The CDA receives numerous phone calls and inquiries about dental and regulatory topics. Some of the most frequently asked questions and their answers are below. If your question isn’t in this listing, please call the CDA at 303-740-6900 or 800-343-3010. Click on the questions below for the answers.
Colorado rules that govern what a dentist may charge for records state that charges may “not exceed the actual cost of the medium and shall not [include] any labor fees. Actual postage costs may also be charged.” In addition, if a patient requests copies of radiographs or other items which cannot be reproduced without special equipment, the dental office may supply a written interpretation. If the patient requests a physical copy of these records, the patient must pay “the actual cost of such reproduction.”
Dentists and dental hygienists must follow certain guidelines issued by the federal Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) to control infection. Dental offices are required follow the CDC’s 2003 “Guidelines for Infection Control in Dental Health-Care Settings”, including the “Summary of Infection Prevention Practices in Dental Settings,” and OSHA’s “Bloodborne Pathogens Standard.” More information may be found through the Center for Disease Control (CDC), www.cdc.gov.
Only licensed dentists can perform procedures that contribute to or result in a permanent change to structures in your mouth. A dental assistant MAY perform the following under the personal direction of a licensed dentist:
- Smoothing and polishing natural and restored tooth surfaces;
- Applying fluorides and other recognized topical agents to prevent oral disease;
- Gathering and assembling information regarding patient history, oral inspection, and dental and periodontal charting;
- Administering topical anesthetic to patients in the course of providing dental care;
- Administering and monitoring nitrous oxide on a patient, under the direct supervision of a licensed dentist;
- Taking x-rays after completing appropriate training;
- Taking impressions, conducting measurements, and assisting in making dentures after a dentist has conducted an initial exam;
- Assisting with try-ins and adjustments of dentures prior to a dentist’s final examination and sign off;
- Repairing and relining dentures (with a signed laboratory work order); and
- Any other task or procedure that does not require the professional skill of a licensed dentist.
Patients who speak languages other than English or who don’t speak English well enough to talk to providers about the care they are providing and who receive dental care through programs that receive federal funding (like Medicaid) are eligible to receive free-of-charge language assistance services.
In addition, according to Title III of the Americans with Disabilities Act, dentists must hire a sign-language interpreter if their client requests one. The Americans with Disabilities Act defines a dental office as a public accommodation that cannot discriminate against individuals with disabilities such as hearing loss. The Americans with Disabilities Act requires dentists to provide communication accessibility for their deaf or hard of hearing patients who use sign language. A qualified interpreter who can accurately convey what both the doctor and patient are saying is vital when discussing the patient’s condition and recommended treatment. It is highly advisable to use an interpreter when providing complex or extensive information to obtain informed consent to a procedure that carries significant risk. Other communication means such as using office computers or written notes are not always sufficient or effective in carrying on a conversation. As for lip reading or speech reading, not all deaf and hard of hearing people are capable of such skills. The best approach is to let the patient indicate the form of communication he/she prefers before the appointment. Deaf or hard of hearing sign language users know, by extensive personal experience, when or if they need an interpreter. If they request a sign language interpreter, “any methods other than sign language” are not considered “effective communication.” Under the Americans with Disabilities Act, the dentist is responsible for the cost of an interpreter and cannot pass the cost on to the patient as a supplemental charge or increased fee for the dental treatment. Should the dentist decline or refuse a request for an interpreter, the patient could file a complaint through the U.S. Department of Justice. For more information, see the “Americans with Disabilities Act Title III Technical Assistance Manual”: http://www.ada.gov/taman3.html
Can a family member or a friend of the patient interpret for them?
Family members/friends/associates or anyone who “claims to know” sign language are often not qualified to interpret for healthcare purposes. Using unqualified interpreters may violate the Americans with Disabilities Act as well as the Colorado Consumer Protection Act. In Colorado, there is an additional requirement that all sign language interpreters hold a national certification to be deemed “qualified.” http://www.coloradodeafcommission.com/pdf/Statutes/Consumer%20Protection.pdf
A list of sign language interpreting agencies is available here: http://ccdhh.com/index.php/sign-language-interpreting-agencies
The regulations under the Americans with Disabilities Act specifically state that you must permit disabled people to bring service animals, such as seeing-eye dogs and hearing dogs, into your office. Nothing in the act requires you to allow service animals into the operatory if the patient does not require the service provided by the animal during the time the dental procedures are being performed. Public accommodations, including dental offices, are not required to supervise or care for service animals. A staff member should remain with the patient at all times and under all circumstances while they are separated from the animal, unless a friend or relative accompanies them.
Dentists, dental hygienists and dental assistants who are diagnosed as HIV positive are not currently required to report their status to the State Dental Board or the Colorado Department of Public Health and Environment. However, the healthcare provider who makes a diagnosis that an individual is HIV positive is obligated to report that finding to the Colorado Department of Public Health and Environment. The department will review all new reports of HIV infection and determine if the individual is a healthcare worker. When a healthcare worker is identified the department will “convene an expert advisory panel to provide advice to the department…(and) make a recommendation on whether the healthcare worker’s current practice represents a risk to patients. If a risk is determined, (the department) will counsel the healthcare worker . . .(and) will monitor the healthcare worker’s voluntary compliance with the counseling message. If the healthcare worker disagrees with the department’s recommendations, the matter may become a mandatory proceeding where the department would issue a public health order and the healthcare worker may challenge the order in a judicial proceeding.”
According to the American Dental Association’s Principles of Ethics and Code of Professional Conduct, “once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient’s oral health is not jeopardized in the process.” To avoid the abandonment of a patient, the Dentists Professional Liability Trust recommends that all emergency needs of the patient be addressed prior to dismissing a patient. If the patient is at a non-emergency point in their treatment and it is clear that a situation has developed that prevents the dentist from practicing quality dentistry to the level of the patient’s needs, the dentist can terminate the patient from their practice by sending a letter advising the patient of the current situation. The patient should also be provided with names of various clinics or clinicians who might be in a position to assume their care. The dentist should also remain available for 30 days to handle any emergencies until the transfer of care can be arranged. These patient dismissal requirements apply only to patients seen within the previous 2 years by a dental practice.
Dental amalgam, commonly referred to as “silver-colored fillings,” contains various metals such as silver, copper and tin. Dental amalgam has been used for more than 150 years without any credible evidence that it is responsible for any health problems. Dental amalgam, one of the most effective and widely used tooth restoration materials, serves the dental healthcare needs of 100 million Americans. In extremely rare cases, some individuals are allergic to amalgams (fewer than 100 cases have been reported in dental literature). However, more than 99 percent of the general population should be able to have amalgam fillings with no allergic response. In the absence of allergic reactions, it is not advisable to have amalgams removed. Removing amalgams can cause damage to healthy teeth and can lead to further dental problems. The U.S. and international agencies responsible for protecting public health — including the Centers for Disease Control and Prevention, Food and Drug Administration, World Health Organization, National Institutes of Health, and U.S. Public Health Service — have done research, reviewed the evidence, and independently concluded that dental amalgam is a safe and effective dental restorative material. Other organizations concerned about public health, such as the Alzheimer’s Association, National Multiple Sclerosis Society and American Academy of Pediatrics have publicly stated that there is no scientific evidence linking dental amalgam with any disease or syndrome. The CDA supports the considerable research that has been done on dental amalgam and encourages further scientific inquiry and dialogue. The Colorado Dental Association concurs with the American Dental Association’s position on amalgams, which can be found on the ADA’s Web site, http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements.