Did you know?
On average, American dentists will face 3 to 5 lawsuits or other legal actions over the course of their careers.
When your time comes, you rely on your progress notes and consent forms as the first line of defense, and rightly so. All too often, however, dentists encounter trouble along the way, not because of their charting errors, but because the documentation they rely on is grossly inadequate. The chart fails the dentist!
Now an in-the-trenches dental malpractice defense attorney — who has for decades defended dentists and faced boards, judges, juries and arbitrators — has developed the ultimate defensive shield for dentists — the ICGD System.
The Ideal Charting for General Dentists system consists of three parts – Progress note templates, Consent forms, and Updates & Alerts.
I. Templates
The ICGD system currently contains these templates. As subscribers request new entries, more information will be added. Instructions are provided so your staff easily can “cut and paste” these temples into your existing software program.
For The Front Office
- Change in Insurance Payments
- Dental Records Request
- Failure To Return To Complete Work
- Patient Brings, Or Promises To Bring, Radiographs
- Permission To Treat A Minor
- Physician Clearance
- Refund of Money
- Refusing Treatment
- Terminating A Patient
- Threats and Swearing
For The Hygienist
- Debridement
- Oral Lesion Detected
- Prophy
- Scaling and Root Planing
For The Dentist or Back Office
- Anxiolysis
- Bleaching
- Bonding (composite)
- Crown and Bridge
- Dentures
- Emergency or Limited Exam
- Endodontics
- Extractions
- Initial or Full Exam
- Implants (traditional)
- Implants (mini)
- Periodontics
- Prescribing Chantix, Wellbutrin, Ambien, Oral Sedation, and similar drugs
- Premedication
- Restorations
- Sleep Apnea
- Veneers (porcelain)
Problem Areas
- Dry Socket
- Endo Complications (broken file)
- Endo Complications (short fill or over fill)
- Paresthesia (lingual or buccal)
- Retained Root Tips
- Suspected Drug Abuse
- Swallowed Tooth or Crown
II. Consent Forms
The ICGD consent forms help dispel the misguided patient notion that unfortunate outcomes occur only from dental malpractice. These forms forecast expected outcomes, such as “92% of root canals are successful, success being (a) the patient is out of pain, and (b) the tooth remains for at least another five years.” This language can insulate you from unreasonable patient expectations.
The ICGD currently contains these consent forms. This list will grow, as subscribers request additional protection.
- Arbitration Agreement
- Bleaching/Whitening
- Bone Grafts
- CBCT Warning
- Consent To Change Preliminary Treatment Plan While Under Sedation
- Crown and Bridge
- Explanation Of Gum Disease And Associated Health Risks
- Extractions
- Fillings
- Explanation Of Immediate Temporary and Permanent Dentures
- Implants
- Orthodontics
- Patient Termination Letters
- Refund of Money and Release of Liability
- Root Canals
- Sedation Instructions
- Sleep Apnea
- Veneers
III. Updates & Alerts
The ICGD charting system is interactive. Subscribers can request new templates or consent forms, in whole or in part. When changes are made, everyone benefits from the collective wisdom of thousands of dentists nationwide.
Subscribers to our Better Package receive our Updates & Alerts, which include real dental-legal case studies and recommendations on risk management best practices. Select case study topics from 2015 include:
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Case Study on Ante’s Law
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Case Study on how to respond to negative Yelp reviews
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Case Study on undiscovered broken endo file for two-step endo
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Case Study on building occlusion to idea/existing condition
In addition to the case studies in our Better Package, subscribers to our Premium Package also receive real-time updates to our the our progress note templates and consent forms. Select updates to our charting system in 2015 alone include:
- Case Study on Ante’s Law
- Update to Extraction consent form adding tuberosity
- Case Study on how to respond to negative Yelp reviews
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Update to Orthodontic consent form adding Invisalign
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Case Study on undiscovered broken endo file for two-step endo
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A new form requiring arbitration for all dentist-patient disputes
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Case Study on building occlusion to idea/existing condition
Here’s how our Ideal Charting For General Dentists stacks up against the competition.
| Advantage | Others | Ours |
|---|---|---|
| % Success Informed Consent | × | ✓ |
| Manages Patient Expectations | × | ✓ |
| More Complete Records | × | ✓ |
| Battle-Tested & Proven Effective | × | ✓ |
| Alerts & Updates | × | ✓ |
| Ongoing Case Studies | × | ✓ |
Testimonials
“I’m much more at peace now using the ICGD system. Progress notes and consent forms are far superior to the ones my software company supplied, and the alerts are invaluable in keeping me current.”
— Sharon Bader, DDS, Peoria, AZ
“Love it Jeff!! Thank you so much!!”
— Ryan P. Arthurs, DDS, Sun City West, AZ.
See for yourself — take a look at the entries below:
Their Chart: Actual Root Canal Treatment entry from a major software company
Reviewed medical history. There have been no changes since patient’s last visit. Topical __ placed. [local anesthetic] __ carpules.
__ canals accessed. Length determined with Apex Locator, hand filed and instrumented w/ rotary files. Canals filled with __ sealent and gutta percha. __ canal filed and filled to size __ at __ mm. Irrigated w/ NaOCl & biopure. Filled access w/ permanent buildup material. Completed endo same day.
Subjective complaints, objective testing and a diagnosis are missing. A decision maker, licensing board or expert witness, scrutinizing this entry, would have no idea why endodontics was needed.
Our Chart: Actual Ideal Charting for General Dentists entry
Data not included in the major software company record are highlighted.
[Emer]. NCMH. Pain x __ days for tooth # __. 1 PA. Sensitive to [hot, cold, percussion, palpation]. [Electronic pulp test]. Dx: __. Explain ADRA for ➀ RCT and PFM ➁ ext ➂ nothing. Pt chooses ➀. Pt signs consent form. No Qs.
OCS -. BP __/__. Stan anes – __ carps. Place rubber dam. O + D [or I + D]. Tooth non-vital. [Purulence]. [apex locator]. Remove decay. File DB # __; MB # __; D # __. Length acceptable [or short]. Rinse copious NaCL. Dry. Place [medicimate]. Dry cotton pellet. Sealer w/cavit. Obdurate w/GG [material]. Pre-op, WL and post-op PAs. PO instrs given. Will call if any problem. [℞]. [DDS/asst initials]
NCMH. OCS-/ BP __/__. No unexpected complaints since last time. Stan anes – __ carps. Reshape canals. Fill w/ GP. Temp seal. ✓ occl. Prognosis [excellent/guarded/poor]. Rec’d post, core, B/U, PFM. Will call if any problems. [℞]. [DDS/asst initials]
Additional ICGD comments to the dentist regarding this template:
Notes: Clinical/radiographical findings that can lead to a diagnosis also should be charted: “PA abscess; perio abscess; deep decay into pulp.”
Add this language when the patient wants to try and save a tooth at all costs. “Tooth # _ non-restorable and rec’d for ext, but pt want to try and save. Heroic effort to save with RCT. Told pt chance of success less than 5%. Pt understands but wants to try anyway.”
Suggestion for new office policy: While gloving up, but before entering the oral cavity, ask your assistant show you the signed endodontic consent form before beginning treatment.
Notes:
Abbreviations:
NCMH – No Change Medical History, PA – periapical x-ray, Dx – diagnosis. ADRA – Advantages, Disadvantages, Risks and Alternatives [the legal standard for informed consent], RCT – Root Canal Treatment, PFM – Porcelain Fused to Metal crown, Qs – questions, OCS- – Oral Cancer Screen negative, BP – blood pressure, O+D – open and drain, I+D – incise and drain, DB – DistalBuccal canal, MB – MesioBuccal canal, D – Distal canal, GG – Gates Glidden, WL – Working Length, PO – Post Operative, B/U – Build Up, ℞ – prescription
Possible Dx:
Irreversible pulpitis – normal periradicular structures
Irreversible pulpitis – acute apical periodontitis