Improving Risk Management by Documenting Dental Professionalism: A White Paper from the IdentAlloy/IdentCeram Council

Introduction

A continuing stream of technological advances in restorative materials has brought many benefits to patients over the years. It has also raised the importance of verifying and documenting the content of those materials, particularly in light of increased concerns over biocompatibility and the rising costs of malpractice premiums. A simple, widely recognized system of material certification is a major contributor not only to successful patient outcomes but also comprehensive, effective risk and practice management.

Wider choices, broader concerns

The range of options in restorative materials today gives dentists an unprecedented ability to match the material to the particular needs of each case. It has also added to the responsibilities that dentists, labs, patients and even insurers have to verify and document that the material being used matches what was ordered.

One compounding factor has been the greater attention now being focused on preventing conditions that can be caused or aggravate by certain restorative materials. Some researchers expect the biocompatibility issue to continue on its growth path. They say that not only has reporting improved but also the population may be becoming more sensitive to certain substances.

For example, theories have been put forth that with body piercing becoming more popular, more and more patients have reached or exceeded their bodies’ tolerance for some types of metal. A dental prosthesis could contain enough of a particular type of metal to put their body over the limit and cause a toxic response.

Know – and document – thy materials

To help dentists and labs avoid this type of result, it has become more important than ever that the content of materials be verified throughout a documented “chain of custody” – all the way from the manufacturer to the patient’s mouth, including the path through the lab, dentist and possibly an intermediate supplier or distributor.

The value of employing such a system would extend beyond improving outcomes. It would serve as a key component of a comprehensive risk management strategy aimed at minimizing the costs of insurance and litigation by improving practice performance on several counts:

  • Accurate, efficient record-keeping: Responsible and effective dental treatments must be based on practitioners understanding all relevant elements of a patient’s history of care. By serving as permanent parts of the patient record, the verification system’s supporting documents would provide an accurate source of information about the types of materials used in prior treatments. (As a side benfit, they would also relieve staff of the need to manually enter that information for new restorations, and they simplify records research as well.)
  • Supporting informed consent: A materials certification system can aid a dentist in discharging his or her obligation to explain to patients enough about a procedure to meet informed consent requirements. In doing so, the system would help guide professionals in each of the of the three critical areas of informed consent. First, when a dentist is explaining why a treatment is needed, he or she can use information contained in the documentation to support their reasons for choosing the particular material. Second, dentists reviewing treatment alternatives with a patient can again use the document’s information to clarify the content of the selected material. Third, dentists can use the materials composition information to thoroughly explain any risks involved with each component, and ease concerns of patients worried about biocompatibility or other issues.
  • Demonstrating the standard of care: No dentist can guarantee that a patient will not suffer an adverse reaction or other problem with a restorative material. But to meet the standard of care dentists are expected to make a significant effort to learn about the risk of such complications. And they are also required to avoid using materials likely to cause such issues. By consistently using a materials documentation system, dentists could show in court that they adhered to the standards of care in their selection of materials. They would simply need to make sure that their labs supply materials certification with each case, and then complete the process by putting the supporting documents in the patient file in its paper form or by scanning it.

Streamlining insurance claims

Documenting materials composition has benefits beyond its role in risk management. Insurers often want to see bills backed up by details about restoration content. Photocopies of certification documents can provide this documentation. Earlier in the process, copies of the certificates can expedite any prior approvals that may be necessary.

A solution at hand

More than 30 years ago, the dental profession gained an easy, inexpensive way to verify and document the composition of materials used in restorations. Overseen by the non-profit IdentAlloy/IdentCeram Council, the IdentAlloy/IdentCeram certificate system gave dental labs and dentists a tool that has become an important adjunct to risk and practice management. It has since played a growing role in helping improve outcomes, raise efficiencies and reduce risk in practices throughout the U.S. and Canada.

Suppliers in the program provide labs with free, two-part certificates with each shipment of an IdentAlloy- or IdentCeram-registered material. With every order for a restoration using that material, the lab retains one part of the sticker for its records. The other part is shipped to the dentist with the restoration to verify composition.

The IdentAlloy/IdentCeram program began by certifying just three types of materials: high noble, noble and predominantly base, reflecting the relatively narrow range of choices available at the time. However, numerous technological advances since then have given dentists unprecedented variety in the materials from which they can choose. Reflecting this, what started as a small program among a few forward-thinking suppliers has become an industry standard, with dozens of leading companies now participating.

In 2013, the IdentAlloy/IdentCeram Council shipped a record 20.7 million certificates to manufacturers and other suppliers for redistribution to their client labs and dentists.

Conclusion

Today’s far wider range of options in restorative materials has combined with the increasing amount of restorative work being done to create an even greater need for dentists to know and to be able to show that the materials used match the materials ordered. This critical task becomes easy with the use of IdentAlloy and IdentCeram certificates.

The future is certain to bring more advances in restorative materials and treatments that result. As the IdentAlloy/IdentCeram program keeps pace with these innovations, more and more labs, dentists and patients can be expected to benefit from those breakthroughs as they take standards of care to new heights.

For more information

To find out more about the IdentAlloy/IdentCeram program, go to IdentAlloy.org or contact Charles E. Yenkner, Executive Director of the IdentAlloy/IdentCeram Council, at (888) 577-2634.[/toggle]To come