Building the Dentist-Patient RelationshipAs of September 1, 2022 – the College of Dental Hygienists of BC, College of Dental Surgeons of BC, College of Dental Technicians of BC, College of Denturists of BC becomes…
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Our practice-related resources provide important guidance for registrants in meeting the standards of practice. Certified dental assistants (CDAs), dental therapists and dentists are responsible for reading BCCOHP’s publications to ensure they are aware of current news and of BCCOHP policies, standards and guidelines.
Cases resulting in the need for patient resuscitation, emergency transfer, referral and/or admittance to hospital, or death, must immediately be reported to BCCOHP’s Registrar by phone (672-202-0448, toll-free within Canada: 1-888-202-0448).
You must also submit a Critical Incident Report to the Registrar’s office.
This report is essential as it provides immediate and accurate information for all concerned parties.
To request a paper copy, please contact us.
Standards and guidelines inform practitioners and the public of BCCOHP’s expectations for registrants.
Guidelines are highly recommended but – while being evidence of a standard – are not, strictly speaking, mandatory. Guidelines contain permissive language such as “should” and “may.”
Standards are, by definition, mandatory and must be applied. Standards are clearly identified by mandatory language such as “must” and “required.”
Advertising for dental services is increasing, as are the channels for advertising.
The updated Bylaw will be enforced by BCCOHP.
More information is available on the bylaw is available below.
Documentation
Bylaw Part 15.03 (Marketing)Interpretive Guidelines for Bylaw 12 (Advertising and Promotional Acitvities) (PDF)**This document (first produced by the Ethics Committee in June 2016) was updated February 2018 in accordance with the 2017 revisions to legacy Bylaw Part 12 (in effect as of November 27, 2017).
Background
The Health Professions Act empowers the Board to make bylaws that regulate and prohibit advertising and promotional activity by registrants.
The Bylaw dealing with advertising and promotional activities was approved by the Board in June 2015 and came into force in October 2016. This version of the Bylaw was the result of much deliberation by the Board and the Ethics Committee, two rounds of consultation with registrants and stakeholders, and consideration of external legal advice.
One of the goals of Bylaw 12 – rooted in the College’s mandate of public protection – was to address the general public’s confusion about the professional titles that had proliferated in the advertising of some dental offices.
The bylaw strives to balance legitimate promotional interests with reasonable limits to prevent the public from being misled or confused.
Key Changes
The proposed changes are limited to qualifications, continuing dental education, titles and designations as laid out in sections 12.08 – 12.11.
The proposed changes apply to references to university degrees, dental-related titles, designations, certificates, certifications, associations, registrations, honours, memberships, diplomas, or any other dental-related referenced derived from or conferred through either their continuing education activities or granted, conferred, or awarded through any other means.
Under the current bylaw, these references are restricted or prohibited entirely. The proposed change allows for them to be made, provided that they are in unabbreviated form and include the year, the jurisdiction, and the name of the granting organization.
Rationale
The College recognizes that policy documents are “living documents” that need to be reflected upon periodically in light of changing legal and social context. The College continues to receive feedback on Bylaw 12. In the time since the bylaw was first approved, the Board reflected on comments that have argued for increased limits (re: qualifications, titles, designations, etc.) and those that have argued for removing them altogether, all while considering the underlying public protection objective of the bylaw.
The public expects clear, understandable and verifiable information about healthcare providers. The public and the profession have consistently expressed concerns with advertising and promotional activities that are confusing and misleading. These factors argue for constraining advertising and promotional activities.
On the other hand, the ability for dentists to advertise and promote themselves and their services is a legitimate commercial interest that also deserves consideration. Restrictions that limit expression can invite a legal challenge under the Charter of Rights and Freedoms.
Restrictions on expression must strike a careful balance between competing interests.
The proposed changes to Bylaw 12 address concerns about limits on registrants’ freedom of expression while remaining loyal to the public protection objectives of the existing bylaw.
The public remains protected by the assurance that information presented by registrants in advertising and promotional materials is complete enough to allow the public to understand what is being stated about a dentist’s qualifications and to make informed choices.
What the Changes Mean
The changes will provide registrants with increased flexibility in referring to their qualifications, continuing dental education, titles and designations in their advertising and promotional activities. By requiring the information provided to be complete and descriptive, these changes protect the public by limiting confusion about professional titles in dentistry. The public also benefits from more information about their dentist’s professional background being available.
The Boundaries in the Practitioner-Patient Relationship guideline document considers the question of when it is appropriate to enter into a practitioner-patient relationship and sets out the ethical obligation of registrants to ensure the treatment is appropriate.
The document provides guidance to registrants to help recognize conflicts and gives advice on how to resolve these conflicts.
Documentation
Boundaries in the Practitioner-Patient Relationship Guideline
We recognize that this is a complex and nuanced topic. To help registrants better understand how the guideline applies to them, we have produced a video.
Key Points
There are three elements that must be in place before providing treatment to any patient:
These principles are enshrined in BCCOHP’s Code of Ethics. They may be compromised when treating anyone with whom there is such a close personal relationship as to create a conflict of interest.
Practitioners should exercise care and judgment in:
The Clinical Practice Guideline for the Early Detection of Oral Cancer provides guidance about the appropriate use of oral cancer screening techniques to help dentists make informed decisions about screening for oral cancer. It was developed by the BC Oral Cancer Prevention Program of the BC Cancer Agency in partnership with BCCOHP.
Documentation
Clinical Practice Guideline for the Early Detection of Oral Cancer
Key points
The purpose of this guideline is to:
Radiographs* (X-rays) are necessary for the evaluation and diagnosis of many oral conditions and diseases. The Dental Radiography Standards & Guidelines were approved and published in September 2015, and articulate BCCOHP’s expectations for registrants regarding dental radiation (including the use of cone beam computed tomography (CBCT) in dentistry).
*For the purpose of this document radiographs includes images
Documentation
Dental Radiography Standards & Guidelines
Key Points
Good dental recordkeeping is critical to the practice of dentistry. It ensures continuity of care for patients and may help to reduce the likelihood of a complaint. The Dental Recordkeeping Guidelines contain the requirements for dental recordkeeping and the ownership, transfer and retention of dental records.
Documentation
Dental Recordkeeping Guidelines
Sample charts/forms
Key points
Dentists must now maintain complete patient records as follows:
In addition to clinical records, other records that must be retained include appointment records, lab prescriptions and invoices. Diagnostic or study models are also considered part of the permanent patient record and must be kept for the prescribed period.
Working models do not have to be retained for any specific period of time. A decision to keep working models should be based on the complexity of the case and is left to the judgment of the individual practitioner.
Exceptions: The above guidelines do not apply to minors and person under a disability. In these cases, the limitation periods do not begin running until the person turns 19 or until the disability ends.
Since the Standards and Guidelines for Minimal and Moderate Sedation was published in May 2014, BCCOHP has received questions about whether or not Certified Dental Assistants are allowed to dispense medication.
In response, the CDA Advisory Committee drafted the document, Dispensing of Non-Prescription Medication by Certified Dental Assistants. This document outlines when dentists are allowed to delegate and supervise CDAs in the dispensing of medication.
Documentation
Dispensing of Non-Prescription Medications by Certified Dental Assistants
Key Points
Obstructive sleep apnea (OSA) is a medical syndrome that is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. The Obstructive Sleep Apnea Standards and Guidelines identify the roles and responsibilities of a dentist treating patients with OSA.
Documentation
Obstructive Sleep Apnea Standards and Guidelines
The purpose of the Obstructive Sleep Apnea Standards and Guidlines document is to:
Standard: A dentist’s role in the treatment of OSA is adjunctive, supplementary and/or collaborative to that provided by the physician. A dentist may provide OA therapy only after receiving a written request or prescription from the attending physician, preferably a physician with advanced training in sleep medicine. Because of the increased rates of morbidity and mortality associated with OSA, a physician (family physician or sleep specialist) must assess the potential for other medical conditions, including OSA, before a dentist provides any treatment for primary snoring.
Home Testing Equipment for Obstructive Sleep Apnea
The treatment of obstructive sleep apnea requires interdisciplinary teamwork between dentists and medical practitioners.
Dentists who rent or provide home sleep apnea testing (HSAT) equipment to patients, through limited business corporations or otherwise, are reminded that the prescription or direction for the provision of overnight home sleep testing equipment must come from a registered medical practitioner. The Ministry of Health requires that anyone doing HSAT must be accredited by the College of Physicians and Surgeons’ Diagnostic Accreditation Program (DAP).
Patient-centred care is defined as care that “is respectful of and responsive to individual patient preferences, needs, and values, and [that ensures] patient values guide all clinical decisions.”
Patient-centred Care and the Business of Dentistry is a foundational ethical document for oral health professionals. The practice of dentistry is changing and so are the economic realities of the profession. This has given rise to new business models that are challenging the traditional ways dentistry has operated. Even as the profession evolves, what cannot change is the focus on the patient.
Documentation
Patient-centred Care and the Business of Dentistry
Key points
This document addresses the inherent ethical challenges of the dual role of a dentist as a treating healthcare professional and as a business person, and holds them up against the patient’s perspective.
It includes 11 principles that reinforce patient-centred care – the principles articulate the conduct expected of registrants, reinforce owners’/managers’ accountability for the conduct of their practices, and are broad enough to apply to all practice arrangements. They are intended to supplement, not subsume, the Health Professions Act and BCCOHP’s Code of Ethics.
The College is frequently asked about the use of prescription drugs in dentistry. Dentists with a full, academic or restricted to specialty registration can prescribe drugs under the Health Professions Act. Dentists may need to administer drugs to provide treatment to a patient or a written prescription may be indicated afterwards. Therefore, it is essential that dental professionals know the requirements for prescribing and dispensing drugs.
The purpose of these standards is to assist registrants in regards to dispensing and prescribing drugs to ensure the safe and effective use of prescription medication.
Documentation
Prescribing and Dispensing Drugs Standards and Guidelines
The Controlled Prescription Program sets the requirements for prescribing controlled substances and was established to prevent forgeries and reduce inappropriate prescribing of selected drugs.
Duplicate prescription pads
Order a duplicate prescription pad >>
Dentists who wish to prescribe any of the monitored drugs must order their duplicate prescription pads through BCCOHP. Dentists without these pads cannot prescribe the monitored drugs. Prescription pads are personalized and numerically recorded, the prescription pad must be maintained intact in chronological order. Some practitioners may require multiple pads due to the nature of their practice, if so, you must advise BCCOHP in writing.
Dentists practising as a locum in more than one office are not required to have their practice address imprinted on the prescription scripts; however, your name and BCCOHP registration number must be imprinted. Only when you are writing the prescription must you then add the practice address and phone number of the practice where the prescription is being written.
Returning prescription pads
Dentists must return all partially and fully unused prescription pads to BCCOHP offices (by XpressPost or courier) for shredding if any of the following occur:
Lost or stolen prescription pads
In the case of lost, stolen or forged prescription pads registrants must:
Learn more about lost or stolen prescription pads >>
Additional prescription information
Resources
Wellness program The wellness program (see Health Matters section on this page) assists dentists, dental therapists or CDAs who are facing addiction or any health issues that could affect their ability to provide safe patient care. Questions about the wellness program? |
The following interpretive guidance is applicable to both the dental office setting – whether or not the dentist is on site – and to private dental hygiene practice.
On February 24, 2020, the Ministry of Health announced amendments to the regulations (scope of practice statements) for dental hygienists, dental technicians, denturists and dentists. Two of the changes that affect the provision of dental hygiene services are:
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It is expected the decision to administer a Schedule I drug will be based on collaborative discussion and decision-making amongst the patient, dental hygienist and dentist and include thorough documentation of those discussions and decisions, including the authorization by the dentist to dispense the drug.
In order for a patient to provide informed consent for the administration of a Schedule I drug, it is expected that patient will be made aware of all of the risks, benefits, associated costs and options (including not administering the drug). In the case of anaesthetic containing a vasoconstrictor, this would include a discussion that while this formulation increases the depth and duration of anaesthesia, it may impact cardiac function.
The dental hygienist and dentist must be satisfied that, following a thorough clinical assessment and review of the medical history, there are no contraindications to the administration of the Schedule I drug.
A prescription can be defined as an authorization for the dispensing of a drug to a patient and may be written or verbal.
Within the traditional model of a dental hygienist and dentist working collaboratively within the same office, the specific requirement in the amended regulations of a prescription prior to administration of a Schedule I drug by a dental hygienist is not expected to change existing protocols. Rather, it will serve to focus the entire dental team on the existing standards of collaborative care, including a complete pre-treatment assessment of the patient, reviewing and updating of the patient’s medical history and a determination through discussion between the dental hygienist and dentist of the need for the administration of the drug for the patient.
Once a need is determined, the dentist can provide a verbal authorization for the drug to be dispensed to the patient and the dental hygienist can proceed with the administration, regardless of whether the dentist is on site or not.
In the case of a private dental hygiene practice, the authorization can be provided by a written prescription from the dentist for the patient or over the phone following the expected standards of collaborative care including assessment, review, and thorough discussion between the dental hygienist and the dentist.
A dentist may choose to make a standing order prescription for a given patient to cover a specific time frame (e.g. three to six months). If this is the case, it is expected the hygienist will review, update and document the patient’s medical status as well as revisit and determine the ongoing need for the drug before each subsequent administration, engaging the prescribing dentist in discussion should any changes be noted.
It is expected the patient record will include:
Reference documents |
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All general dentists and certified specialists administering sedation and general anesthesia must adhere to the requirements outlined in BCCOHP’s relevant standards and guidelines.
Keep up to date on sedation and GA news here >>
Documentation
Standards & Guidelines | Addenda |
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Register your sedation qualifications / apply for facility authorization
General dentists and certified specialists who intend to provide moderate sedation, deep sedation or general anesthesia must have their qualifications approved by BCCOHP.
Facilities where deep sedation and/or general anesthesia will be administered must first be inspected and authorized.
Questions?
Learn more about sedation and anesthesia here. If you have questions, please contact us.
The Infection Prevention and Control Guidelines provide Dental Health Care Providers with the knowledge of principles and standards to inform and properly implement necessary infection prevention and control measures in a safe and effective manner.
The Board approved the Infection Prevention and Control Guidelines at its May 2012 meeting, and the document was distributed to dentists and CDAs with the summer 2012 Sentinel.
Documentation
Digital impressions are not a restricted activity. When the current College Bylaws were enacted in 2009 under the Health Professions Act, the rapid development in digital imaging and related software applications was not anticipated. As such, the College’s interpretation of Bylaw 8.06(2)c has evolved. The making of a digital image (to be used as an electronic impression) is not a restricted activity and can be performed by anyone in the dental office.
The authorization and supervision by a dentist of a certified dental assistant is required for any analog impression and occlusal record (e.g. alginate, polyvinyl siloxane, etc.). Making digital impressions is low risk to the patient, in contrast with the risk involved in the making of an analog impression or occlusal record (e.g. aspiration or swallowing of impression material; soft and hard tissue trauma from metal or plastic tray; tray becoming locked in mouth when impression material sets). Regardless of the modality, the dentist is ultimately responsible for determining whether the final image or impression is of appropriate quality for its use going forward.
The following standards describe the responsibilities of dentists, dental therapists and certified dental assistants (CDAs) in providing dental care to the public in B.C.
Protection of the public is better served by putting standards into place proactively rather than having to react in the event of an infection control incident.
The IPAC guidelines reflect current knowledge of the transmission of infection, and how to prevent and control it, as well as the expectations of the public and government. Wherever possible, the recommendations are based on data from well-designed scientific studies. In the absence of scientific evidence, certain recommendations are based on strong theoretical rationale, suggestive evidence or opinions of respected authorities. Some requirements are provincially and federally legislated.
The guidelines are a living document that will be updated as necessary. Dentists, dental therapists and CDAs are expected to continue to use their professional judgment in implementing them.
The IPAC guidelines were approved by the Board at the May 2012 meeting and went into effect immediately. All dentists and CDAs received a copy of the guidelines shortly after. BCCOHP now expects all dentists to implement the IPAC guidelines in their dental offices.
No. You may need to reorganize your sterilization area to facilitate organization and processing, i.e. with clear separation of clean and dirty areas with separate sections for receiving, cleaning and decontamination; preparation and packaging; sterilization; drying/cooling; and storage (p.24).
Equipment that is used to clean, disinfect or sterilize (e.g., ultrasonic washers, washer-disinfectors, sterilizers) must meet standards established by Health Canada. If your current sterilizer does not meet the time, temperature and other operating parameters recommended by the manufacturer of the sterilizer, you will need to have your sterilizer repaired or replaced (p.24).
If you are replacing your sterilizer, we recommend purchasing one with current features such as recording devices that print out cycle time, temperature and pressure (p.29).
Note: If you are using a vapo-sterilizer/chemi-clave sterilizer, there are stringent air quality controls for exposure to biological and chemical agents made under the Workers Compensation Act. See p. 24 in the guidelines for more information.
BCCOHP does not promote or endorse any specific infection control products, equipment or manufacturers. BCCOHP recommends purchasing equipment and products that will enable oral health professionals to meet the requirements of the IPAC Guidelines.
There are different options available for implementing this requirement. You can purchase your own biological monitoring system, there are commercial sterilization monitoring companies that provide this service, and there are services provided by various dental sundries suppliers that may be utilized.
Not unless your professional judgment determines that it is clinically appropriate to use a safety-engineered needle in a particular circumstance. The College’s position is based on the WorkSafeBC report “Preventing Needle Stick Injuries and the Use of Dental Safety Syringes” (2010), which found that additional design modifications are required prior to recommending universal use of currently available models of safety-engineered syringes/needles (p.19)
As with many things in the IPAC Guidelines, you must use your professional judgment. The guidelines state that if a product is received from the manufacturer who has guaranteed the instrument’s sterility, it need not be sterilized prior to initial use. Newly purchased non-sterile critical and semi-critical items must be inspected and processed according to manufacturer’s instructions prior to use. Any product that comes in a clean state that the manufacturer indicates is ready for use does not need to be sterilized provided that it is used directly from the new package (p.24).
BCCOHP’s mandate is protection of the public, and these guidelines promote protection of both the public and dental health care providers. Spatter or spray from dental procedures can contaminate the fabric of scrubs/uniforms and lab coats, and can lead to cloth-borne transmission of pathogens to people and surfaces.
It is the dentist’s responsibility to develop a policy that uniforms and scrubs worn during patient care procedures should not be worn outside the dental office (p.20).
Information Sheets provide a factual summary or outline of instructions, information and/or processes that are relevant for BCCOHP registrants.
The purpose of this information sheet is to identify when it is within the Dentists Scope of Practice to prescribe and administer Schedule 1 medications, such as Botulinum Toxin Type A (i.e. Botox®) and smoking cessation drugs, such as Zyban®.
Documentation
Key Points
– the patient is a “patient of record” at the dental practice;
– the drug is part of a comprehensive dental treatment plan;
– the patient has received a comprehensive dental examination;
– the patient completed a full medical history and has been assessed;
– informed consent has been obtained;
– treatment takes place in an appropriate clinical setting.
Use of dermal fillers remains outside the scope of practice of dentists
Dentists are reminded that performing any procedure outside their scope of practice is illegal and not covered by malpractice insurance.
Currently, the administration of dermal fillers is not part of the scope of practice of general dentists in B.C. The Board formed a working group of oral surgeons knowledgeable in the area of dermal fillers to research the issues surrounding the use of dermal fillers by dentists. The Board accepted the group’s recommendation that dermal fillers are technically challenging and carry a significant enough risk of adverse effects to not be included in the scope of practice of general dentists at this time.
The Board acknowledged that dentists could potentially attain the competencies required to safely administer dermal fillers, but decided that until the education and experience required for competent administration could be established, dermal fillers remain outside the scope of practice of dentists. The only exception to this rule is for dentists who have had training in the use of dermal fillers as part of an accredited specialty program and have received approval from BCCOHP.
The dermal filler working group will conduct further investigation into what would be required to safely administer dermal fillers and report back to the Board for further consideration when that work is complete. The Board requested that general dentists be added to the working group to ensure a balanced perspective, so three general dentists will be appointed to the working group.
In addition, another group is being struck to consider this issue at the national level. As soon as further investigations have been carried out, BCCOHP will update the profession. Dentists are reminded that performing any procedure outside their scope of practice is illegal and not covered by malpractice insurance. This puts both the patient and the dentist at significant risk.
The core of the dentist-patient relationship is a trusting relationship. This document provides some of the key obligations and roles that each of the dentist and the patient can expect of each other.
With a better common understanding of what can be expected from each party, communication between dentists and patients can be improved, and concerns that could mature into a complaint can be resolved quickly and amicably between the doctor and the patient.
Documentation
The purpose of this information sheet is to provide clarity to registrants and the public about the issue of settlement agreements and complaints to the College.
Documentation
Key Points
The purpose of this information sheet is to outline the appropriate process for dismissing a patient when the dentist-patient relationship breaks down and cannot be repaired.
Documentation
Dismissing a Patient – Practical and Ethical Concerns
Key Points
The purpose of this information sheet is to provide clarity to registrants and the public regarding the use of VELscope screening to identify potential oral mucosal diseases, including oral cancer.
Documentation
Key Points
As of June 1, dentists in BC can become authorized to access PharmaNet. This joint initiative between BCCOHP and BC’s Ministry of Health marks a significant and positive change that will enhance the safety of dental patients and the public.
Practitioner access to PharmaNet is only for the purpose of direct patient care: providing health services to an individual in the context of a professional health practice. It is subject to strict privacy and security measures designed to prevent unauthorized access and protect the information of BC residents.
As a prescribing dentist, you may permit other regulated oral health professionals to use PharmaNet on your behalf, specifically and directly to support clinical care (e.g., to populate a patient’s chart before a visit).
What is PharmaNet?
PharmaNet is the province-wide network that links BC community pharmacies to a central data system. It keeps a record of every prescription dispensed in a BC community pharmacy and is administered by the Ministry of Health. PharmaNet:
Who can access PharmaNet?
June 1, 2022 is the beginning of the enrollment period for dentists (independent PharmaNet users) and those they designate to support them (on-behalf-of users).
There are five steps you must complete in order to apply for access to PharmaNet. More information about each is below, together with links to relevant resources.
Step 1: Set up your mobile BC Services Card app
If you do not already have the BC Services Card on your mobile device you will need to set it up.
Note: The BC Services Card app connects with PRIME – the system used to connect health care providers with PharmaNet. PRIME uses your name, birthdate and address from the BC Services Card.
Set up your mobile BC Services Card
Step 2: Choose a vendor
Next, research and contract an approved PharmaNet software vendor. Below is a list of vendors who have confirmed their ability to work with dentist PharmaNet users:
Please note: although PharmaNet lists five software vendors on its web page, only two have confirmed that they can provide this service for CDSBC registrants.
Step 3: Identify a signing authority
Identify a signing authority. This person, or someone they delegate to, will register the site in PRIME (see step 4). The signing authority will need:
Step 4: Register your site/practice in PRIME
The signing authority, or delegate, must register the site/practice in PRIME.
A “site” is a combination of the practice’s physical location and PharmaNet software vendor. If a practice uses the PharmaNet application of more than one vendor, it has more than one site; each must be registered separately, but under the same responsible organization.
If you have completed steps 1-3, follow the instructions in the online video tutorial to register your site in PRIME.
Step 5: Register yourself in PRIME
You will need:
Note: You will not receive a confirmation email. You can log in to PRIME to check your status.
If you have already enrolled in PRIME
Dentists are independent PharmaNet users as of June 1, 2022.
If you enrolled in PRIME before June 1, 2022 as a Dentist you need to:
Visit PRIME for more information and a how-to video, or begin your enrollment through the PRIME application.
Resources
Support
BC Services Card App Support
1-888-356-2741 (Canada and USA toll free)
604-660-2355 (Within Lower Mainland or outside Canada and USA)
PRIME Support
1-844-397-7463
PRIMESupport@gov.bc.ca
BCCOHP policies contain information which should be considered by dentists in the care of their patients.
The Blood-Borne Pathogen Policy addresses BCCOHP’s requirements for registrants who are infected/affected with Hepatitis B, Hepatitis C, and HIV.
Read the BCCOHP Blood-Borne Pathogen Policy (PDF).
The policy encourages a safe working environment and maximizes the use of measures to prevent blood-borne viral transmission to patients. The determining factor between what actions a registrant must take and whether they can safely practise is whether they are providing, or assisting with, “exposure-prone” procedures.
In the event of a registrant-to-patient blood exposure during an exposure-prone procedure, both the registrant and the patient should be tested for blood-borne viruses, and the registrant must immediately file a Critical Incident Report with BCCOHP. This applies to all BCCOHP registrants.
BCCOHP also has a policy statement on the Treatment of Patients Living with HIV/AIDS (PDF).
In 2007, the American Heart Association (AHA) revised its recommendations, limiting the conditions for which endocarditis prophylaxis is recommended before dental treatment to those associated with the highest risk. Patients with certain heart conditions no longer require short-term antibiotics prior to dental treatment as a measure in preventing infective endocarditis.
The British Cardiac Society and the British Society of Anti-microbial Chemotherapy also provide therapeutic guidelines relating to endocarditis prophylaxis (updated in 2004 and 2006, respectively), which vary somewhat from those of the AHA.
In Canada, dentists using either the current British or American guidelines may provide justifiable patient care. As such, BCCOHP encourages dentists to reference current guidelines published by these and other organizations including the Canadian and American Dental Associations. Professional judgment should also be relied upon to determine the most appropriate course of action for individual patients.
It would be appropriate for the dentist to consult with the patient’s cardiologist or other treating physician before initiating treatment.
Click on the links below for information sources about this topic.
Note: BCCOHP does not officially endorse these sources.
Any time a dentist or dental practice uses a name that is not their registered legal name, they are using a trade name. The College does not require registrants to seek approval of trade names for dental practices (This was formalized by the Board in 2016).
BC Corporate Registry request for consent
The College will provide consent to requests from the BC Corporate Registry regarding trade names based on two criteria:
*Since a trade name is considered to be a form of advertising and promotional activity, it must comply with BCCOHP’s Code of Ethics (PDF) and bylaws.
Billing under a trade name
Patients should not be billed for dental services under the trade name alone – the dentist’s proper name or the dental corporation name should be clearly indicated on all invoices.
Practice facility signage
All dentists are required to conspicuously display their proper name or if applicable, their dental corporation name, on a sign at their practice. This is particularly important in group practice settings to ensure the public can easily identify the dentists who provide services at the practice. A trade name should not be used on its own to conduct the practice of dentistry.
Incorporating?
Read the instructions for dentists intending to practise under a corporation name.
Good dental recordkeeping is critical to the practice of dentistry. It ensures continuity of care for patients and
may help to reduce the likelihood of a complaint.
BCCOHP often receives questions from both dentists and patients about ownership of and access to records. A simple discussion of access to records is provided below.
Note that complete requirements for dental recordkeeping and the ownership, transfer and retention of dental records can be found in BCCOHP’s Dental Recordkeeping Guidelines (PDF).
Do patients have a right to their dental records? Can a dentist ever withhold them?
A patient owns all of the information contained in their patient chart and has the legal right to access a copy of their complete dental record. Dentists are obligated by law to provide copies of what the patient has requested, including radiographs, study models and photographs. A reasonable fee may be charged to cover the cost of duplicating the records and radiographs.
Dentists may not withhold a patient’s records even when the patient owes money for dental work. Fee disputes or other disagreements between the patient and dentist are not grounds to withhold access to, or transfer of, patient records.
Do dental offices have to provide the records to another dental office?
Dental Offices must also provide the patient records if another dental office requests them. It is acceptable to provide a complete copy of the records or send the originals to the new office with a request that the records be copied and returned. Specific requirements for retention of records are included in BCCOHP’s Dental Recordkeeping Guidelines.
A reasonable fee may be charged to cover the cost of duplicating the records and radiographs.
Under the Health Professions Act, the BCCOHP Bylaws establish a patient relations program to prevent professional misconduct, including that of a sexual nature.
Professional misconduct of a sexual nature is defined as sexual intercourse or other forms of physical sexual relations between the oral health professional and a patient. It includes touching, behaviour or remarks of a sexual nature. These are differentiated from touching, behaviour and remarks that are clinical in nature and appropriate to the dental service being provided.
Proposed amendments to BCCOHP’s patient relations bylaw regarding the treatment of spouses was opened for consultation and approved by the Board. The amendment has been filed with the Ministry of Health and came into force August 19, 2016.
Patient relations and treatment of spouses
The Board has amended BCCOHP’s patient relations bylaw so that spousal treatment would not be included in the definition of “professional misconduct of a sexual nature.”
The amended bylaw reads as follows:
“It is not professional misconduct of a sexual nature to provide dental services to one’s spouse; rather, that is a matter of professional ethics involving
(a) patient autonomy
(b) free, full and informed consent by the patient; and
(c) objectivity of care on the part of the practitioner.”
The amendment to Bylaw 4.12 (5) regarding the patient relations program was open for consultation in February 2016, with minimal feedback received. The revised legacy bylaw came into force August 19, 2016.
The Ministry of Health Services’ position
The introduction of the Health Professions Act and the BCCOHP Bylaws defined any sexual relations with a patient as professional misconduct of a sexual nature. The Ministry of Health recently shifted its thinking and has advised all health regulators that the government will not impose the specific contents of a patient relations program. The Ministry expects health regulators to deal with this as an ethical issue.
All dentists are legally and professionally obligated to respond in the event of a dental emergency.
A dental emergency exists if professional judgement determines that a person needs immediate attention to deal with uncontrolled bleeding, uncontrolled swelling, traumatic injury or uncontrolled severe pain. Dentists have an obligation to consult with and provide emergency dental care to members of the public, or make a reasonable attempt to provide alternative arrangements in their absence.
The following resource packages provide resources for dentists and patients should they have a dental emergency.
Documentation
Work on harmonizing our courses is ongoing. Please check our website regularly for updates.
The College assists dentists, dental therapists or CDAs who are facing addiction or any health matters that could affect their ability to provide safe patient care*.
Under section 33 (4) (e) of the Health Professions Act, the inquiry committee may, on its own motion, investigate a registrant regarding a physical or mental ailment, an emotional disturbance or an addiction to alcohol or drugs that impairs his or her ability to practise the designated health profession.
All health matters are treated confidentially in a separate stream from BCCOHP’s regular complaints and discipline process.
Upon receipt of expert medical advice, the registrant may be asked to voluntarily withdraw from practice until such time as they have been determined fit to practice. Our aim is to see the individual recover and return to work in a sustainable way. BCCOHP works with registrants to determine a pathway back to safe practice.
If you are (or know of) a BCCOHP registrant suffering from a health matter, please contact BCCOHP’s Monitoring department using our contact form.
*a number of health matters may fit into this category of altered physical and/or cognitive competency.
More than 20 health professions in BC are regulated under the Health Professions Act (HPA). All health professionals regulated under the HPA have a professional, ethical and legal responsibility to report any unsafe practice or serious professional misconduct of any other regulated health practitioner (to the regulatory body that the practitioner is registered with).
This means that if a BCCOHP registrant believes that the public is at risk because a practitioner is not competent or is suffering from a physical or mental ailment, emotional disturbance or alcohol/drug addiction that impairs their ability to practise, they have a duty to report this regardless of whether the practitioner is from their own profession or a different health profession.
The HPA provides legal immunity to health professionals who comply with this duty to report as long as the report is made in good faith and is based on reasonable and probable grounds.
Sexual misconduct must also be reported to a registrant’s health regulatory body; however, where concerns about sexual misconduct are based on information from a patient, the consent of the patient or their parent/guardian must be obtained before making the report. Note that this duty to report is distinct from the requirement to report a child in need of protection as set out in section 14 of B.C.’s Child, Family and Community Service Act.
File a report
Because the duty to report under the HPA applies across the health professions, where you are required to make a formal report you must submit it in writing to the regulatory body with which the health professional in question is registered. Practitioners are advised to contact the college of the individual they are reporting to discuss the format and procedure for submitting their concern.
Several practitioners who share a concern may submit one report; however, it must be signed by all the practitioners submitting it.
For more information about your duty to report under the HPA, read our Duty to Report FAQ below.
BCCOHP registrants and their families can access additional assistance and support through the following programs:
Dentist Wellness Program (BCDA) previously DPAP
The Dentist Wellness Program (DWP), created in partnership with Doctors of BC’s Physician Health Program, offers counselling and support services from a team of clinical counsellors.
Learn more on the BCDA Member Site or access DWP 24/7:
Phone: 1-800-661-9199 ( Toll free)
Member Assistance Program (CDSPI)
The Members’ Assistance Program (MAP) provides confidential, no-cost support for all dentists, dental staff and their immediate family members. MAP services help to prevent and manage personal or professional issues that can affect physical, emotional or financial well-being. Short-term counselling support, professional guidance, resources and referrals are available.
Learn more on the CDSPI website or access MAP 24/7 by:
Phone: 1-844-578-4040
Online: workhealthlife.com (enter CDSPI as your organization when prompted)
Mobile app: MY EAP
There is growing recognition by health regulators that addiction is a disease for which recovery pathways exist, and that those recovery pathways should be separate from complaints and discipline. CDSBC operates in this manner and works with registrants seeking treatment. The way BCCOHP deals with health matters is confidential.
If you suffer from an addiction/dependency disease, you have a duty to protect the safety of patients and legal/ethical obligation to cease practice immediately and notify BCCOHP in confidence through Manager, Monitoring and Compliance, Moninder Sahota’s direct phone line: 672-202-0448 (ext. 5345).
Additionally, if you are aware of another registrant’s addiction/dependency, it is your professional, ethical and legal duty to report it to the College.
What will happen next?
BCCOHP’s collaborative approach to treatment and monitoring guides registrants through treatment and provides a pathway back to safe practice. The essential elements of the addiction recovery pathway typically include:
| 1 | Practitioner’s agreement to voluntarily withdraw from practice until deemed medically fit to return (failing a voluntary agreement, BCCOHP has the ability to take action under the Health Professions Act – section 35) – Counselling support is available through the MAP and DWP Programs – Access to practitioners able to step in as locums (to maintain the practice on behalf of the practitioner while undergoing treatment) can be accessed through the BCDA |
| 2 | Assessment by a physician with addiction medicine expertise recognized by BCCOHP |
| 3 | Treatment (in accordance with expert recommendations) |
| 4 | Post-treatment assessment and planning for return to work |
| 5 | A formal agreement with BCCOHP to fulfill certain conditions for return to practice (and during continued practice) |
| 6 | Upon return to work, a period of ongoing monitoring by the addiction medicine expert and the treatment team, which includes monitored return-to-work protocols |
What happens if I relapse?
Addiction is a chronic brain disease with a complex etiology and a tendency for relapse; however, success rates for professionals who enter a structured program are high. The data for physicians who undergo rigorous standards of treatment and monitoring (similar to those of the BCCOHP Wellness Program) indicates that 5-year abstinence rates from substance abuse disorders are in excess of 80 per cent, which far outperforms other treatment programs*.
Should relapse occur:
*Six lessons from State Physician Health Programs to Promote Long Term Recovery: DuPont, M.D. and Skipper, G.E. 2012; Journal of Psychoactive Drugs Vol. 44(1), 72-78
All health professionals who are regulated under B.C.’s Health Professions Act (HPA) have a professional, ethical and legal responsibility to report any unsafe practice of any other regulated health practitioner.
The duty to report under the HPA applies across professions. This means that a professional who belongs to one regulatory college is legally required to report a professional from any regulatory college (including their own).
Regulated health practitioners are legally required to report if they believe on reasonable and probable grounds that another regulated health practitioner’s continued practice of their profession might constitute a danger to the public. This may cover a wide range of conduct.
For example, practitioners are obligated to report when they have a good reason to believe that the public is in danger as a result of another practitioner suffering from a physical or mental ailment, an emotional or cognitive disturbance, or an addiction to drugs or alcohol that impairs their ability to practice.
Sexual misconduct must also be reported. Where concerns about sexual misconduct are based on information provided by a patient in the context of a professional – patient relationship, the consent of the patient or their parent/guardian must be obtained before making the report.
Where a professional is hospitalized for psychiatric care or treatment, or for treatment for addiction to alcohol or drugs, and is therefore unable to practice, the chief administrator of the hospital or private facility, and every treating physician, is obligated to report the professional to the regulatory body with which they are registered.
It can be a difficult decision to decide whether to report a colleague to their regulatory body. A duty to report can be triggered by “reasonable and probable grounds” that a reportable situation exists. Such grounds exist when a health professional believes there is a reliable basis for their suspicion and when a reasonable person in our society would also believe that the evidence supports such a belief.
If a health professional is concerned, they should contact the college of the professional in question to obtain clarification about the situation, or to determine if it is necessary to make a formal report. Making an inquiry (without specifying the name of the practitioner) does not automatically turn into a formal report.
In non-emergency circumstances that concern potentially substandard practice, it may be appropriate to contact the professional directly for clarification before deciding whether a report to their regulatory college is necessary. BCCOHP occasionally receives complaints from dentists about colleagues that are founded on simple misunderstandings that could have easily been clarified without the need to report to BCCOHP.
No. The HPA provides immunity to health professionals who comply with the duty to report as long as the report is made in good faith and is based on reasonable and probable grounds.
A health professional is in violation of the law if they do not meet their legal, professional or ethical responsibility to report a practitioner under the HPA’s duty to report requirements.
In addition, the practitioner may be subject to disciplinary measures taken by their regulatory college and may also be the subject of a complaint filed by the college to which the professional with the impairment, ailment, addiction or ethical issue belongs.
It is understandable that a professional may wish to protect their identity when reporting a fellow practitioner, as this may be an uncomfortable situation; however, the duty to report is a legal obligation that is necessary for the protection of the public and no regulatory college can guarantee anonymity when a report is made.
Regulatory bodies investigate and assess reports submitted under the duty to report based on the protection of the public, the maintenance of public confidence in professions and the legitimate expectations of complainants, professionals and the public that allegations will be fairly assessed and investigated.
While public safety is always the primary concern, B.C.’s health regulators also strive to respect the dignity and privacy of the health professional. Appropriate treatment and medical monitoring may be put in place if warranted.
Where you are required to make a formal report, you must submit the report in writing to the regulatory body with which the health professional is registered. Practitioners are advised to contact the college of the individual they are reporting to discuss the format and procedure for submitting their concern.
In a situation where several practitioners share a concern, they may submit one report. However, the report must be signed by all the practitioners submitting it.
You can find information about duty to report in the following sections of the HPA:
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