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By Daniel J. Schulte
MDA Legal Counsel
Published in the December 2006 issue of the Journal

Question: I am a general dentist who wants to expand his practice. I received an ad for a seminar on dental implant surgery. The company putting on the course also sells surgery kits.

The ad represents that the seminar will make me "proficient in dental implant surgery" such that I can "greatly expand my practice and revenue by adding implant surgery services." This seminar requires a fraction of the time required to obtain a dental specialty certification in oral and maxillofacial surgery.

Before I attend the seminar and invest in the equipment necessary, I would like to know something about my liability exposure. If I am accused of an act of malpractice arising from a surgical implant case, will I be judged according to the general dentist’s standard of practice or the standard of practice applicable to a dentist with a specialty certification in oral and maxillofacial surgery or some other specialty?

Answer: There is only one standard of practice. Any dentist alleged to have committed an act of malpractice is judged by this standard.

Remember, all dentists licensed in Michigan are able to practice within the scope of the practice of dentistry as defined in Michigan’s Public Health Code. This scope of practice is broadly defined as follows: "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 oneself out as able to do any of these acts."

Michigan’s scope of the practice of dentistry sets forth no limitations whatsoever on the type of dental services you may provide, based on the fact that that you are a general dentist or a specialist. In other words, a general dentist may legally provide oral surgery, orthodontic, prosthodontic, periodontic, pediatric, endodontic or oral pathology services without having obtained a specialty certification. (There are, however, limitations on a general dentist’s ability to advertise the providing of specialty services; for that discussion, please see the "Dentistry and the Law" archive at online)

As I am sure you know, not all implant surgeries are perfectly performed. Typical complications include nerve injuries, infections, sinus perforations, loss of adjacent teeth, etc. Should any of these complications arise and you be sued for malpractice, the fact that you are a general dentist will not affect the standard of care by which you will be judged. The standard of care will be the same whether you are a general dentist or a specialist. But you will be found to be liable for malpractice if you have not met this standard of care.

The exact standard of care to be applied in any given case is one of the issues decided by the jury. This determination is made after hearing testimony from both the plaintiff’s and the defendant’s expert witnesses. The plaintiff’s expert witness will likely be a dentist with a certification in the specialty out of which the claim for malpractice arises. This will force you to locate and hire an expert witness with the same specialty certification.

The fact that the jury is presented with expert testimony from two experts who are specialists may lead it to conclude that the standard of practice may only be met by a dentist with the same education and training. This will, of course, depend on the facts and circumstances of each case.

With this in mind, general dentists who have not completed the education and training necessary to obtain a specialty certification should provide specialty services only after careful consideration. Advertisements claiming that a few days or weeks of seminar coursework will provide you with the same ability as a specialist who has completed years of postgraduate training and passed a board examination should be met with great skepticism.

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