Expert: Mark Bornfeld DDS - 7/9/2007

Question
QUESTION: Hi Dr. Bornfeld,

Last month I had a routine cleaning done on my teeth.  I had one the previous 6 months as well, but this was a result of switching dentists at the time.  After the cleaning I was told I was finished and that I could go home.  I asked "well, isn't the dentist going to come in and check to see if I have cavities?".  And the hygienist responded "were you supposed to see the dentist today?". I was really taken back by that reply and I didn't reply but had a funny look on my face.  In the end I didn't get a once over by the dentist.  I am 30 years old, and in all of my trips to the dentist for cleanings, I have ALWAYS had the dentist check, poke, and prod my teeth for cavities.  Isn't this a routine practice?  

Lately, I have been noticing that I have sensitivity on my left back molar when I chew gum, and I'm pretty sure it's a cavity, and I'm annoyed that now I have to go back (by the way, I'm 30 weeks pregnant) to have this taken care of, when it should have been discovered at my last appointment.  What do you think?

Thanks for your time and insight!


ANSWER: Dear Tanya,

Your question touches on several issues. The first is a matter of communication, and whether you either explicitly or implicitly scheduled your appointment for the purpose of a "cleaning" (the term "cleaning" is imprecise, and could refer to several different dental procedures). A receptionist could legitimately interpret a request for a cleaning literally, and may have reserved time only with the dental hygienist in an effort to comply with that request. However, it is the legal responsibility of a dentist to provide diagnostic services prior to implementing treatment. Any harm that resulted to you as a result of the dentist's failure to examine your mouth could legitimately be considered professional negligence.

In some states, there has been lobbying on the part of dental hygienists for the right to independent practice-- i.e., independent of dentists. However, with the exception of Colorado, all dental hygienists must be either under the general supervision or direct supervision of a dentist-- in other words, the dentist takes professional responsibility for errors of omission or commission made by the hygienist. In other words, the dentist is legally compelled to personally supervise the hygienist's work, if only to sign off on the cleaning.

You should know that your pregnancy introduces special considerations regarding professional liability. It is customary for dental treatment to be limited to emergency interventions during pregnancy-- especially during the first and third trimesters. This practice is done more out of medico-legal risk reduction than any benefit to the patient. However, you can probably expect that your dentist will postpone any treatment or diagnostic x-rays until after your pregnancy is over.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.  I'm still a little confused.  This was a routine six month cleaning.  I scheduled it as a result of the dentist telling me that I was due for one.  I never realized that you must specifically ask for the dentist to see you after a cleaning is preformed--I had always assumed that this was standard--as it was always the case in the past.  I have had some work done with this dentist before.  3 cavities filled, and a filling done on my left eye tooth that had had a root canal preformed on it.  I know that my pregnancy poses some dental issues, but they have permission from my OBGYN to preform fillings, cleanings, and x-rays in case of an emergency.  Do you think that I should go back at this point and have my dentist check to see if I do indeed have cavities, or should I just wait until after I give birth?  Is there any significant risk to me to wait another two-three months?  Thanks again.


Answer
Dear Tanya,

You are correct-- you should not have needed to explicitly ask to be seen by the dentist; you should have been examined by him as a matter of office policy.

You should return to your dentist to assess your dental sensitivity. He will need to decide whether any necessary treatment should be postponed or implemented, based on the constraints of your pregnancy and your obstetrician's orders.

Mark Bornfeld DDS