Evidence-based dental practice:searching the literature and writing areport.”

In addition, the UofT dentistry librarystaff are available to answer questionsabout search techniques and otheravailable resources. The contactinformation is:http://dentistry.library.utoronto.ca or416-979-4916, press 1 and thenextension 4560.

TRIP AND GOOGLE SCHOLARGoogle Scholar -http://scholar.google.caTRIP -http://www.tripdatabase.com.A search conducted through GoogleScholar or TRIP (Turning Research IntoPractice) provides abstracts and somefull text articles, plus access to so-calledgrey literature.

Grey literature is a term used in libraryand information science. This categoryof information includes material notpublished commercially or not widelyaccessible. It may nonetheless be animportant source of information forresearchers. Examples of grey literatureinclude conference proceedings, excerptsfrom textbooks, theses, associationnewsletters and information for patients,technical reports from governmentagencies or scientific research groups,working papers from research groups orcommittees, white papers, and preprints.

TRIP also provides images, videos andeducational material.

Many of the resources produced will bethe same as those provided by PubMed,but the search results will be moregeneralized and voluminous.


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QUALITY ASSURANCE PROGRAM

COLLEGE CONTACT Dr. Greg Anderson – Practice Enhancement Consultant416-934-5620 1-800-565-4591

[email protected]


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MALPRACTICE MATTERSRISK MANAGEMENT ADVICE FROM PLP

What does it mean to be an expert?Experts play an important function in the legalprocess by helping the parties and the ultimatedecision-maker understand issues in thedispute beyond a layperson’s knowledge. Theymust have special skills, education, and/ortraining to be accepted by the court asqualified to comment on a particular topic.

Beyond that basic requirement, there are manyqualities that make an expert witness more orless effective. The following are examples ofwhat a good expert is not.

An expert should not be a hired gunLitigants and lawyers should be wary ofprofessional experts who abandon activepractice in favour of writing opinions andappearing as witnesses at trials all over thecountry, continent, or abroad. Judges tend toview such hired guns with skepticism,especially if they always act for one side.

Many dentists generouslyoffer their time, money, andclinical services as a way ofgiving back to theircommunity and profession.However, perhaps becausecompensation is involved,they may not view acting asan expert in the same light.

This article describes the roleof an expert in a dental-legaldispute and encouragesmembers to considerproviding expert assistanceto patients and colleagues.

Acting as an expert: Another way of giving back


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Ongoing engagementin the profession canbe critical to thestrength of anexpert’s opinion. Forexample, in actionsfor dentalmalpractice, expertevidence is oftenrequired to determinewhether thedefendant met thestandards of theprofession and

whether the treatment provided causedharm to the patient. Since the standard ofcare is evaluated by measuring thedentist’s actions against those of hispeers, the best standards experts are notprofessional witnesses with little or norecent clinical experience, but rathercompetent, well-regarded colleagues whopractise in the same or a similarenvironment as the defendant. Andwhile it is not uncommon to look to otherjurisdictions for expert input oncausation, opinions from foreigners onstandards of practice carry less weightthan those of local practitioners.

An expert is not an advocateExperts are expected to remain objective.Unfortunately, though, some experts feela duty to help their clients by strayingbeyond their expertise or offeringopinions that do not withstand closescrutiny. Ironically, this often prolongsproceedings rather than resolving them,resulting in increased cost, anxiety, andinconvenience to everyone involved,including the client.

Courts are becoming increasinglyintolerant of such witnesses. In Ontario,judges are more and more willing todisallow or restrict expert testimony onthe basis of inadequate qualifications,which can be devastating to the client’scase. An expert who exaggerates, isargumentative, or appears biased riskshaving her evidence rejected and causingirreparable damage to her professionalreputation.

An expert is not the judge or juryAt the other end of the spectrum, someexperts believe they are not bound by,and may even be morally or legallyobliged to ignore, the instructions of theperson retaining them. For example, anexpert may exceed the scope of hermandate out of fear that omittinginformation from her report is misleadingand could contribute to an injustice.

It is not up to the expert to decide whatthe outcome of the case should be orwhat the judge or jury needs to know.The issues in litigation are framed by theparties, and some of the facts an expertmay discover may not be relevant to theproceedings. It is neither unethical norunprofessional for an expert to accede toa request to limit her review and writtencomments, though legal counsel willusually want to know if the expert’sopinion on extraneous matters would beunhelpful to the client’s position. Thelawyer will determine whether theexpert’s concerns make her vulnerable asa witness at trial.

EXPERTS HELPENSURE THATWORTHY PATIENTSRECEIVE EARLY,REASONABLECOMPENSATION FORTHEIR INJURIES ORPROVIDE SUPPORTTO COLLEAGUESWHO HAVE DONENOTHING WRONG.

MALPRACTICE MATTERSRISK MANAGEMENT ADVICE FROM PLP

An expert is not a treatingpractitionerSimilarly, in the course of reviewing a matter,an expert may come across something shefeels should be disclosed to another party. Adental or medical expert for the defence might,for example, conclude that the patient/plaintiffis suffering from a previously undiagnosedcondition requiring treatment.

In such circumstances, the expert has no legalduty to advise the patient of her findings; shedoes, however, have obligations to her client,and she must be careful not to breach clientconfidentiality. An expert who believes she hasuncovered something about which the otherside should be made aware should thereforeadvise the instructing lawyer, who will decidewhat to do with the information. If the problemis potentially serious, the lawyer will likelyconvey the expert’s concerns to opposingcounsel.

Giving BackPatients and PLP sometimes have difficultyfinding dentists to comment on a case. Somepractitioners may feel they are not qualified tohold themselves out as experts or areuncomfortable reviewing another dentist’s care.Many say they are too busy, and others arelikely put off by the relatively low hourly ratessome patients and PLP can afford to pay.

A lawyer approaching a clinician to request adental-legal opinion has likely already doneenough homework to determine that she hasthe right qualifications and qualities tocomment on the matter. And although writingreports does not always come naturally, theinstructing lawyer will outline the questionsrequiring the expert’s attention and provideguidance on approach and format.

Importantly, dental experts perform a valuablepublic service. Since PLP only compensatesthose injured as a result of dental negligence,patients require expert input to advance theircases and PLP often needs expert commentaryto determine if a matter should be settled ordefended. Experts help ensure that worthypatients receive early, reasonablecompensation for their injuries or providesupport to colleagues who have done nothingwrong.

So the next time someone asks you to providean expert opinion in a PLP matter, give it someserious thought.


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COLLEGE CONTACT René Brewer – Director, Professional Liability Program416-934-5609 1-877-817-3757

[email protected]

Acting as an expert: Another way of giving back

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RISK MANAGEMENT

Dealing with unhappypatients and the threat of litigationLike most health professionals, dentists will inevitably havepatients who are dissatisfied with their clinical care ortreatment results. Such situations are usually stressful, andthe dentist’s anxiety will be compounded if a patient’scomplaints are accompanied or followed by a demand forcompensation or a threat of legal action.

The following are important guidelines and strategies fordealing with unhappy or threatening patients.

RISK MANAGEMENT DOS AND DON’TS

Remain calm and professional The manner in which a health care provider deals with anunhappy patient or an adverse eventmay play as much a part in whathappens next as the incident itself. Nomatter how upset or difficult the patientmay be, you must try to remainprofessional. Rather than engaging in anargument, hear the patient out. Allowingthe patient a chance to vent may defuse the situation andenhance the prospects of having a productive discussion.

Be empatheticStudies have shown that apologizing to a patient for a lessthan ideal treatment outcome does not increase the risk oflitigation against the health professional, but failing to offersympathy in such circumstances may. And since such anapology is not admissible in legal proceedings, there’s noreason not to say “I’m sorry.”

No matter how upset ordifficult the patient maybe, you must try toremain professional.

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Notify PLP You must contact PLP immediately ifyou become aware of circumstancesrelating to dental services providedby you that could give rise to aclaim (a demand for compensation).Not only is timely reporting arequirement under the terms of yourliability protection, but getting PLPinvolved early also increases thechances of resolving a disputequickly and favourably. Failure toreport a potential claim may impairPLP’s ability to assist you with thatmatter, so when in doubt, call.Never assume the problem will goaway if you just ignore it.

Keep notes about legal matters separate from theclinical recordInformation about legal proceedingsthreatened or commenced by apatient and any conversations youmay have with PLP staff do notform part of the patient’s chart andshould be recorded in a separate,confidential document.

Maintain confidentialityIn order to protect yourself and thepatient’s privacy, only discussspecifics of a reportable patientsituation with PLP staff or thelawyer assigned to assist you. If youare having trouble coping and needto speak to a friend or confidanteabout the matter, be sure not todisclose the patient’s name orpersonal health information.

Consider referring the patient toanother dentistYou should consider whether arequest for compensation by apatient suggests a breakdown in thetherapeutic relationship. Continuingto treat a dissatisfied patient ortrying to fix your own mistakes isrisky business, and it may be inyour and the patient’s best intereststo refer the patient to a colleague forfurther or remedial treatment.Obviously, except in an emergency,you should not treat a patient whohas threatened or commencedproceedings against you or whoselegal representative has contactedyou regarding alleged deficiencies inyour care.

Don’t offer compensation oradmit liabilityAdmitting liability or offering anysort of compensation to a patient,including a refund of fees or payingfor the costs of retreatment, prior tocontacting PLP could jeopardizeyour liability protection.

Don’t alter recordsIt is dangerous for a health careprovider to alter or add to a chartafter a patient has expresseddissatisfaction with treatment. Atbest, any such changes will be seenas self-serving; at worst, they willbe considered fraudulent. Eitherway, they seriously undermine thatpractitioner’s defence in a legalaction. If you learn of a patient’sconcerns and feel that the record isinaccurate or incomplete, anyinformation a subsequent healthpractitioner would need to knowmay be recorded in the chart as aclearly identified late entry.Information that is irrelevant to thepatient’s ongoing care, however,such as the content of a previousinformed consent discussion, shouldnot be added to the chart and shouldrather be noted in a separatedocument.

It may be in your and thepatient’s best interests torefer the patient to acolleague for further orremedial treatment.

If you learn of apatient’s concerns andfeel that the record isinaccurate orincomplete, anyinformation asubsequent healthpractitioner wouldneed to know may berecorded in the chartas a clearly identifiedlate entry.

COLLEGE CONTACT René Brewer – Director, Professional Liability Program416-934-5609 1-877-817-3757

[email protected]

RISK MANAGEMENT

Dealing with unhappy patients and the threat of litigation

The College’s Practice Advisory on Professional Advertising, last updated inNovember 2012, was created to help members comply with the professionalmisconduct regulations made under the provincial Dentistry Act.

The Advisory highlights advice on how toensure compliance with the regulations. Partof that advice states: “incentive programs,including giveaways, contests, draws or freeproducts or services” should not be includedin any professional advertisement.

It is important to understand what is meantby the word “services.” It does not includedental services. In this context, it refers tomarketing incentives of non-dental services.

When it comes to fees, the fees charged bydentists are not regulated by the College. Youmay reduce your fees or charge no fee forservices you provide. However, it would beconsidered inappropriate to do that solely onthe basis of whether or not the patient haddental insurance. If fees are advertisedspecifically, those fees must apply to all patients, regardless of insurance coverage.

In addition, a patient should not have to bring in a coupon or something similar tohave the benefit of the lower fee.

This Advisory is posted in the RCDSO Library found in the Knowledge Centre onthe College website at www.rcdso.org.


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PROFESSIONAL PRACTICE

Clarification of the advice onadvertising of dentalfees and services

COLLEGE CONTACT Dr. Fred Eckhaus – Senior Dental Consultant, Professional Conduct416-934-5624 1-800-565-4591

[email protected]

T REMINDER ABOUT TESTIMONIALSAs outlined in the Practice Advisory on ProfessionalAdvertising, the College considers promotional materials thatinclude testimonials a violation of the advertising regulation.

The recent Ontario Divisional Court Decision of Yazdanfar v.College of Physicians and Surgeons of Ontario found that theregulator’s prohibition of advertising that contains patienttestimonials or superlatives is consistent with the CanadianCharter of Rights and Freedoms. Such advertising restrictionsare necessary to ensure “a high degree of professionalism andthe protection of the public from irresponsible and misleadingadvertising.” Testimonials, in particular, are of concern because“the public is left with an unbalanced and biased assessment, asonly favourable descriptions are included in such testimonials.The public does not know the circumstances of the reliability ofthis information.”

In this scenario, dental laboratory services are providedexclusively for the patients of the office. The treatingdentist oversees the dental laboratory operation andassumes responsibility for the quality of the finishedproducts.

It is natural that questions arise about the supervision ofan in-office dental laboratory like this by a dentist andabout the operation of a commercial dental laboratoryoffering services to the professional community at large.

The College draws a clear distinction between an in-officedental laboratory and a commercial operation.

In Ontario, only a registered dental technologist or adentist may supervise a commercial dental laboratory. Itis the College’s position that any dentist who proposes tosupervise a commercial dental laboratory must be able tofulfill the same role as the RDT.


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College draws cleardistinction betweensupervision of an in-officedental laboratory and acommercial operationIn today’s market,

many dental offices

offer patients full

service with many

aspects of dental care

at a single location,

including on-site

dental laboratory for

the construction and

repair of some dental

prostheses and

appliances. WHAT THE LEGISLATION SAYS:Section 32(1) (a) of the Regulated Health Professions Act, 1991 stipulates thatno person shall design, construct, repair or alter a dental prosthetic, restorativeor orthodontic device unless the technical aspects of the design, construction,repair or alteration are supervised by a member of the College of DentalTechnologists of Ontario or the Royal College of Dental Surgeons of Ontario.

I

The College of Dental Technologists ofOntario has published standards aboutdental laboratory supervision for itsmembers that stipulate that thesupervising RDT must:

•Assume full responsibility andaccountability at all times for thetechnical aspects of dentaltechnology practice, as well as forthe administration of the laboratory.

•Be responsible for overseeing thedesign, construction, repair andalteration of each dental prosthetic,restorative or orthodontic devicethat is processed in the laboratory.

•Ensure that no case can be released,other than on an interim basis,without his or her authorization.

•Only supervise a single laboratoryon a given day and be availablewithin the suite of offices housingthe laboratory when prescriptionsare processed.

Such authorization means that thesupervisor has:

1. Examined all records supplied bythe prescribing dentist and any otherrecords, such as impressions, intraoralrecords, models, diagrams, and writtenand verbal instructions that arenecessary to the design, fabrication,repair or alteration in question.

2. Certified that the records reviewedare adequate to design, construct,repair or alter the case.

3. Examined the case for conformity tothe prescription.

4. Certified that the case was designed,constructed, repaired or altered inaccordance with the CDTO’s standards.

5. Confirmed that the invoiceaccurately reflects the processes,materials and charges for the case.

RCDSO will use this same CDTOdocument to determine whether amember of this College has performedaccording to acceptable standards andis maintaining their responsibilities asa health-care professional.

The complete CDTO document isavailable online at www.cdto.ca underthe label “Standards of Practice.”

In addition, all invoices, designconsultations and any documentauthorizing the release of the casemust clearly identify the supervisingRDT or dentist.

If the invoice or document does notproperly identify the supervising RDTor dentist, members should takeprecautionary measures to determine ifa qualified practitioner was onsiteduring the design and/or fabrication ofthe dental appliance. If in doubt,members should call the CDTO at 416-438-5003 or toll-free at 1-877-391-2386 or get in touch with theCollege.


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COLLEGE CONTACT Dr. Lesia Waschuk – Practice Advisor416-934-5614 1-800-565-4591

[email protected]

LOOK FOR THE STAMPDentists are reminded to look for the official verification stamp ofthe supervising RDT that signifies the case conforms to acceptablestandards and the RDT accepts responsibility for its release. If a dentistsupervises the commercial laboratory, then look for the signature or OntarioDental Association verification stamp of the supervising dentist.

NEED TO KNOW

In the United States, the Food and Drug Administrationis responsible for overseeing the safety and effectivenessof many of these products. This includes drugs andmedical devices that are marketed in the United States,whether they are manufactured in domestic or foreignestablishments. The FDA regulates the material used inthe construction of crowns, bridges, and other devicescommonly fabricated by dental laboratories.

Here in Canada, the Medical Devices Bureau of HealthCanada has the same role as the US Food and DrugAdministration. Health Canada has authority in medicaldevice regulation through the Medical DevicesRegulations of Canada’s Food and Drugs Act.

Almost everything a dentist uses in daily practice isregulated under some aspect of the Medical DevicesRegulations. This includes dental tools, such as dentalinstruments and equipment, and dental restorative andprosthodontic materials that are regulated as medicaldevices. Under the regulations, medical devices,including dental materials and devices, are classified inone of four classes of risk, with Class IV as the highest.


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Elaborate Health Canadasafeguards protect againstillegal or counterfeit dental materials

Periodically media

stories, especially from

the United States,

report on findings of

lead in dental

prostheses produced in

a dental laboratory.

I

For example, here are some of the devices orproducts that fall into these classes:

•Class II: hand instruments, dental units,orthodontic materials

•Class III: endosseous dental implants, dentalrestorative materials, dental sealants, dentalcasting alloys

•Class IV: bone void fillers containing human oranimal tissue

The key point is that Health Canada regulates themanufacture, importation and sale of medicaldevices, but not the use of the products.

In nearly all cases, a manufacturer must apply for aMedical Device Licence for a device to be authorizedfor sale in Canada. For example, in the applicationprocess for a Class III device licence, themanufacturer provides Health Canada with a pre-market review document. It includes appropriateobjective documentation proving that the newmaterial is effective and safe in accordance withCanadian medical devices regulations.

This pre-market review document containsbackground information about the product, includinga description of the device, its chemical composition,physical and mechanical properties, the designphilosophy and marketing history of the product,and reports of any adverse events or recallsassociated with the sale of the device in anyjurisdiction.

It also contains a summary of safety andeffectiveness clinical and preclinical studiesperformed on the product, as well as any appropriatelabelling information that includes warnings,precautions, any purposes and uses for which thedevice is manufactured, instructions for use, expirydate, etc.

Health Canada relies on independent auditorsaccredited by the Standards Council of Canada and

trained by Health Canada to audit manufacturers’quality systems to ensure that they comply with ISO13485, an international consensus standard formedical device quality systems.

REQUIREMENTS FOR DENTAL RESTORATIONSAND PROSTHESES MANUFACTURED IN ANDOUTSIDE CANADA

Canadian Dental Laboratories•Fixed dental restorations or prostheses (crowns,bridges, inlays, onlays, veneers, and implantfixtures) are Class III medical devices and theirimportation or sale in Canada is subject to theMedical Devices Regulations.

•Fabricators of fixed dental restorations orprostheses must have a Class III device licence forthe restorations or prostheses they fabricate,unless the fabrication of the device is conductedor supervised by a dental technologist who is amember of a self-regulating profession.

•Fabricators are required to use licensed materialsin the fabrication of dental restorations andprostheses.

Fixed Dental Restorations or ProsthesesFabricated Outside Canada•Manufacturers of fixed dental restorations orprostheses from outside Canada must have aClass III device licence for that restoration orprosthesis.

•The device is required to be fabricated ofmaterials licensed under Canada’s MedicalDevices Regulations.

•Dentists who import crowns and bridges directly from an offshore lab do not need anEstablishment Licence, but the offshorelaboratory or manufacturer that fabricated thefixed dental restorations or prostheses must have a Class III licence to fabricate crowns orbridges, etc.


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DENTISTS NEED TO ENSURE DENTALMATERIALS ARE SAFE AND EFFECTIVEThe bottom line for dentists is that medicaldevices that are not licensed for sale in Canadashould not be purchased.

Health Canada strongly advises dentists not toenter into any contractual agreements withmanufacturers to purchase medical devices untilthey have confirmed that the manufacturer hasobtained a device licence. This is because somemanufacturers have advertised devices for saleprior to obtaining a medical device licence.

How do you do that? Information on licenseddevices is available online on the Health Canadawebsite. Go to www.mdall.ca and you will find asearchable list of all licensed medical devices.There is also an archive of devices that werepreviously licensed for sale but no longer have avalid medical device licence.

Dentists who are contemplating the purchase of aClass II, III or IV device should use this list toverify that the manufacturer has a valid licence.

It is important to conduct this verification eachtime you are considering the purchase of amedical device, as these licences can besuspended by Health Canada, cancelled duringthe annual renewal of licences by Health Canada,or discontinued by the manufacturer.

COLLEGE CONTACT Dr. Lesia Waschuk – Practice Advisor416-934-5614 1-800-565-4591

[email protected]

Elaborate Health Canada Safeguards Protect Against Illegal orCounterfeit Dental Materials

Information on licensing requirements of theMedical Devices Regulations is available from:

Manager, Device Licensing Services DivisionMedical Devices BureauHealth Canadaphone : 1-613-957-7285fax: 1-613-957-6345e-mail: [email protected]

Consumer and trade complaints may besubmitted to Health Canada at:

Health Products and Food Branch InspectorateOntario Operational Centrephone: 416-973-1600fax: 416-973-1954e-mail: [email protected]

Health Canada depends on dentists and otherhealth care professionals to report adverseincidents related to medical devices. Anyserious or unexpected adverse incident relatedto medical devices should be reported toHealth Canada.

Health Products and Food Branch InspectorateHealth CanadaAddress Locator: 2003DOttawa, Ontario K1A OK9HOTLINE: 1-800-267-9675


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As reported in the last issue of Dispatch, Council hasapproved a new College position on the use of botolinumtoxin and dermal fillers by Ontario dentists:

Members who wish to use botulinum toxin anddermal fillers may do so, but only for proceduresthat are within the scope of practice of dentistry.

Members may inject botulinum toxin and/ordermal fillers intra-orally for either therapeutic orcosmetic purposes, or botulinum toxin extra-orally for therapeutic purposes, but in either caseonly if they are appropriately trained andcompetent to perform the procedures.

It is not within the scope of practice of dentistryand members are not authorized in Ontario toinject botulinum toxin or dermal fillers extra-orally for cosmetic purposes.

Members who wish to use these substances as described areexpected to successfully complete a course of instruction thatadheres closely to the following criteria. The course should:

•be conducted by persons who have had recognizededucation and training, preferably university-based, andsignificant experience in the parenteral administration ofthese substances.

• include a didactic component with formal evaluation thataddresses:

• pharmacology of these substances;

• physiological activity of these substances;

• diagnosis of relevant conditions;

• indications for the use of these substances, as well as other first-line treatment modalities;

• contraindications for the use of these substances;

• related head and neck anatomy;

• adverse reactions and their management;

• include a hands-on clinical or clinical simulationcomponent with formal evaluation;

•promote the critical evaluation of research and literature onrelated topics.

Due to the potential for serious and even life-threateningadverse reactions to this neurotoxin, members who wish touse botulinum toxin extra-orally for therapeutic purposes,such as for the management of certain temporomandibulardisorders and other oral-facial conditions, and especiallywhere this involves deep injections and/or injections belowthe inferior border of the mandible, are expected to pursuemore extensive training.

Educational requirementsfor the use of botulinumtoxin and dermal fillers by Ontario dentists

COLLEGE CONTACT Dr. Michael Gardner – Manager, Quality Assurance416-934-5611 1-800-565-4591

[email protected]

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The College first issued Guidelines onEducational Requirements and ProfessionalResponsibilities for Implant Dentistry in June1995. Since then, there have beenconsiderable advancements in theknowledge and technology related to bothsurgical and prosthetic phases of implantdentistry. Dental implants are increasinglyan important treatment option for dentistsand their patients.

In May 2013, following circulation of a revised draftdocument to all members and other stakeholders to obtaintheir input, Council approved new Guidelines on this subject.

The Guidelines were distributed to College members with theAugust/September issue of Dispatch and are posted atwww.rcdso.org in the RCDSO Library found in theKnowledge Centre.

New Guidelines onEducational Requirementsand ProfessionalResponsibilities for Implant Dentistry

WHAT YOU NEED TO KNOW.


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[email protected]

HERE ARE THE 10 THINGS YOU NEED TO KNOWABOUT THE COLLEGE’S NEW GUIDELINES.•Guide dentists in the use of “best practices” for providingimplant dentistry.

•Broadly divide clinical cases into two levels of complexity:straightforward cases and complex cases. Using thisframework, dentists are advised that the level ofcomplexity of the cases they elect to undertake should reflect thecommensurate level of training and courses they have successfullycompleted, and the competency and experience they have acquired.

•Describe initial education requirements that dentists must successfullycomplete in order to undertake straightforward cases. Of particular note isthe increase in the minimum initial education requirements for dentistswishing to provide both phases (surgical and prosthetic) of dental implanttreatment from four days to seventy hours of combined instruction

•Describe additional education requirements that dentists mustsuccessfully complete in order to undertake complex cases.

•Describe ongoing educational requirements for dentists involved inimplant dentistry in order to maintain their knowledge and clinical skills.

•Emphasize the necessity for careful patient evaluation and treatmentplanning, followed by meticulous execution of treatment steps, to achievethe desired outcome.

•Deal with each of the successive treatment steps in detail under separateheadings.

•Provide guidance regarding the management of complications.

•Describe recordkeeping requirements.

•Include several checklists to help dentists assess their preparedness toundertake the different levels of complexity of clinical cases and improvetheir situational awareness.

DENTAL IMPLANTSHAVE BECOME ANINCREASINGLYIMPORTANTTREATMENTOPTION FORDENTISTS ANDTHEIR PATIENTS

“

TThe patient complained that he had asignificant amount of dental work performedby his dentist, but that nearly all of the workhad to be redone. Specifically, two bridgesplaced by the dentist, both less than fiveyears old, had to be removed. In addition,the abutment teeth for the bridges werecracked and had to be extracted, and otherteeth that the dentist had crowned alsoneeded to be extracted because they becameloose.

The dentist explained that when the patientfirst attended her office, he admitted that hehad not visited a dentist for over three years.The patient, a heavy smoker, had poor oralhygiene, and was also suffering from boneloss and numerous areas of decay. Thedentist explained that extensive treatmentwas required and the patient agreed.However, the patient explained that he wason a rather limited budget, and that he couldnot afford all of the required treatment. Thedentist agreed to provide the treatment at asignificant discount.


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Allowing a patient to dictatetreatment

PRACTICE BITES

Treating patients with

financial limitations can

present a number of

challenges. The dentist

shares her expertise and

recommendations, while

the patient expresses his

desire for treatment within

the patient’s budget. The

following case illustrates

that it is not always

possible to provide

appropriate treatment

within the boundaries set

by the patient.

PRACTICE BITES

The dentist advised that the treatment consisted of:

•A crown on tooth 11: This crown was laterfractured due to an accident and was repairedwith a post, core and new crown at no charge.

•A crown on tooth 21: This crown later showeddecay around the buccal margin andeventually fractured as well. The dentist againplaced a post, core and a new crown at agreatly reduced cost to the patient.

•Treatment of tooth 12 in an effort to save thetooth: The tooth had a questionable prognosis.The patient had been referred to an oral andmaxillofacial surgeon to discuss the option ofan implant. The dentist said that she did whatshe could to save the tooth and advised thepatient that the tooth would not last.

•A bridge spanning teeth 44-47

•A bridge spanning teeth 13-17

In evaluating the treatment provided, theInquiries, Complaints and Reports Committeepanel noted that:

•Although extensive treatment was provided,there were insufficient discussions about therisks, benefits, options and costs of thetreatment.

•It was not clear that the dentist fully informedthe patient of the condition and prognosis forhis teeth.

•The tooth preparations for the bridge spanningteeth 44-47 were inadequate. In addition,both the 44 and the 47 were poor choices forabutment teeth. Tooth 44 was thin with over-extended root canal treatment and insufficientfill, and tooth 47 was angulated.

•For the bridge spanning tooth 13-17, againboth abutment teeth were poor choices. Tooth13 was over prepared, while tooth 17 hadbeen endodontically treated and hadinsufficient tooth structure left to be a suitableanchor for the bridge.

In light of its finding, the panel recommendedthat the dentist take a course in informedconsent, as well as a comprehensive hands-oncourse in fixed prosthodontics. Theprosthodontics course would include diagnosis,treatment planning, discussion of options and therestorability of teeth. The panel also advised thedentist that she should not allow a patient todictate treatment, for financial reasons orotherwise, when in her professional judgementthe treatment is likely to be unsuccessful.


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...NOT ALLOW APATIENT TO DICTATETREATMENT WHEN, INYOUR PROFESSIONALJUDGEMENT, THETREATMENT IS LIKELYTO BE UNSUCCESSFUL.

“


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NEWS

In early October, College PresidentDr. Peter Trainor and CollegeRegistrar Irwin Fefergrad appearedbefore the Standing Committee on

the Legislative Assembly to make theCollege’s presentation regarding Bill 70,An Act to amend the Regulated HealthProfessions Act (Spousal Exception),2013.

RCDSO was in full support of this Bill andwent on record that it was pleased that theproposed legislation gives each regulatorthe discretion to deal with this matter in away that is appropriate for them.

In his presentation, Dr. Trainor emphasizedthat the College understands its role toprotect the public and the StandingCommittee and the public of Ontarioshould have full confidence in our abilityto deal with sexual abuse matters with allintegrity and vigour as intended in theoriginal RHPA legislation.

He went on to assure the StandingCommittee that spousal abuse is not aproblem within the dental profession. Ashe explained, for decades, starting waybefore the decision of the Court of Appealin 2009, thousands and thousands ofdentists have treated their spouses. Andthey have done so safely and without anycause for concern, said Dr. Trainor. “Since1993, at our College there has only beenone complaint about a dentist treating aspouse – and that complaint was filed bysomeone other than the spouse,” statedDr. Trainor.

In closing, he reiterated the College’ssupport for Bill 70 as proposed. However,he added one caveat. He asked that, oncethe Bill receives Royal Assent, theaccompanying regulations get fast tracked.

On October 23, Bill 70 was carried onthird reading in the Ontario Legislature.

I

College appears before legislativecommittee on spousalexemption legislation


37

On November 14, 2013, RCDSO Council passed, in principle, a regulationchange that once passed into law would allow dentists to treat their spouses.As you know, the College has been actively involved in advocating to theMinistry to allow this exemption for spouses.

This proposed regulation change is now in circulation for a period of 60 daysto members and stakeholders to allow an opportunity for feedback andcomment. This is a requirement of the RegulatedHealth Professions Act. The consultation informationis now posted on the College website.

Following the 60-day circulation period, Council willmeet in a special session to consider all thesubmissions and, if warranted, give final approval tothe regulation.

Once the regulation is approved by Council, it will beimmediately delivered to the Minister of Health andLong-Term Care. She is then required to have theregulation sealed before being brought forward forapproval by Cabinet. Only at that point, once theregulation is approved by Cabinet, will dentists belegally allowed to treat their spouses.

Typically this is not a fast process but the College willcontinue to urge government to expedite the approvalof the regulation.

PLEASE SEND YOUR COMMENTS AND FEEDBACK ONTHE PROPOSED REGULATION CHANGE TO:

Irwin Fefergrad, RegistrarRoyal College of Dental Surgeons of Ontario6 Crescent Road, Toronto, ON M4W 1T1Email: [email protected].

ALL RESPONSES MUST BE RECEIVED BY THE COLLEGE ON OR BEFOREMONDAY, JANUARY 20, 2014.

PROPOSED REGULATION AMENDMENT

The following proposed regulationwas passed, in principle, by Councilat its November 14, 2013 meeting:

“Conduct, behaviour or remarks thatwould otherwise constitute sexualabuse of a patient by a memberunder the definition of “sexualabuse” in subsection 3(1) of theHealth Professions Procedural Codeof the Regulated Health ProfessionsAct, 1991, shall not constitutesexual abuse, if the patient is themember’s spouse; and the member isnot engaged in the practice ofdentistry at the time the conduct,behaviour or remarks occur.”

GGoing to the dentist can be a highly stressful event for anypatient. This anxiety can be further heightened in thosesuffering from a particular mental illness and be manifested bythe unmasking of emotional or cognitive deficits.

It is also important to realize that, when a patient admits tohaving a mental illness, it not the same as admitting to anyother serious health issue. That is because usually theadmission incurs more suspicion than support from thosearound them.

Because of this stigma, many patients with mental illness maynot willingly discuss their problem. Also, there may behesitation because of self-denial or even the patient’s lack ofinformation about their illness.


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MOOD DISORDERSPsychiatric illness:Towards a successfuldentist-patientinteractionFINAL PART OF FOUR PART SERIES

This is the fourth and final part of a series of articles

created to provide dentists with a greater understanding of

mental illnesses and their impact on peers and patients.

DR. DAVID CLARK

CLINIC DIRECTOR, DENTAL SERVICES

ONTARIO SHORES CENTRE FOR MENTAL HEALTH

SCIENCES (ONTARIO SHORES), WHITBY

Problems may only manifest later asthey encounter stress duringtreatment. Or patients may becomemore willing to be open as theybecome more comfortable, sensingempathy and genuine understandingfrom the dentist and all othermembers of the team.

To be effective, a patient/dentistinterview must focus both on thecontent, the verbal dialogue, and onthe process, non-verbalcommunication like behaviouralclues.

A successful patient/dentist interviewneeds to acknowledge the potentialseverity of a particular psychiatricdisorder as discovered in the initialhistory taking or medication review.This is particularly important aspatients with chronic mental illness,especially dementia, may be poorhistorians.

As with any medical condition thatappears poorly controlled or perhapsnot yet diagnosed, like high bloodpressure or the signs and symptomsof diabetes, we need to communicateto the patient our inability to proceed


39

AT THE CHAIRSIDEOpen-ended questions one might ask of your patient to enhance the understanding of a particular psychiatric diagnosis

When was your mental illness diagnosed?

What are/were your original symptoms?

What psychiatric medications are you taking?

How long have you been taking the medication(s); changes in dosages?

Who is the GP/psychiatrist treating this condition?

Can you tell me about your previous dental experiences?

Have you experienced any oral side effects to your prescribedmedications, such as dry mouth, burning tongue, excessive saliva orswollen gums?

Approaches to a successful consultation or referral

Incorporate any referral as one part of the patient’s evaluation fordental care.

Ensure staff also supports both the referral and the patient.

Treat the referral in a matter-of-fact fashion as with any outsidespeciality referral.

Provide as much detail as possible to the family physician orpsychiatrist in order to assist you in your provision of comprehensivedental care for your patient.

Communicating with a patient who may be suffering from a psychiatric illness

Respect the patient and the reality that they might be living with.

Be direct, straightforward and yet, maintain a strong sense of empathy.

Maintain consistency, predictability and employ positive reinforcementin order that the patient knows what to expect.

Exercise patience and flexibility at all times. Understand andappreciate the episodic nature of mental illness.

Maintain both a non-judgemental attitude and heightened sensitivityto a patient’s potential sense of shame or embarrassment surroundinghis/her current dental situation.

E

with safe dental care untilfurther information can beobtained through the patient’sphysician or psychiatrist toensure that a suitable level ofcontrol or stability has beenachieved. As always, anyoutside consultation isdependent on the explicitconsent of the patient orsubstitute decision maker.

Unlike other medical problems,there are no specific blood testsor other diagnostic tools, suchas a blood pressure monitor orx-ray assessment, that can beused to gain further informationon the current status of thepatient’s mental healthproblems.

In addition, the dentist mustfacilitate the patient’sunderstanding of their currentdental needs in a way that thepatient will understand. Thismight require a subsequentfollow-up appointment to againreview clinical findings andtreatment options if the patientis unable to assimilate properlyall of the information gatheredduring the initial appointment.Without such an understanding,the patient would be unable tooffer true informed consent.

Of course, in instances of truecognitive impairment (e.g.

dementia) it is important tohave a caregiver or substitutedecision-maker in attendance atthe appointment.

The degree of control or stabilityof a particular psychiatric illnessmay vary continuously,depending largely oncompliance with prescribedmedications, as well as thepatient’s potential vulnerabilityto outside stressors as aconsequence of other social,emotional or medicalcircumstances. This would alsoinclude potential issues of on-going substance abuse.

A key difference in treatmentapproach for patients with amental illness is that long-termoral health goals may need tobe reduced to a series of short-term goals.

The dental professional shouldstrive to be aware andempathetic and understandingof the potential signs andsymptoms of mental illness inorder to begin to establish atrusting and viable rapport withthe patient.

The provision of safe andeffective dental care remains akey component in any qualityof life improvement for thosesuffering from chronic mentalillness.


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E

MOOD DISORDERS:Psychiatric illness: Towards a successfuldentist-patient interaction

A KEY DIFFERENCEIN TREATMENTAPPROACH FORPATIENTS WITH A MENTAL ILLNESS IS THAT LONG-TERM ORALHEALTH GOALSMAY NEED TO BE REDUCED TO A SERIES OF SHORT-TERMGOALS.

“

PRACTICE ENHANCEMENT TOOL

Recently I completed the online testcalled the Practice Enhancement Toolsent from the RCDSO.

Having practised for over 40 years myinitial reaction was defensive and I wassomewhat intimidated. A whole monthto complete 200 questions in an "openbook" format seemed reasonable though.The process turned out to be fair,educational and actually fun.

Over the years I have chosen restorative,surgery and practice management overother fields in my continuing educationcourses. The PET soon demonstrated tome my shortcomings in pathology andespecially in pharmacology. Byinvestigating the answers I learnedeasily and I've decided to pursue moreCE in those areas. Discovering

educational resources was a big part ofthe process.

The test is well named and the principalsinvolved in its development should beapplauded by the membership. We areself-governed and this quality assurancevehicle is comfortable. The online helpmechanism is terrific and the computersoftware is very user friendly. There isplenty of time to complete the questionsand to review one’s answers. The finalresult feedback is immediate uponcompletion with a big congratulations.

DR. DEREK MJ TURNERToronto

PET ASSESSMENT

Just a note on PET. At first I thought thisto be very degrading to my degree andability to practise dentistry. Having doneit I have changed my position.

It was actually fun, challenging andrewarding as it confirms what I thought.I knew that I did know this stuff.

Looking forward to the next one.

DR. ROBERT PERKINSLondon


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MAILBAG

IN THE

College Mailbag*

*

MARK YOUR CALENDAR… 2014 COUNCIL MEETINGS

Thursday, March 6 • Thursday, June 12 • Thursday, November 13

New meeting location: Metropolitan Hotel, 108 Chestnut Street, Toronto

Council meetings are open to the public. The only exception is for any in camera portion of the meetingdealing with personnel matters or other sensitive or confidential items.

Meetings usually start at 9:00 a.m. The agenda is available either at the meeting or in advance on request.

PLEASE NOTE: Seating is limited so if you wish to attend, please contact Angie Sherban in advance.

Calendar of Events

COLLEGE CONTACT Angie Sherban – Executive Assistant

416-934-5627 [email protected]

We want to hear from you. Wewelcome your feedback onanything that you read in Dispatchor on any of the College’s policies,programs and activities.Sometimes a letter may not beprinted with the author’s nameeither on request or due to itsconfidential nature. All lettersprinted in Mailbag are used withthe author’s permission. TheCollege reserves the right to editletters for length and clarity.

COLLEGE CONTACTPeggi Mace – Director of Communications 416-934-5610 • [email protected]

TThe dental profession holds a specialplace of trust within society. As a result,society extends opportunities andprivileges to the profession that are notavailable to the public at large. In return,the profession makes a commitment thatits members will adhere to high standardsof clinical expertise and ethical conduct.

The ethical behaviour of dentists is one ofthe most important factors in thepromotion of quality dental care and recognition ofdentists as professionals. Continued public trust in thedental profession and in the principle of profession-ledself-regulation is dependent on the commitment ofindividual dentists to high standards of ethical conduct.

Ethical behaviour is the foundation of the public’scontinuing trust in the effectiveness of self-regulation.


42

PEAK

The Importance of Ethics to the Dental Profession

PEAK (Practice Enhancementand Knowledge) is a Collegeservice for members. The goal isto regularly provide Ontariodentists with copies of keyarticles on a wide range ofclinical and non-clinical topicsfrom the dental literaturearound the world.

It is important to note thatPEAK articles may containopinions, views or statementsthat are not necessarilyendorsed by the College.However, PEAK is committed toproviding quality material toenhance the knowledge andskills of member dentists.


43

PEAK


[email protected]

To provide our members with a unique perspective on this issue, PEAK ispleased to offer the following article along with the current issue ofDispatch: “Dentists Versus Auto Mechanics – Are There EthicalDifferences”, from the Summer 2013 issue of the Journal of the AmericanCollege of Dentists. The article was written by Dr. Crystal Riley in 2008,while she was an undergraduate dental student at the Schulich School ofMedicine and Dentistry, Western University.

The article compares and contrasts the ethical perspectives of dentists withanother occupational group, auto mechanics, in relation to several issues,including:

•the primary concern of both groups

•billing procedures

•advertising

•emergency care

•the level of autonomy provided to patients/clients

•the amount of disclosure given to patients/clients

•the ability to judge the work of others

•the freedom to pursue romantic relationships withpatients/clients.

In analyzing the differences between dentists and automechanics, the author determines that dentists have muchgreater ethical obligations to the public, which are capturedin a Code of Ethics and enforced by a self-regulatory bodythrough regulations. She concludes that it is theresponsibility of all dentists to consider the effects of theiractions on the individual patient, society, the dentalprofession and, finally, themselves.

The College’s Code of Ethics sets out principles of ethicalconduct, which are based on the core ethical values of integrity, fairness,beneficence, compassion and respect for patient autonomy. The College’sCode of Ethics is available from our website at www.rcdso.org.

IT IS THERESPONSIBILITY OFALL DENTISTS TOCONSIDER THEEFFECTS OF THEIRACTIONS ON THEINDIVIDUAL PATIENT,SOCIETY, THEDENTAL PROFESSIONAND, FINALLY,THEMSELVES


44

NEWS

RCDSO President Dr. PeterTrainor has been appointed tothe Ethics Committee on ClinicalResearch at the University ofWaterloo for a three-year term.The appointment began onOctober 1.

It is very special that a dentist fromthe regulatory environment has beenappointed to this importantcommittee.

The University of Waterloo has twoResearch Ethics Boards: the ClinicalResearch Ethics Committee and theHuman Research Ethics Committee.As constituted sub-committees of theUniversity of Waterloo’s SenateGraduate and Research Council, bothof these committees are establishedand empowered under the authorityof the University of Waterloo Senate.

The Clinical Research EthicsCommittee (CREC) has jurisdictionover clinical trials research (i.e.,involving a drug or natural healthproduct or its medical device testing)conducted under the auspices of theUniversity of Waterloo and anyresearch involving a controlled act asdefined under the Regulated HealthProfessionals Act of Ontario, 1991.

The university,located at the heartof Canada’stechnology hub,has become one ofCanada’s leadingcomprehensiveuniversities with34,000 full- andpart-time studentsin undergraduateand graduate programs. It is home tothe world’s largest post-secondaryco-operative education program.

In 2012 Maclean’s magazine againrecognized the University ofWaterloo as the most innovativeuniversity in Canada.

Waterloo is consistently one of thetop universities in the ReputationSurvey of the Maclean’s annualrankings of Canadian universities.Waterloo is among the top three inCanada in the categories of BestOverall, Highest Quality and Leadersof Tomorrow. This is the 21stconsecutive time that Waterloo hasbeen ranked Canada’s top universityfor innovation.

COLLEGE PRESIDENTRECEIVES PRESTIGIOUSAPPOINTMENT



45

Dr. Cunningham continues to beavailable to address assessment andtreatment needs of dentists byhelping them to find suitableassessors, treatment providers, andresidency programs. All calls to Dr. Cunningham are private andconfidential. His phone number is adirect line to a dedicated phone usedonly for this purpose.

In November 2012, the College, asa member of the Canadian DentalRegulatory Authorities Federation,organized a two-day nationalconference here in Toronto ondealing with addiction in dentistry.This conference was jointlysponsored by CDRAF and theCanadian Dental Association.

The conference helped the leadersfrom the dental community acrossthe country to learn more aboutaddiction disease, explore theappropriate roles of professionalassociations and regulators, anddiscuss how to formally supportdentists and their families.

Now, this year, we achieved anothersignificant milestone. The Collegehas entered into a specialrelationship with Homewood HealthCentre. Homewood has set up theDental Professional AddictionProgram. This program is tailor-made for dental professionals toensure those who are addicted havequick access to effective treatment.With 130 years of experience in thefield of addiction medicine,Homewood is a centre of excellencefor addiction care in Canada.

In the last issue of Dispatchmagazine, the College was pleasedto distribute a brochure called“Overcome Your Addiction” jointlyproduced by us and Homewood.

The latest development is that ourunstinting efforts to support Ontariodentists struggling with addictions ispaying off now for dentists rightacross the country. HomewoodHealth Centre has agreed to acceptdentists from other provinces andterritories into its DentalProfessional Addiction Program.This is wonderful news for theprofession.

My fervent personal wish is that theCollege will continue with itsdetermined commitment to thisissue. We need to do everything wereasonably can to create a culture indentistry where no dentist isconfronted by a prevailing sense ofhelplessness in the face of addiction.

With a recovery rate of around 90%for health care professionals intreatment, this is a cause worthy ofour efforts. Dentists struggling withthis disease are our friends,classmates and colleagues. Theydeserve the dignity of recovery.

Addiction help tailor-made for dentists now open to all of CanadaContinued from page 5

HOW TO REACH DR. CUNNINGHAMDedicated Direct Line: 647-867-6025All calls are private and confidential.

RCDSO WELLNESS CONSULTANT

Dr. Graeme Cunningham, RCDSO Wellness Consultant, is also available foraddressing assessment and treatment needs of dentists by helping themfind suitable assessors, treatment providers and residency programs.


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Une aide contre la toxicomanie spécialement conçue pourles dentistes est désormais offerte partout au Canada

CHRONIQUE DU PRÉSIDENT

Suite de la page 5

Nous avons tenté d’aplanir plusieursdes obstacles à un traitementapproprié. C’est pourquoi vers lemilieu de 2010, le Collège a annoncéla création d’un service de bien-être envue de soutenir les dentistes del’Ontario aux prises avec desproblèmes de toxicomanie.

Le Collège a signé avec trois centres detraitement une entente spécialeprocurant aux dentistes de l’Ontarioun accès immédiat à l’évaluation et autraitement. Chacun de ces centres sespécialise dans le traitement desprofessionnels de la santé en crise auxprises avec des troubles detoxicomanie. Ces centres sont le FarleyCenter de Williamsburg, en Virginie, leTalbott Recovery Campus d’Atlanta,en Géorgie, et le Homewood HealthCentre de Guelph, en Ontario.

Dès le début de 2011, le Collège a eurecours aux services du Dr GraemeCunningham à titre de consultantspécial en bien-être pour permettreaux membres du Collège de venir àbout de leurs problèmes dedépendance ou de toxicomanie.

Le Dr Cunningham est l’homme toutindiqué pour occuper cette fonction. Ila joué un rôle de premier plan dans lamise sur pied du programme sur lasanté des médecins de l’OntarioMedical Association. À titre d’ancienprésident de l’Ordre des médecins etchirurgiens de l’Ontario, il comprend latâche particulière d’un organisme deréglementation, à qui il revientd’assurer la protection du public touten offrant à un fournisseur de soins desanté malade tout le soutiennécessaire à son rétablissement. Il a

également dirigé le service detoxicomanie du Homewood HealthCentre de Guelph.

Le Dr Cunningham demeuredisponible pour prendre en mains lebesoin d’évaluation et de traitementdes dentistes en leur permettant detrouver les évaluateurs, lesfournisseurs de traitement et lesprogrammes résidentiels qu’il leurfaut. Tous les appels au DrCunningham sont privés etconfidentiels. Son numéro detéléphone correspond à une lignedirecte utilisée uniquement à cette fin.

En novembre 2012, à titre de membrede la Fédération canadienne desorganismes de réglementation dentaire(FCORD), le Collège a tenu ici même àToronto un congrès national de deuxjours sur la manière de combattre latoxicomanie en dentisterie. Ce congrèsétait commandité conjointement par laFCORD et l’Association dentairecanadienne.

Ce congrès a permis aux chefs de filecanadiens de la dentisterie d’enapprendre davantage sur latoxicomanie, d’examiner le rôleapproprié des associationsprofessionnelles et des organismes deréglementation et de discuter desmoyens officiels de venir en aide auxdentistes et à leur famille.

Nous avons atteint cette année unautre jalon important. Le Collègeentretient désormais des relationsprivilégiées avec le Homewood HealthCentre. Ce centre a mis sur pied àl’intention des professionnels de ladentisterie un programme detraitement de la toxicomanie. Ce

programme bien structuré permetd’offrir rapidement accès à untraitement efficace à ceux quimanifestent une dépendance. Grâce àses 130 années d’expérience dans ledomaine de la toxicomanie,Homewood est un centre d’excellencepour ce genre de soins au Canada.

Dans le dernier numéro de la revueDispatch, le Collège a eu le plaisird’insérer une brochure intitulée« Overcome Your Addiction », élaboréeconjointement par nous et Homewood.

Nos efforts incessants pour appuyerles dentistes de l’Ontario aux prisesavec une dépendance connaissent unnouveau rebondissement et portentdésormais fruits pour les dentistes detout le pays. Le Homewood HealthCentre a résolu d’ouvrir aux dentistesdes autres provinces et territoires sonprogramme de traitement de latoxicomanie destiné auxprofessionnels de la dentisterie. Cesont là d’excellentes nouvelles pournotre profession

Je souhaite avec ferveur que le Collègepoursuive avec détermination sonengagement envers ce problème. Nousdevons tout faire pour créer endentisterie une culture dans laquelleaucun dentiste n’éprouve unsentiment d’impuissance face à latoxicomanie.

Avec un taux de succès d’environ90 % chez les professionnels de lasanté, ce traitement est digne de nosefforts. Les dentistes qui sont auxprises avec cette maladie sont nosamis, nos compagnons de classe etnos collègues. Ils méritent la dignitéd’une entière guérison.

FROM THE REGISTRAR


47

It is common practice now to involverepresentatives from other regulatory collegesand topic experts as members of workinggroups, looking at everything from serologystatus to the use of drugs in pain management.We have begun adding members of the publicwho have been involved in our process to ourstakeholder distribution list for consultations.

This is good practice and progress. It meansbetter and more informed decision-making.

More changes are nowunderway. At its Novembermeeting, Council unanimouslyadopted a set of eighttransparency principles. Theycan be found on our websiteunder Who We Are/Mission andValues.

Several other major health careregulators, including medicine,nursing, pharmacy, optometryand physiotherapy, haveadopted these same principles.In fact, we worked on theirdevelopment together. It is allpart of a major collaborative project as we replyto the question from government about how wemight be more transparent in the regulatorywork we do and make more informationavailable to the public.

The purpose of these principles is to guide futuredecisions about making more informationavailable to the public.

This is not a new challenge for this College.

We were a leader in making reprimands open tothe public. At its meeting last month, Councilpassed in principle a bylaw change that wouldallow posting information on our website whendeficiencies are found during office inspectionsfor facility permits for the use of dentalanesthesia and for the operation of dental CT

scanners. This is an area of significant impact onthe safety of the public, as we now issue close to1,500 facility permits.

The College understands that a commitment totransparency is yet another important way tofulfill our mission to work always in the interestsof public safety and protection. In fact,transparency is one of our core values, alongwith trust, accountability, equality, accessibility,fairness and responsiveness.

We have made it very easy formembers and the public to getinformation too. We have avibrant and remarkablewebsite where information iseasy to access. As you willrecall, our approach to makinginformation public on ourwebsite garnered great praiseduring the external review byregulatory expert Harry Caytonof The Professional StandardsAuthority in London, England.

Of course, the overridingimperative is to strike a

balance between openness and fairness to ourmembers. For example, is it reasonable andresponsible to make public the fact that acomplaint has been laid? I believe it would beunacceptable to leave our members open tocomplaints filed for nefarious motives.Accusations that are unfounded and untestedwill damage a reputation and a career.

As we move forward, I am sure there will bemany more challenges. But I don’t think we cango far astray if we are guided by the profoundstatement made by one of the former SupremeCourt of Canada Justices originally from Ontario,the Honourable Mr. Justice Peter Cory, when hesaid: “Everything that prevents light being shedonly leads to darkness and suspicion.”

Where there is no openness, no airing of facts, there is no trust, no justice.Continued from page 48

TRANSPARENCY ISONE OF OUR COREVALUES, ALONG WITH TRUST,ACCOUNTABILITY,EQUALITY,ACCESSIBILITY,FAIRNESS ANDRESPONSIVENESS.


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FROM THE REGISTRAR

IIt is hard to believe but there was a time, and not too long ago in theannals of time in the last century, when what went on at the College wasbehind closed doors. Council meetings were not open to the public. In thecomplaints process and the discipline process, there was no disclosure ofallegations, of evidence or of the results of our investigations. Disciplinehearings were held in secret. Reprimands were done in secret. There waseven a time when there were no public representatives sitting at thepolicy decision-making table of Council.

Those days are long gone now. The doors and windows are open.Disclosure is now full and complete – within the confines of what islegally permissible, of course. Hearings are open and the decisionspublished. Our website hosts the College Register containing informationabout dentists. Council meetings are open to the public. Minutes ofCouncil meetings, once approved, are posted on our website.

All these changes are markers of how far our commendable commitmentto transparency has travelled over the past few decades.

For some time now transparent policymaking has been the norm at theCollege. In fact, it is a requirement of our governing legislation, theRegulated Health Professions Act. The 60-day consultation period forbylaw and regulation changes involves an open process with theopportunity for input from our members and relevant stakeholdercommunities.

Where there is noopenness, noairing of facts,there is no trust,no justice.

Continued on page 47

IRWIN FEFERGRAD

RCDSO Dispatch_2013_v27_no4 – page 31 - PTIFA

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