By Dan Schulte, J.D.
MDA Legal Counsel
From the July 2012 issue of the Journal
Question: Can someone licensed as an M.D. or D.O. provide services that would fall within the dental scope of practice? For example, could an M.D. or D.O. extract a tooth, prescribe antibiotics for a patient with an abscessed tooth, etc.?
Answer: This issue has not been addressed by the Michigan Court of Appeals or Michigan Supreme Court since the Dental Practice Act and Medical Practice Act were repealed in 1978. The Dental Practice Act and Medical Practice Act were replaced with the Public Health Code, which has been amended by the Legislature several times since 1978.
Prior to 1978, there were three reported cases addressing this issue. One (decided in 1916) involved an M.D. who advertised in a local paper that he would be extracting teeth certain days of the week. Applying pre-1978 statutes, the Michigan Supreme Court affirmed a lower court’s conviction of the M.D., holding that both extracting teeth and advertising to do so were illegal.
The other two cases (decided in 1917 and 1977) are similar in that they both involved situations where an M.D. was providing a service that was within the scope of both professions. For example, Hill vs. Highland Park General Hospital involved a plastic surgeon who extracted a patient’s tooth in the course of treating a broken jaw. The patient developed an infection, resulting in a portion of his jaw bone being removed. The patient sued the plastic surgeon, alleging that the extraction of the tooth and repair of the jaw fracture were within the practice of dentistry, and therefore the plastic surgeon was negligent per se by providing these services without being licensed to practice dentistry. The court in both cases declined to hold that M.D.s/D.O.s and dentists always perform mutually exclusive functions and instead held that when services “overlap” the scope of medical and dental practice they may be performed by either.
The following have been the scope of practice statutes since 1978:
Dentistry: “The diagnosis, treatment, prescription, or operation for a disease, pain, deformity, deficiency, injury, or physical condition of the human tooth, teeth, alveolar process, gums or jaws, or their dependent tissues, or an offer, undertaking, attempt to do, or holding one’s self out as able to do any of these acts.”
Medicine: “The diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic tests, or other means, or offering, undertaking, or attempting to do, or holding oneself out as able to do, any of these acts."
As you can see, the scope of dental practice is limited to the “human tooth, teeth, alveolar process, gums or jaws, or their dependent tissues.” The scope of medical practice is not limited to specific areas of the human body. Instead, the scope of medical practice includes treatment of any disease, ailment, etc., without regarding to what part of the human body is affected.
Theoretically, M.D.s and D.O.s could provide services considered to be within the scope of dental practice, because the scope-of-practice statues overlap. Practically speaking, however, this should rarely, if ever, be the case. It would be unwise for an M.D. or D.O. to actively engage in providing dental services without being properly trained and qualified to provide the services in accordance with the standard of care applicable to dental practice. Most M.D.s and D.O.s are not so qualified and trained. As the court in the Hill vs. Highland Park General Hospital case pointed out, a patient is not prevented from pursuing a malpractice case against a M.D. or D.O. who has extracted a tooth or provided some other service within the scope of dental practice without proper training and qualifications. In such a case the M.D. or D.O. would be held to the dental standard of care (i.e., how a properly trained and qualified dentist would have performed the procedure). Claims could also be made for lack of informed consent (if the patient was not advised that the service should be performed by a dentist or an M.D. or D.O. trained and qualified to perform the procedure) and/or for not referring the patient to a dentist.