May/June 2013 Dispatch

ENSURING CONTINUED TRUST DISPATCH MAY/JUNE 2013

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DISPATCH Vol. 27, No.2 • May/June 2013Dispatch is the official publication of the Royal College of Dental Surgeons of Ontario (RCDSO). RCDSO is the regulatory body governing the practice of dentistry in Ontario. Dispatch is published four times a year. The subscription rate is included in the annual membership fee. The editor welcomes comments and suggestions from our readers.

MANAGING EDITOR Peggi Mace

SENIOR EDITOR Angelo Avecillas

ART DIRECTION AND PRODUCTION Roger Murray and Associates Incorporated

COVER DESIGN Matthew Hollister and Public Good Social Marketing Communications

REGISTRAR Irwin Fefergrad, CS, BA, BCL, LLB(Certified as a Specialist by the Law Society of Upper Canada in CIVIL LITIGATION and in HEALTH LAW)

Reprint Permission

Material published in Dispatch should not be reproduced in whole or in part in any form or byany means without written permission of the College. Please contact the editor for permission.

Environmental Stewardship

This magazine is printed on paper certified by the international Forest Stewardship Council ascontaining 25% post-consumer waste to minimize our environmental footprint. In making thepaper, oxygen instead of chlorine was used to bleach the paper. Up to 85% of the paper is madeof hardwood sawdust from wood-product manufacturers. The inks used are 100% vegetable-based.

PUBLICATION MAIL AGREEMENT #40011288

ISSN #1496-2799

FRONT & BACK

4 The President’s MessageSelf-regulation can and does work – and work well

44 From the RegistrarTaking smart risks means finding something worth fighting for

DEPARTMENTS

Quality Assurance12 e-Portfolio: frequently

asked questions

15 Practice Enhancement Toolresource list available on website

22 Making decisions about theright CE course for you

24 When searching for information,don’t forget about libraries

Web Spotlight16 Member resources on rcdso.org

21 Latest issue of Source Guide now online

Malpractice Matters18 Associates and Principals:

Issues and Pitfalls

20 Good News from PLP: Increased Excess Coverage

20 Professional Liability Protection for Staff

Practice Bites26 The importance of

keeping patients’information confidential

Professional Practice28 Know your personal

immunization status!

30 New guideline for the preventionof orthopedic implant infectionin patients undergoingdental procedures

32 Patients with eating disorders:Challenges for the oralhealth professional

34 PEAKCharacteristics and Cost Impactof Severe Odontogenic Infections

36 College Mailbag

37 Calendar of Events

ISSUE ENCLOSURES

Discipline Summaries

PEAK: Characteristics and Cost Impactof Severe Odontogenic Infections


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PRESIDENTDr. Peter Trainor

VICE PRESIDENTDr. John Kalbfleisch

Dr. Robert CarrollDr. David Clark Dr. Lawrence Davidge Dr. Sven GrailDr. John Kalbfleisch Dr. Lisa Mary Kelly Dr. Elizabeth MacSween Dr. David SegalDr. Joe StaskoDr. Peter TrainorDr. Flavio Turchet Dr. Ron Yarascavitch

Royal College of Dental Surgeons of Ontario6 Crescent Road, Toronto ON M4W 1T1

416-961-65551-800-565-4591fax: [email protected]

RCDSO COUNCIL MEMBERS

APPOINTED BY LIEUTENANT-GOVERNOR IN COUNCIL

Marianne Park WoodstockBeth Deazeley OakvilleManohar Kanagamany MarkhamKelly Bolduc-O’Hare Little CurrentTed Callaghan SudburyKurisummoottil Joseph Thunder Bay Catherine Kerr StevensvilleEvelyn Laraya Toronto Dr. Edelgard Mahant TorontoJose Saavedra WoodbridgeAbdul Wahid Scarborough

ACADEMIC APPOINTMENTS

Dr. David Mock University of TorontoDr. Richard Bohay Western University

6 RCDSO in partnership with Homewood Health Centrelaunches new addiction treatment program for dentists

9 Assessments underway for physicians working in dental clinics

10 Annual renewals of HPC certificate of authorization

11 Annual facility permit renewals for CT scanners

37 2012 Annual Report

38 Fairness Commissioner praises College for its good work

39 HPRAC Chair thanks the College for its leadership in self-regulation

WWe all know that we are a health care regulator. Our primarymission, as mandated by law, is to work in the interests of publicsafety and protection.

But underlying that mandate, what we are really about is themanagement of risk and uncertainty.

You can never eliminate risk. But the objective of any goodgoverning board and well-run organization is to manage risk wisely.

In today’s climate of mounting regulations and higher standards ofaccountability from consumers and government, we have no choicebut to continually improve.

We need to act quickly and with intelligence and confidence. Weneed to make the most of opportunities when they emerge.

Experience has shown that well-managed institutions with robustrisk management practices are less likely to encounter difficulties.

They are also less likely to be subject to the intervention of outsidemonitoring agencies, like the Office of the Ontario FairnessCommissioner, or even the Minister of Health.

Being a regulator is a complicated business. There is a broad anddiverse range of laws and regulations, policies and agreements thatimpact our operating environment daily.

We knowingly accept a level of risk as an aspect of day-to-daybusiness activities. But generally our appetite for risk is fairly low.

And so it should be. Everything about our organization is underconstant scrutiny.


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THE PRESIDENT’S MESSAGE

Self-regulation canand does work – and work well

PETER TRAINOR


For example:

• There are the ongoing reviews of our registrationpractices by the Office of the FairnessCommissioner.

• The Health Professions Appeal and Review Boardoversees and reviews the decisions of ourDiscipline Committee panels.

• The Minister of Health has regulatory collegesunder a microscope. She has the power to directlyintervene into the affairs of a College when shehas lost confidence in College and its governingCouncil to appoint a supervisor. She has alreadyexercised that power.

• Our financial operations are subject to an annualreview by third party auditors who report directlyvia the Audit Committee to Council.

• And finally, there is our reputation. This is one ofour greatest assets. We have a trusted brand. It isidentified with quality. But our reputation isconstantly on the line.

So far, our College has done superbly well in all ofthese areas.

Of course, no organization can be perfect. But it mustbe in control.

To do that it needs to address issues in a meaningfulway. It needs to manage proactively not reactively.

We want to know how effective we are in protectingthe public and promoting confidence in dentists andin our role as a regulator.

If something is out of sync, we want to know about it. If we could do better, we want to knowabout that too.

We wanted empirical proof from an independentorganization that the current model of regulation herein Ontario can and does work.

We believe that could be important evidence tocombat the many nay-sayers who are questioningthe value of our model of self-regulation.


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L’autoréglementation,c’est possible et çafonctionne bien

Suite à la page 41Continued on page 40

NNous savons tous que nous sommes on organisme deréglementation des soins de santé. Notre missionprincipale, tel que l’exige la loi, consiste à promouvoirla sécurité et de la protection du public.

Ce qui toutefois sous-tend ce mandat et nous définitréellement, c’est la gestion des risques et del’incertitude.

Nous ne pourrons jamais éliminer les risques, maisl’objectif du conseil de gouvernance de tout bonorganisme bien dirigé consiste à gérer les risques demanière avisée.

Dans la conjoncture actuelle d’une règlementationcroissante et d’une responsabilisation de plus en plusstricte imposée par les consommateurs et lesgouvernements, nous n’avons d’autre choix que denous améliorer sans cesse.

Nous devons agir rapidement, intelligemment et avecconfiance. Nous devons tirer le meilleur parti desoccasions qui se présentent.

L’expérience démontre que des institutions bien géréeset dotées de solides pratiques de gestion des risquesont de meilleures chances de tirer leur épingle du jeu.

Elles sont également moins exposées à l’interventiond’organismes externes de surveillance tels le Bureaudu commissaire à l’équité de l’Ontario, voire même leministre de la Santé.

Le rôle d’un organisme de réglementation estcomplexe. La gamme des lois, règlements, politiqueset ententes qui ont une incidence sur nos activitésquotidiennes est vaste et diversifiée.

Nous acceptons volontiers que certains risquesaccompagnent nos activités quotidiennes, mais notreappétit pour le risque demeure généralement faible.

TThe path to coping with addiction has been streamlined andsimplified for dental professionals in Ontario thanks to anagreement between the Royal College of Dental Surgeons ofOntario (RCDSO) and Homewood Health Centre.

All a dentist needs to do is call a number for help.

The College, in partnership with Homewood Health Centre,is launching an addiction treatment program tailor-made fordental professionals that will ensure those who are addictedhave quick access to effective treatment. This comes at atime when addiction and its devastating effects was a topicat the CDRAF/CDA Wellness Conference, held last Octoberin Toronto.

“The American Dental Association estimates that 10 to 15per cent of dental professionals practicing in the US have analcohol or drug problem and we expect a comparablesituation in Canada,” said Dr. Peter Trainor, president of theCollege. “Dentists who have a substance abuse problempose a danger not only to themselves, but also to thepatients who depend on their care and good judgment. It’s vital that they have quick access to quality treatmentthat is specifically designed to meet the needs of health care professionals.”


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RCDSO IN PARTNERSHIP WITHHOMEWOOD HEALTH CENTRElaunches new addictiontreatment program tailor-made for dentists

No one chooses to

have an addiction –

but anyone can

choose to address

an addiction.

Established in 1883, Homewood HealthCentre is a cornerstone of mental healthand addiction treatment in Canada. With130 years of experience in the field ofaddiction medicine, Homewood isrenowned for quality treatment, medicalintegrity, and the breadth and depth ofits interdisciplinary team.

Homewood offers a specialized 35-daytrack for health care professionals withinits in-patient addiction program.

“Our agreement withHomewood provides astreamlined admission processfor dental professionals thatwill ensure access to addictiontreatment within 72 hours ofHomewood receiving thereferral,” explains Dr. Trainor.“Members in crisis will beaccommodated immediately foradmission. Homewood willassess the patient and developan individualized care plansuited to the patient’s needs.”

Homewood’s addictionprogram offers a continuum ofcare for addicted individuals

and their families, spanning preventionand health promotion, harm reduction,abstinence-based in-patient and out-patient treatment and follow-up.

The 35-day program, which is based ontwo basic principles – abstinence andlifestyle change – consists of threephases: assessment, treatment andaftercare.

Phase 1 – Assessment,Detoxification and Stabilization

This phase, which usually lasts five-to-seven days, provides an opportunity forclinicians to assess the extent of thepatient’s addiction and related problems.All aspects are considered, including thepatient’s physical, psychological, family,social and spiritual well-being.Components include: medicalmanagement of withdrawal anddetoxification; medical stabilization;psychiatric stabilization and educationand preparation for the treatment phase.

Phase 2 – Recovery Program

This phase, lasting 28-to-30 days,involves intensive group work focusingon skill development, educationalgroups, and relapse-prevention toolsspecifically designed for health careprofessionals. Other features of theprogram include ongoing assessment,psychological referral and testing,psychiatric consultation and ongoingmedical supervision, as clinicallyindicated. Depending on the needs of theindividual, transfer to anotherHomewood program may berecommended.

Discharge planning, the final stage ofthis phase of treatment, is specificallytailored to health professionals.


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ADDICTION AFFECTSEVERYONE, WITH FAMILYMEMBERS AND CLOSEFRIENDS FEELING THEIMPACT. HOMEWOOD’SADDICTION PROGRAMINVITES FAMILYMEMBERS TOPARTICIPATE IN A TWO-DAY FAMILY PROGRAMAND EVENING FAMILYINFORMATION SESSIONS.

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Phase 3 – Aftercare

“One of the strengths of Homewood’sAddiction Program is its 36-week follow-up aftercare program,” said Dr. HarryVedelago, addiction specialist and thephysician who is director of the addictionprogram. “Patients are discharged to thecare of their personal physician forfollow-up. Homewood supplements thiswith weekly group sessions, focused onrelapse prevention, which are held at the Homewood facility in Guelph, inaddition to six sessions of one-on-onecounselling offering recovery and social

supports. The counselling sessions areavailable to health professionalswherever they practise in Ontario.”

Addiction affects everyone, with familymembers and close friends feeling theimpact. Homewood’s addiction programinvites family members to participate ina two-day family program and eveningfamily information sessions. Familycounselling is also available, dependingon the individual family needs.

The cost of the 35-day DentalProfessional Addiction Program for an RCDSO member is $33,000, which includes all services. To reserveaccommodation at Homewood, a non-refundable deposit of $7,000 will be required once an admission date is confirmed, with the balance to be paid at the end of the first weekfollowing admission.


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Over the past several years, the College has publishednumerous articles on the topic of wellness in Dispatch. In an effort to help members find this information, we have created a new section on our website that has all of the articles published in Dispatch.

The College is committed to continuing its emphasis on the values of remediation, rehabilitation and support forthose dentists who struggle to cope with addiction.

WHERE TO GET MORE INFORMATIONCheck out the special Wellness section in the MemberResource Centre on the College website at rcdso.org.

RCDSO IN PARTNERSHIP WITH HOMEWOOD HEALTH CENTRE

launches new addiction treatment program tailor-made for dentists

Help is just a phone call awayfor any RCDSO member. If you have an addiction and needtreatment, call the number below, and aHomewood representative will assist you.

Realizing you have an addiction and needhelp is the first step; making that call toHomewood can put you on track to copingwith an addiction.

The number to call is: 1.866.478.4230

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NEW WELLNESS SECTION ON RCDSO.ORG

RCDSO WELLNESS CONSULTANT DR. GRAEME CUNNINGHAMDedicated Direct Line: 647-867-6025All calls are private and confidential.


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The assessments, which began inApril, fall under the authority ofthe CPSO’s Out-of-HospitalPremises Inspection Program.This program, introduced in2010, advances patient safety byregulating physicians at healthcare facilities where certain levelsof anesthesia are administeredduring specified procedures.

RCDSO is working collaborativelywith the CPSO to ensure publicsafety and has asked that dentistsco-operate fully with the CPSOinspectors during the assessmentprocess.

The physician to be assessed isresponsible for ensuring thatdentists are made aware of thedate that the CPSO assessor willbe on site. Fees associated withthe assessment are theresponsibility of the physician andnot members of RCDSO.

The CPSO assessor will onlyassess the physician. Our Collegehas its own facility permit andinspection process in place for theareas that fall within the dentist’sresponsibility, including thephysical space of the clinic.However, if concerns are raisedregarding the standardsmaintained by the physician, theymay be reported to RCDSO forinformation.

Both colleges continue to discussoptions for aligning the twoassessment programs tostreamline the process for bothphysicians and dentists.

Assessmentsunderway forphysicians workingin dental clinicsThe College of Physiciansand Surgeons of Ontario(CPSO) has begun to assessphysicians who provideanesthesia to patients indental offices. More than150 physicians currentlyprovide parenteral sedationor general anesthesia indental clinics throughoutthe province.

FEE REDUCTION FOREARLY PAYMENTThe annual renewal fee of$200 is due by August 31.This fee is discounted to $175if the College receives yourcompleted annual renewalform and fee on or before July31 and you met the annualrenewal requirements.

To renew your Certificate ofAuthorization, you arerequired to submit thecompleted annual renewalform, along with the following:

Applicable Fee: Payable tothe Royal College of DentalSurgeons of Ontario.

Statutory Declaration: FormB executed by a director of thecorporation before acommissioner, lawyer ornotary public not more than15 days before the annualrenewal form is submitted.

Current-dated Certificate ofStatus: Issued by the Ministerof Government Services notmore than 30 days before theday it is submitted to the

College and dated prior to theexecution of your StatutoryDeclaration.

EXPIRY DATEAll Certificates ofAuthorization expire onAugust 31 of every year,regardless of the initial datethat it was issued. That meansfor dentists who applied for aCertificate of Authorization thisyear, it is only valid untilAugust 31.

STATUTORY DECLARATIONFORM BThe Statutory Declarationcertifying that the corporationis in compliance with Section3.2 of the BusinessCorporations Act must besworn in the physical presenceof a commissioner, lawyer ornotary public. Provinciallegislation requires thisStatutory Declaration to beexecuted not more than 15days before your application issubmitted.

CERTIFICATE OF STATUSA Certificate of Status is a one-page document issued by theMinistry of GovernmentServices that indicates thecorporation is active.Provincial legislation requiresthat a current-dated Certificateof Status accompanies yourannual renewal form,regardless of how new yourHPC is.


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Annual Renewals of HPCCertificate of Authorization in the Mail During June

COLLEGE CONTACT Camille Ripley – Administrative Assistant, Registration416-961-6555 1-800-565-4591

[email protected]

DOS AND DON’TS ABOUT HPC RENEWAL PROCESSDO ensure that you are in the physical presence of thecommissioner, lawyer or notary public to have your StatutoryDeclaration executed.

DO NOT sign and date the Statutory Declaration prior to yourattendance with the commissioner, lawyer or notary publicthat swears your declaration dated prior to the execution ofyour Statutory Declaration.

DO ensure that you submit a current-dated Certificate ofStatus of the corporation.

DO NOT fax your paperwork to the College as the annualrenewal form and the Statutory Declaration must haveoriginal signatures.

WHERE TO GET MOREINFORMATIONCheck out the specialsection for healthprofession corporations inthe Member ResourceCentre on the Collegewebsite at rcdso.org.


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The annual renewal of thefacility permit for yourdental CT scanner is onthe horizon. If youcurrently hold an annualfacility permit, yourannual renewal form willarrive in the mail duringAugust.

ANNUAL RENEWAL FEEThe annual renewal fee of$400 is due October 31. Thisfee is applicable to everyfacility holding an annualfacility permit for the purposeof operating a dental CTscanner. To renew your permit,you are required to submit thecompleted annual renewalform sent to you during themonth of August.

EXPIRY DATEAll annual facility permitsexpire on October 31 of everyyear, regardless of the initialdate of issuance. This meansthat, regardless of when theannual facility permit wasissued, it is only valid untilOctober 31.

REGULAR MAINTENANCE Please note that all facilitypermit holders are responsiblefor developing andmaintaining a qualityassurance program to ensurethe accuracy and reliability ofthe facility’s equipment. Thisincludes ensuring that thedental CT scanner is properlymaintained and calibrated asrecommended by themanufacturer.

Written records of regular (i.e. at least annual)maintenance and equipmentcalibration must be kept on file for review by the Collegeas required.

SIGNED ATTESTATIONAs part of the renewal process,the facility permit holder willbe responsible for signing anattestation declaring that onlydentists authorized by theCollege and listed on theannual facility permit areprescribing, ordering, andtaking the dental CT scans atthe facility.

Annual Facility Permit Renewalsfor CT Scanners in the Mail During August

COLLEGE CONTACT Katya Shtrachman – Administrative Assistant, Registration416-961-6555 1-800-565-4591

[email protected]

WHERE TO GET MOREINFORMATIONCheck out the specialsection for dental CTscanners in the MemberResource Centre on theCollege website atwww.rcdso.org.

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On April 1, 2013, the College successfully launchedthe new online e-Portfolio. You can now track yourcontinuing education pointsonline and know at a glance howmany points you have achievedin each category and how manyare left to fulfill your 90 CE-point requirement.

The e-Portfolio includes afrequently asked questions (FAQ) section that youcan refer to as you use the program. The Collegeupdates this section as questions come in frommembers, but we thought it would be helpful toinclude some of those questions here in Dispatch,along with other questions we’ve received frommembers about the e-Portfolio and continuingeducation requirements.

e-Portfolio:Frequently Asked Questions

QUALITY ASSURANCE PROGRAM

How do I log into my e-Portfolio?To access your e-Portfolio, youmust first log into your memberresource centre account. Onceyou have logged in, look at thenavigation menu on the left sideof the screen and click Your e-Portfolio. This will log you intoyour e-Portfolio account whereyou can log your CE activities.

How do I log my CE activities?Logging CE courses through your e-Portfolio is verystraightforward. The first step isselecting an activity type. Thereare 10 different activity types.Once you've selected the activitytype, fill out the entry form withthe required information.

After you've logged your activity,you can always go back to editthe entry. You can also choose to attach any certificates orsupporting documentation.

How do I achieve my requirement of 90 CE points?At least 15 CE points must beobtained from successfullyparticipating in Category 1 corecourses approved by the QualityAssurance Committee. Once you

reach your minimum 15 CE-pointrequirement, additional CE pointsearned by taking Category 1 corecourses count towards yourCategory 2 minimum requirementand your overall 90 CE-pointrequirement.

You must also obtain a minimumof 45 CE points in Category 2.Once you reach your minimum45 CE-point requirement,additional CE points earned bytaking Category 2 courses counttowards your overall 90 CE-pointrequirement. However, you muststill obtain 15 CE points inCategory 1.

There is no mandatory CE pointrequirement for Category 3. You can achieve your overall 90 CE-point requirement byearning those points in Categories1 and 2. You can earn points inCategory 3 towards your overall90 CE-point requirement,provided you fulfill your CE obligations for Categories 1 and 2.

What happens to the CE points I haveaccumulated sinceSeptember 15, 2007?This only applies to memberswho were registered with theCollege before December 15,2011.

Since September 15, 2007, theCollege has asked members tokeep track of their CE points onlog sheets. The CE points earnedduring the transition period canbe used towards your currentthree-year cycle, which began onDecember 15, 2011. These CEpoints must be claimed in theappropriate categories. As withany CE activities, to claim pointsyou must have certificates orsupporting documentation.

When does my CE cycle begin?For current members, your CEcycle begins on December 15 of acalendar year and runs for threeyears ending on December 14.

For new members who have justregistered with the College, yourCE cycle begins on December 15of the calendar year in which youregistered.

If you are enrolled in a full-timepost-graduate program, you areexempt from CE requirements.However, it is your responsibilityto inform the College’s QualityAssurance department.


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How do I know if I shouldclaim my CE points incategory 2 or 3?You can claim CE points in Category2 for courses given by an approvedsponsor that are clinical dental innature. For self-study programs,these must be given by anapproved sponsor, be clinical dentalin nature and have an independentassessment component.

You can claim CE points in Category3 for CE activities offered by non-approved sponsors, or offered byapproved sponsors on non-clinicaldental topics that are relevant to thepractice of the profession.

Please note that general attendanceat dental conventions qualifies forCE points in Category 3. If youattend a course/lecture/seminar ona clinical dental topic whileattending at a dental conventionoffered by an approved sponsor,you may claim this portion of yourCE points in Category 2 and thebalance in Category 3.

Can I claim points for CEactivities completed beforeSeptember 15, 2007?No. The previous CE program endedon September 14, 2007. Weentered a transition period fromSeptember 15, 2007 – December14, 2011 and the new QA programwas implemented on December 15,2011.

You can claim points for CEactivities completed during thetransition period.

How do I know if asponsor is approved ornon-approved?Although the College does notapprove specific CE courses, we doaccept programs for CE points inCategory 2 based on the approvedsponsor categories. The list ofapproved sponsor categories, aswell as the list of approved studyclubs, is on the College website atwww.rcdso.org under ContinuingEducation.

As a general rule, most non-approved sponsors are dentists whooffer courses themselves or somedental labs and supply companies.You can check to see if a sponsor isapproved by the Academy ofGeneral Dentistry at www.agd.orgor with the American DentalAssociation at www.ada.org. Allnon-approved sponsors are requiredto inform dentists of their status onthe certificate or supportingdocuments given to attendees.

How do I report mycontinuing education tothe College?You need to keep your e-Portfolioup-to-date, as well as keep anypaper records of your CE activitiesand log sheets you have completedduring the transition period. At theend of a three-year cycle, there willbe a random selection of memberswho will have their e-Portfolio andsupporting documentationreviewed. You will be asked by theCollege to submit your certificatesand supporting documentation.


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e-Portfolio: Frequently Asked Questions

ACCESS YOUR MEMBER RESOURCE CENTRE ACCOUNTYou access your personal member resource centre account throughthe College website. To access your account, you must enter yourregistration number and unique password. If you have registered ane-mail address with the College, click Forgot Password and an e-mail with your temporary password will be sent to the address youhave on file with the College.


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As you know, theCollege’s PracticeEnhancement Tool hasbeen up and runningsince January. TheCollege continues torandomly selectmembers to completePET, and we havereceived some positivefeedback from those ofyou who have alreadycompleted theassessment. Some of that feedback is in the mailbagfeature of this issue of Dispatch on page 36.

For those of you who have yet to be selected or arein the process of completing the assessment, theCollege has put together a list of resources that youmay find helpful. There is no single source ofinformation to help you complete PET, but the list ofresources compiled by the Quality Assurancedepartment has links to information on thecompetencies currently covered by PET. As newcompetency areas are incorporated into PET, theresource list will be updated with new informationto help members through the assessment.

The current resource list is available on the Collegewebsite at www.rcdso.org in the KnowledgeCentre/Quality Assurance Program section. You canalso download it from the quick links available onthe ‘Members’ section on the website homepage.

You are free to review the resources we have puttogether for PET before, during or after completingyour assessment. Remember, as you complete yourassessment you can pause during a session, log outand research a particular subject area beforeproceeding or use a built-in feature of PET thatallows you to flag questions that you would like toreview before answering.

Practice EnhancementTool resource listavailable on website

COLLEGE CONTACT Dr. Greg Anderson – Practice Enhancement Consultant416-934-5620 1-800-565-4591

[email protected]


OOur new website has a number of important resources formembers. Many of these resources can be found in thepublicly accessible Member Resource Centre area of the site.

If you click on the Member Resource Centre section on ourwebsite, you are taken to the page below.

From here, you can log into your personal member resourcecentre account toaccess your e-Portfolio, updateyour e-mailaddress, etc.

If you look at theleft side navigationmenu, you will seethat you can alsofind resources andforms related tohealth professioncorporations,sedation andanesthesia, dentalCT scanners, lettersof standing, riskmanagement andour practiceadvisory services.


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Member resources on rcdso.org

Website Spotlight is a regular

feature that highlights

important content found on

the College’s website,

www.rcdso.org. Adventurous

types who eagerly await the

next spotlight can visit our

site and tour the many

e-resources available online,

such as the member resource

centre, standards of practice

and information on the

College’s Quality Assurance

program.

WEBSITE SPOTLIGHT


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You don’t have to log into yourmember resource centre accountto access these sub-sections.

Each sub-section containsrelevant forms, articles fromprevious issues of Dispatch, andcontact information for Collegestaff who can help you.

For example, the section onsedation and anesthesia has theCollege standard of practice,

registration form and facility permit application form onthe right side of the page. If you scroll down, you will seeresources including checklists and a sample oral moderatesedation record and also a series of Dispatch articles onthe topic.

These sections are updated with relevant information as itbecomes available, so be sure to check the site regularlyfor updates.

COLLEGE CONTACT Angelo Avecillas – Communications Specialist/Webmaster416-961-6555, ext 4303 [email protected]

WEBSITE SPOTLIGHT

PLPPLP and the Practice Advisory Service often receive enquiriesfrom members about issues arising from the associate-principal relationship. For example, an associate may beunsure about his obligations when directed by the principal toperform treatment that may be unnecessary or inappropriate;a principal may need advice on responding to patient concernsabout care provided by an associate; or there may bequestions about access to patient records by an associate whohas left the practice.

As regulated health professionals, all dentists are legallyresponsible for their own conduct. An associate must thereforeexercise independent and reasonable judgment and would notescape blame for providing unwarranted or otherwiseimproper treatment, or for straying beyond his skills andabilities, simply because he was acting on the principal’sinstructions. At best, the principal may share liability forrecommending the therapy or for inadequate training orsupervision of the associate.

Dentists who are also employers may be held accountable notonly for their own acts and omissions, but for those of theiremployees as well. Principals or clinic owners may thus beexposed to vicarious liability for the actions of associate-


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MALPRACTICE MATTERSRISK MANAGEMENT ADVICE FROM PLP

Associates andPrincipals: Issues and Pitfalls

PLP

employees even if they have personally donenothing wrong.

For this and other reasons, it is notuncommon for patients or their lawyers toapproach a principal with a demand for arefund or compensation for allegeddeficiencies in treatment rendered by anassociate. If this occurs, the principal shouldnot comment on the allegations or offer anypayment on behalf of the practice or theassociate. Rather, he or she should ensurethat the associate is aware of the request andboth dentists should phone PLP for advice onhow to respond.

If an action is commenced against both andthe only claim against the principal is forvicarious liability, efforts will be made toextricate that defendant from the proceedings.Should settlement be deemed appropriate,payment will be made only on behalf of themember(s) whose care is found to be sub-standard.

In some cases, an associate learns of apatient’s concerns after leaving a practice. Inorder to investigate the matter, PLP requirescopies of the patient’s dental records. In law,the physical records may be the property ofthe practice, but their content belongs to the

patient. It would therefore be a breach ofprivacy for the principal or owner to providecopies of the chart to the associate or PLPwithout the patient’s authorization. Of course,once that consent has been received, thehealth information custodian has anobligation to comply with the patient’s requestin a timely fashion.

Sadly, many of the calls to PLP aboutassociate-principal rights and responsibilitiesare made only after the relationship hassoured, and many involve problems triggeredby unfortunate remarks made by one aboutthe other.

It is worth remembering that finger-pointingbetween dentists does nothing to enhance theimage of the profession and may actuallyincite patient complaints and litigation. It isalso worthwhile to keep the phone numbersfor PLP and the Practice Advisory Servicehandy and contact us early in the hopes ofstopping trouble before it starts.


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COLLEGE CONTACTS René Brewer – Manager, Professional Liability Program416-934-5609 1-877-817-3757

[email protected]

Lesia Waschuk – Practice Advisor, Quality Assurance416-934-5614 1-800-565-4591

[email protected]

PLPF

SSome time ago, the Regulated HealthProfessions Act was amended to mandateindividual malpractice coverage for everyregulated health professional. Thatprovision has never been proclaimed inforce, but the Minister of Health and Long-Term Care recently ordered all health careregulatory colleges to pass measuresrequiring their members to have liabilityprotection by June 30, 2013, to take effectno later than January 1, 2014.

Under the RCDSO contract with ENCON

Insurance Managers, the definition of“Insured(s)” includes a member’s or healthprofession corporation’s employees, exceptthose who have or are required by theirgoverning body to have professionalliability protection.

Therefore, any non-dentist regulated healthprofessional in your practice will not beeligible for PLP assistance as of January 1,2014, if not before. It would be wise toexplore alternatives for those employeessooner rather than later.

For some time, College members have hadthe ability to purchase excess liabilityprotection of $8 million, for a total of $10million per occurrence. We are pleased toannounce that, in response to enquiriesmade on behalf of the membership, theexcess coverage provider has agreed tooffer increased protection, the exact

amount and cost of which will bedetermined on a case-by-case basis andsubject to underwriter approval.

Any interested members should contact theMarsh Canada Health Care Team at 416-349-4387 or 416-349-4544.


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Good News from PLP:Increased Excess Coverage

Professional LiabilityProtection for Staff

COLLEGE CONTACT René Brewer – Manager, Professional Liability Program416-934-5609 1-877-817-3757

[email protected]


21

The 2013 version of the membership listings,a.k.a. the Source Guide, is now posted on theCollege’s website. This electronic version is easyto search to find the specific information youneed, like practice addresses and phone numbersfor a particular dentist.

As usual, the information is divided into anumber of key categories that are all easilysearchable to find the information that you andyour staff need:

• dental specialists by specialty

• dentists in alphabetical order

• dentists by geographical area

• health profession corporations.The electronic version can be printed off in itsentirety, or you can print off specific pages orsections. You can search the document to lookfor exactly what you need; for example, aspecific dentist by name. Just type the dentist’sname in the ‘Find’ field and press enter. You willbe taken to the first page that containsinformation on that dentist. Because somedentists share the same surname, if the firstmatch is not who you were looking for, continueto press enter to scroll through the list ofmatches.

The information in the Source Guide is asaccurate as possible as of March 31, 2013. Forthe most current information in real time, pleaseuse the ‘Find a Dentist’ button available fromthe home page of the College website atwww.rcdso.org. The register is easy to use andyou can filter by city and specialty.

If you have questions or concerns about yourpersonal listing, please contact staff in theregistration area of the College.

Latest issue of SOURCE GUIDE now online

COLLEGE CONTACT Angelo Avecillas – Communications Specialist/Webmaster416-961-6555, ext 4303 [email protected]

2013Source Guideto Dentists and Specialists in Ontario

Continuing education is a cornerstone of professionalpractice and a key component of the College’s QualityAssurance program. Continuing education activitiesneed to support ongoing competence, incorporateexisting or changing standards of practice and prepareyou for changes in the practice environment ortechnological advances. While learning needs andpriorities change over time, in the end, the ultimate goalis to facilitate continuous quality improvement.

There are many ways to pursue this obligation: viewingDVD-based programs, subscribing to onlinepresentations and webinars or participating in livedidactic and hands-on courses. When it comes to livecourses, there are a vast array of venues, formats,individuals and organizations from which to choose.Many courses also accommodate and encourageauxiliary participation.

Given your busy schedule, defined budget, and thevariety of speakers, course topics and course sponsorsavailable, selection of continuing education activitiescan be challenging.

Ongoing self-assessment is an important strategy in thisdecision-making process and some of the followingfactors could be part of your considerations:

• A specific patient treatment may be forthcoming soadditional training is desirable or necessary in orderto prepare for this and/or similar procedures. Or, inorder to provide certain services in your practice,such as sedation or implants, you need to addressthe specific educational requirements as set out inthe related College guidelines or standards ofpractice.

• Difficulties occasionally arise while providingtreatment, so you decide to upgrade yourknowledge and skills necessary to solve and/orprevent certain problems.

• Patient demographics and/or patient demandmotivate you to incorporate particular technologies,materials or services into your practice.

• Course selection can also be influenced by practicalissues, such as a suggestion from a colleague, aconvenient course time at an affordable cost, aprogram with a hands-on component, a reasonabletravel distance, or perhaps combining a CE eventwith a vacation.

• You may develop scientific, technological orfinancial interests in particular dental or even non-dental subject areas, perhaps after reviewing anintriguing course synopsis or reading an engagingjournal article.


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Making decisionsabout the rightCE Course for you


Details of the course sponsor or program speaker arealso significant factors in course selection; for example:

• Will financial or commercial interests in a particularproduct or service be discussed in the program?

• Has a speaker authored articles in peer-reviewedpublications and/or have an affiliation with anacademic institution?

• Is the course PACE approved by the Academy ofGeneral Dentistry (AGD) or has it received CERPrecognition by the American Dental Association(ADA)?

• Is it a course offered by a College-approvedsponsor?

The College has a list of approved sponsor categoriesposted on our website at rcdso.org in the QualityAssurance area. Dentists taking a clinical dental courseprovided by an approved sponsor may claim CE pointsin Category 2 of the Quality Assurance Program.

Non-clinical courses, in areas such as practicemanagement, communication or finance, and clinicaldental courses given by non-approved sponsors areeligible for CE points in Category 3.

Then there are the Category 1 core courses that must berelevant to the practice of dentistry and offered by anapproved sponsor. These courses must also be submittedto the Quality Assurance Committee for considerationand approval.

In reviewing these courses, the QA Committee considerssuch factors as:

• course providers are recognized experts on thesubject;

• the quality of the delivery mode;

• references or links to supportive educationalmaterials;

• absence of any commercial bias;

• whether there is an independent assessmentcomponent;

• accessibility to all members equally.

An updated list of Category 1 courses isposted on the College website in theKnowledge Centre too. It includes coursesfrom organizations such as the OntarioDental Association, Ontario Academy ofGeneral Dentistry, the University ofToronto, Western University, the Centre forAddiction and Mental Health, AmericanCollege of Dentists and the TorontoAcademy of Dentistry

The online Knowledge Centre is also whereyou will find information on the College’sLifeLong Learning programs and webinars.

Participating in CE activities can be an enjoyablejourney. At the same time, you are learning somethingnew, reinforcing previous knowledge, integratinginformation into practice and improving treatmentoutcomes.

However, before implementing new learning intopractice, it is your responsibility to ensure that thecourse content is congruent with the standards ofpractice, regulations and current evidence-basedguidelines.


23COLLEGE CONTACT Dr. Greg Anderson – Practice Enhancement Consultant

416-934-5620 1-800-565-4591

[email protected]


THE PRACTICEENHANCEMENTCONSULTANT ISREADY TO PROVIDEMEMBERS WITHASSISTANCE INCOURSE SELECTIONAND OTHERCONTINUINGEDUCATIONINITIATIVES

Whether searching for aparticular textbook ordental journal, findingonline references orlearning how to conduct aliterature search,academic libraries arethere to help.

Each of the two facultiesof dentistry in Ontario hasa library offering servicesto students, faculty,alumni and non-alumnidentists, as well as to thegeneral public.

UNIVERSITY OF TORONTOThe library at the University ofToronto, located within the Facultyitself, provides a number of optionsfor dentists to access information.For those dentists who are able tovisit the library, all the textbooksand print journals are accessible forreview and computer terminals areavailable in order to access any ofthe electronic journals.

In fact, between print and electronicversions, the library offers access toover 250 dental journal titles.Although photocopying is availableon-site, those wishing to print anyof the online articles to which thelibrary has rights can do so byvisiting any of the University ofToronto libraries, such as Robarts,

Ontario Institute for Studies inEducation (OISE), or the GersteinScience Information Centre.

Alumni dentists may purchase eitheran Alumni Reader card or AlumniResearch Reader card. Both of thesecards allow you to borrow printbooks and journals, as well as CD-ROMs and DVDs, from anyUniversity of Toronto library for aspecified period of time. Non-alumnimay also purchase a ResearchReader card, although there is ahigher associated fee. There is anadditional service called the DigitalLibrary for Alumni, available only toalumni, which provides onlineaccess, from anywhere, to select fulltext articles from several dentaljournals.


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When searching for information,don’t forget about libraries


The U of T Dentistry websitepresents a multitude of electronicresources, as well as additionalinformation on the products andservices available.

Under the e-resources heading onthe main page, you can selectResearch Guides, which offersseveral resources including a ClinicalDecision Making Desktop Library.This guide provides links to severaldatabases, articles, organizationsand journals, with some of thecontent available at no cost.

Within the Clinical Decision MakingDesktop Library, the EBD (Evidence-Based Dentistry) tab offers abstractsand commentary from the Journal ofEvidence-Based Dentistry andsuggested textbooks on the topic.

The Resources by Subject tab leadsthe user to abstracts of systematicreviews and articles from relatedjournals, while the Database tablinks the viewer to such search toolsas PubMed or TRIP.

Once again under Research Guides,general information regardinglibrary services is available byclicking on the InformationResources for Dentists Guide.

WESTERN UNIVERSITYThe Allyn and Betty Taylor Libraryat Western University, located oncampus in the Natural SciencesCentre, serves several facultiesincluding the Schulich School of

Medicine and Dentistry. This facilityhouses the dental collectionsupporting all of the programsoffered by Schulich Dentistry.

Dentists able to visit Taylor Librarywill also have access to all textbookand print publications for use withinthe library. In addition, the libraryoffers guest access to computerterminals to explore and make useof electronic resources available atWestern.

When visiting any of the Westernlibraries, the Taylor Library websiteprovides research support for thedental programs and is facilitatedthrough the Program Guide forDentistry. This guide providessuggested resources for a variety ofpublication types, and aids in theresearch process in all areas ofdentistry.

The Taylor Library has facilities forboth photocopying and printing,used by guests purchasing a GraphicServices debit card at the ServiceDesk. There are also optionsavailable for both alumni andvisitors to borrow print resources.Alumni dentists may acquire, free ofcharge, a Western Alumni Cardwhich allows a member to borrowregular loan items includingtextbooks. Non-alumni may beeligible for a Visitor Library Card.The Western website has furtherinformation on the applicationprocess.


25

CONTACT INFORMATION FOR LIBRARIESIt is wise for anyone wishing to visit one of thelibraries to first check the hours of operation.

Faculty of Dentistry LibraryUniversity of Toronto124 Edward Street, Room 267 Toronto ON M5G 1G6

website: dentistry.library.utoronto.ca

email: [email protected]

phone: 416-979-4916 (press 1 and then extension 4560)

Allyn and Betty Taylor LibraryWestern UniversityNatural Sciences CentreLondon, ON N6A 5B7

website: lib.uwo.ca/taylor

email: live link from website

phone: 519-661-3168

COLLEGE CONTACT Dr. Greg Anderson – Practice Enhancement Consultant416-934-5620 1-800-565-4591

[email protected]


INTERLIBRARY LOANSDentists who are unable to attend either aWestern or a U of T library personally are stillable to borrow a textbook or purchase ajournal article by visiting their local publiclibrary, registering with them, and requestingan interlibrary loan. When seeking a textbook,the requested text, if available, is then shippedto the local library for a fee.

DDentists deal with confidential information every day. Theinformation is most often related to a patient’s health, but it mayalso be related to finances. In cases where a dentist is treatingmultiple family members or other people who know eachother, it is incumbent on the dentist to be even more carefulabout discussing one patient with another. The followingcomplaint illustrates how the Inquiries, Complaints andReports Committee (ICR) dealt with such an incident.

The patient wrote to the College complaining thatthe dentist:

• breached patient confidentiality bydisclosing details of his treatment andaccount status to a work colleague without consent;

• called his home numerous times regarding payment of an outstanding account.

The patient was referred to the dentist by a work colleague, who indicatedthat the dentist would offer discounts for the treatment he provided. Thepatient saw the dentist on a number of occasions and paid an initial invoice.The patient noted that he was told that any additional charges would becovered by insurance. The patient claimed that he never saw how much his


26

The Importance ofKeeping Patients’InformationConfidential

PRACTICE BITES

PRACTICE BITES

insurance was billed or whattreatments the dentist claimed wasperformed. Finally, the patientcomplained that the dentist haddiscussed both his treatment andthe status of his account with thecolleague who had referred him tothe office.

In his response to the complaint,the dentist noted that problemswith the patient first began whenthe patient refused to pay hisinsurance co-payment and alsofailed to forward to the dentistfunds he received from hisinsurance. The dentist noted that inhis waiting room there was aprominently posted informationsheet that reminded patients oftheir responsibility regarding co-payments. The dentist alsoasserted that an estimate for acrown had been submitted andprovided to the patient.

The dentist explained that his staffhad called the patient many timesin an effort to clear the outstandingaccount. Messages were left for thepatient, but none were returned. Inaddition, the dentist had sent thepatient a detailed accountstatement with copies of all of thepatient’s insurance payments.

The dentist confirmed that thepatient had been referred by hiswork colleague, who was a regularpatient. When the work colleaguesaw the dentist for his own

treatment and enquired about thedentist’s experience with thepatient, the dentist admitted thatthe office had experienced somedifficulty collecting the outstandingaccount.

The dentist added that, althoughhe made this statement, he did notdiscuss the patient’s treatment ormedical history. The dentist’sversion of this discussion wascorroborated by the workcolleague, who stated that, whilethe dentist did not discuss thepatient’s treatment, he did mentionhis efforts to collect the funds owedto him. The work colleague addedthat the dentist suggested that hespeak with the patient aboutpaying the account before anylegal proceedings were started.

In reviewing the complaint, the ICRpanel noted that it shared the

patient’s concerns aboutconfidentiality. The panel pointedout that it is the dentist’sprofessional duty to protect theconfidentiality of patients’ personaland health information. This dutyalso includes information related toa patient’s financial and accountstatus.

Accordingly, if the patient did notconsent, it was improper for thedentist to discuss the patient’saccount status with a friend oracquaintance. The panel also feltthat it was improper for the dentistto involve the work colleague inthe attempt to collect funds fromthe patient.

The panel also noted a lack ofdocumentation about the treatmentprovided or the cost. Similarly, themember’s records did not containany invoices from the dentist to thepatient explaining the treatmentrendered. Ultimately, the panelordered that the dentist attendbefore a panel for an oral caution.Specifically, the dentist wascautioned that he is obligated tomaintain confidentiality, and thatany disclosure of a patient’sconfidential information withoutconsent is a breach of hisprofessional duties. The dentistwas further cautioned that heshould provide a clear and detailedstatement of account to patients forall treatment rendered.


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...HE IS OBLIGATEDTO MAINTAINCONFIDENTIALITY,AND THAT ANYDISCLOSURE OF A PATIENT’SCONFIDENTIALINFORMATIONWITHOUTCONSENT IS ABREACH OF HISPROFESSIONALDUTIES.

“

A


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PROFESSIONAL PRACTICE

All OHCWs should be adequately immunized againstthe following diseases:

HEPATITIS B MEASLES

MUMPS RUBELLA

VARICELLA INFLUENZA

DIPHTHERIA PERTUSSIS

TETANUS POLIOIt is important that all OHCWs know their personalimmunization status and ensure that it is up-to-date.OHCWs should consult with their family physicianabout the need for immunizations, as well as baselineand annual tuberculosis skin testing. The CanadianImmunization Guide sets out recommendations andschedules for adults, including those engaged in theprovision of health care.

Hepatitis B is the most important vaccine-preventableinfectious disease for all workers engaged in healthcare. The risk of being infected is a consequence of theprevalence of virus carriers in the population receivingcare, the frequency of exposure to blood and otherbody fluids, and the contagiousness of hepatitis Bvirus (HBV). Immunization against HBV is stronglyrecommended for all OHCWs who may be exposed toblood, body fluids or injury involving sharps.

Serological testing for anti-HBs should be conductedone to two months after completion of the three-dosevaccination series to establish antibody response.OHCWs who fail to develop an adequate antibodyresponse should complete a second vaccination series,followed by retesting for anti-HBs. OHCWs who fail to

Know Your PersonalImmunizationStatus!Immunizationssubstantially reducethe number of oralhealth care workers(OHCW) susceptibleto infectious diseases,as well as thepotential for diseasetransmission to otherstaff and patients.That is whyimmunizations are anessential part ofinfection preventionand control programs.


29


respond to the second vaccination seriesshould be tested for HBsAg.

Nonresponders to vaccination who areHBsAg-negative should be counselledregarding precautions to prevent HBVinfection and the need to obtainimmunoglobulin prophylaxis for any knownor probable parenteral exposure to HBsAg-positive blood.

OHCWs who are HBsAg-positive should seekguidance regarding necessary andreasonable steps to prevent HBVtransmission to others and the need formedical evaluation. In particular, OHCWswho may perform exposure-proneprocedures should be assessed on a case-by-case basis regarding the need for possiblework restrictions.

COLLEGE CONTACT Dr. Michael Gardner – Manager, Quality Assurance416-934-5611 1-800-565-4591

[email protected]

ILLNESS AND WORK RESTRICTIONSOHCWs may be concerned about contracting illnesses in thedental office. Such occurrences can be minimized by employingbest practices for infection prevention and control, including:

• ensuring adequate and appropriate immunization of all OHCWs;

• triaging patients and rescheduling those who are ill;

• adhering to routine practices, including effective hand hygienebefore and after each patient contact.

Unique situations that may warrant particular attention by anOHCW include:

Dermatitis – When the protective skin barrier is broken, as occurswith chapped hands or exzema, an OHCW is at increased risk ofacquiring and transmitting infection through the exposed area.Good skin care should always be practised. Any areas of dermatitisshould be covered with bandages, in addition to wearing gloves.

Immunocompromised staff – Immunocompromised OHCWs areat increased risk of becoming infected and may suffer more severeconsequences. They may also be at risk of shedding viruses (e.g.influenza) for prolonged periods. Where feasible, job functions andassociated exposure risks should be considered.

OHCWs who have an upper respiratory illness (e.g. common cold)should take the necessary precautions to prevent the transmissionof micro-organisms to patients and other staff. Diligent handhygiene is especially important. OHCWs who have a severerespiratory illness with fever, acute viral gastroenteritis withvomiting and diarrhea, or acute conjunctivitis should stay at homeuntil their symptoms have subsided.

OHCWs who have oral and/or nasal herpes simplex infections (i.e.cold sores) should pay particular attention tohand hygiene and not touch the affected area.In this situation, the use of a mask may help toremind the worker not to touch the lesions.

For further information about best practicesfor infection prevention and control, please

refer to the College’s Guidelines on Infection Prevention andControl in the Dental Office. They are available in the KnowledgeCentre of our website at www.rcdso.org.

IMPORTANT NOTICEOHCWs who may perform exposure-prone procedures have anethical obligation to know their serologic status. If infected,dentists should seek guidance from the College with respect tothe potential for transmission of their infection to their patients.

T


30


As described in the new guideline, the AAOS/ADArecommendations are:

The practitioner might consider discontinuing the practiceof routinely prescribing prophylactic antibiotics forpatients with hip and knee prosthetic joint implantsundergoing dental procedures.

We are unable to recommend for or against the use oftopical oral antimicrobials in patients with prosthetic jointimplants or other orthopedic implants undergoing dentalprocedures.

In the absence of reliable evidence linking poor oralhealth to prosthetic joint infection, it is the opinion of thework group that patients with prosthetic joint implants orother orthopedic implants maintain appropriate oralhygiene.

The AAOS and ADA have advised that these recommendations arenot intended to stand alone. Treatment decisions should be made inlight of all circumstances presented by the patient. Treatments andprocedures applicable to the individual patient rely on mutualcommunication between patient, physician, dentist and otherhealthcare practitioners in accordance with evidence-basedmedicine applicability.

New Guideline for thePrevention of OrthopedicImplant Infection inPatients UndergoingDental Procedures

The American Dental Association(ADA) and the AmericanAcademy of OrthopaedicSurgeons (AAOS) have releaseda new evidence-based guidelineon the prevention of orthopedicimplant infection in patientsundergoing dental procedures.The new guideline has threerecommendations and replacesthe previous 2009 AAOSInformation Statement onAntibiotic Prophylaxis forBacteremia in Patients with JointReplacement.

Based on a collaborativesystematic review of the scientificliterature, the AAOS and theADA have found that theevidence does not supportroutine prescription of antibioticprophylaxis for patients withjoint replacement undergoingdental procedures.


31


INTERPROFESSIONAL CONSULTATION IS IMPORTANTMembers are reminded that patients may present with arecommendation from a physician that is inconsistent with currentguidelines for antibiotic prophylaxis. This may reflect a lack offamiliarity with the guidelines or special considerations about thepatient’s medical condition of which the dentist is unaware. In suchcircumstances, members are encouraged to consult with the physician.

Ideally, consensus should be reached among the professionals involved.However, each is ultimately responsible for his orher own treatment decisions.

As a result of this consultation, the dentist maydecide to follow the physician’s recommendationor, if professional judgment dictates that antibioticprophylaxis is not indicated, decline to provide it. Inthe latter circumstance, the dentist may suggestthat the physician should prescribe for the patientas she or he deems appropriate.


[email protected]

ADVICE FROM THE COLLEGEMembers should review the new guidelinefrom the AAOS and the ADA and implement itin their offices.

The evidence does not demonstrate thatantibiotics taken before dental procedureshelp prevent infections of orthopaedicimplants, and the routine use of antibiotics inthis manner has potential side-effects, suchas increased bacterial resistance, allergicreactions, diarrhea and possibly death.Therefore, members should not prescribeantibiotic prophylaxis unless patients have amedical condition that may place them atgreater risk for implant infections.

Medical conditions that may place patients atgreater risk for implant infections include (butare not limited to) diabetes, rheumatoidarthritis, cancer, chemotherapy and chronicsteroid use. For patients with such medicalconditions, decisions about antibioticprophylaxis should be made in consultationwith their physicians in a context of opencommunication and informed consent.

The full guideline, executivesummary, shared decisionmaking tool and othersupporting documents areavailable from both websites ofthe AAOS at www.aaos.org andthe ADA at www.ada.org.

EEating disorders represent a serious, lifethreatening psychiatric illness affecting adisproportionate number of females. Thelifetime prevalence is approximately 3%.

This illness usually arises duringadolescence, a period of major lifetransitions.

Adolescence is a time for a search ofindividuality, purpose, andindependence, when identification withpeer groups becomes increasinglyimportant. The result may be a selectiverejection of beliefs and values that wereestablished previously by family, peersand society in general.

Constant bombardment from the mediawith images of ultimate thinness haspushed dieting into the realm of sociallyacceptable behaviour. The etiology ofeating disorders is, however, often morecomplex, involving an intricate interplayamong biological, psychological and

social issues. Research now suggestspossible genetic links contributing to thedevelopment of eating disorders.

While food appears to be the centralissue, in reality it is the characterizationof food-related problems that become anoutlet for the expression of a variety ofmore serious underlying psychosocialissues or disturbances. The result is aproblematic coping strategy.

Common co-morbid psychiatric disorderscan include depression, anxiety orpersonality disorders and substanceabuse. While sociocultural factors instilla desire for thinness and beauty, theyoften simultaneously stigmatize obesity.

Dieting quickly becomes a measure ofself-esteem giving the individual a senseof personal control that results in anongoing obsession with weight loss,food and exercise. Such a change infocus perpetuates the illness with


32

Patients with Eating Disorders:Challenges for the OralHealth ProfessionalPART TWO OF FOUR PART SERIES

This is the second of a four part series of articles created

to provide dentists with a greater understanding of

mental illnesses and their impact on peers and patients.

DR. DAVID CLARK

CLINIC DIRECTOR DENTAL SERVICES

ONTARIO SHORES CENTRE FOR MENTAL HEALTH

SCIENCES (ONTARIO SHORES), WHITBY

potentially severe consequences. Themind develops a distorted or evendelusional thought process about bodyimage, perceiving oneself as continuallybeing too fat. Psychopathology quicklytranslates into a physiopathology defininga particular subtype of eating disorder.

The three main types of eating disordersinclude:

•Anorexia nervosa characterized byfood restriction and being chronicallyunderweight.

•Bulimia nervosa characterized bybinge eating and inappropriatecompensatory behaviours ultimatelyresulting in feelings of guilt and lowself-esteem.

•Binge-eating characterized bycompulsive overeating in whichpeople consume huge amounts offood while feeling out of control andpowerless to stop.

Not surprisingly the early detection ofeating disorders is important, because ofthe potential psychological and somaticcomplications, and for the effects on oralhealth as well.

Dentistry can play a significant role in thediagnosis, support, and long-termmanagement of those patients sufferingfrom an eating disorder. However, as withany significant health issue, one of thegreatest challenges for the dentist is toperceive that a medical problem, such asan eating disorder, represents a threat to apatient’s overall physical or oral health orboth combined.

Without this perception oracknowledgement, there is far lessengagement of secondary preventivebehaviours that could lead to earlieridentification, referral and treatment.

As well, the opportunity for collaborationand integration of oral health care withmental health care services is lost.

Eating disorders continue to represent aserious, and often fatal, threat to anindividual – a threat which can beprevented through earlier recognition andtreatment.

Every dental practice will undoubtedlyinclude patients dealing with a particulareating disorder. Many of these patientsmay appear healthy, despite struggling on the inside with this illness. Patientswith eating disorders often become verysecretive in their contacts with any health care professional because of the

self-denial, shame and guilt associatedwith the illness.

That is why it is important for dentistsand their staff to become more familiarand confident in recognizing the variousoral signs and symptoms of eatingdisorders. At the same time, it is equallyimportant to demonstrate empathy andsupport to your patient.

The best course of action is collaborationwith a multidisciplinary health care teamthat is designed to provide earlyintervention and management of theunique physical and psychological needsof patients suffering from an eatingdisorder.


33

AT THE CHAIRSIDEORAL SIGNS AND SYMPTOMS OF EATING DISORDERS

enamel erosion with increased thermal sensitivityincreased caries rategingivitis, periodontitisxerostomia, sialadenosismucosal atrophy

POSSIBLE DENTIST-PATIENT INTERVIEW QUESTIONSYour teeth are quite badly damaged. I am not totally certain why this hashappened. But we do see these kinds of changes quite often in young men andwomen who drink a lot of diet drinks. Is this something you do on a regularbasis?

Sometimes the kind of changes that I see in your teeth show up when a youngperson is making herself/himself sick. Is this something you do?

Do you ever eat in secret?

CLINICAL INTERVENTION STRATEGIESInterim preventive care: bicarbonate rinses, fluoride trays/rinse, dry mouthprotocols, desensitization

Definitive treatment (modified protocol): provisional restorations, desensitization

Definitive treatment (normal protocol – purging behaviour has ceased): veneers,endodontics, orthodontic repositioning, full coverage restorations

CThe impact of severe odontogenicinfections is often underestimated. The disease process is insidious and most patients presenting to a hospitalemergency department with acute pain of odontogenic origin have experiencedmultiple warning signs and symptomsleading up to the event.

In the pre-antibiotic era, severeodontogenic infections were frequently associated withmortality. Mortality rates were considerably reducedwith the discovery and application of antibiotics.However, the increased use and misuse of antibiotics areassociated with the emergence of multiple resistantbacterial strains that now pose a serious public healthconcern and a growing danger to our modern healthcare system.


34

PEAK

Characteristics andCost Impact of Severe OdontogenicInfectionsPEAK (Practice Enhancementand Knowledge) is a Collegeservice for members. The goal isto regularly provide Ontariodentists with copies of keyarticles on a wide range ofclinical and non-clinical topicsfrom the dental literaturearound the world.

It is important to note thatPEAK articles may containopinions, views or statementsthat are not necessarilyendorsed by the College.However, PEAK is committed toproviding quality material toenhance the knowledge andskills of member dentists.

P E A KCharacteristics and cost impact of severeodontogenicinfectionsJONATHON S. JUNDT, DDS

RAJESH GUTTA, BDS, MS

This PEAK article is a special membership service from RCDSO. The goal of PEAK (Practice Enhancement and Knowledge) is to provide Ontariodentists with key articles on a wide range of clinical and non-clinical topicsfrom dental literature around the world.

PLEASE KEEP FOR FUTURE REFERENCE.

Supplement to May/June 2013 issue of Dispatch magazine

PRACTICE ENHANCEMENT AND KNOWLEDGE


35

PEAK

KEY POINTS TO CONSIDER:• Strategies to improve oral health care through areduction in the incidence of untreated dental carieswould maximize the use of health care resourcesand likely decrease the incidence of severeodontogenic infections.

• While antibiotics are an essential adjunct to surgicalmanagement, their use alone may contribute toworsening of the patient’s condition.

• Early diagnosis and definitive surgical intervention ofodontogenic infections portend a better prognosis.

• General practitioners must be able to recognize theclassical signs of severe odontogenic infections, sothat referral to the appropriate health careprofessional can be expedited. This referral could belife-saving.


[email protected]

Severe odontogenic infections are always a riskto patients and are a significant economicburden to public health care facilities. Incorrector late treatment may lead to seriouscomplications that could have been avoided.

To provide a broader perspective on this issue,PEAK is pleased to offer members thefollowing article with the current issue ofDispatch: “Characteristics and Cost Impact ofSevere Odontogenic Infections”, from theNovember 2012 issue of Oral Surgery, OralMedicine, Oral Pathology, Oral Radiology.

The article presents a retrospective analysis ofthe clinical presentation, surgical managementand cost implications of hospital inpatients

treated for odontogenicinfections at a publictertiary hospital in theUSA.

The study involved athree-year chart reviewto measure multipleoutcomes, includinglength of stay, cost ofhospitalization, site ofinfection, number ofinfected spaces,

microbiology profile, antibiotics administered,intensive care unit stay, number of daysintubated, comorbidities, number of operatingroom visits, imaging studies and whetherpatients received preadmission treatment.

The study found that the average length ofstay was 4.57 days at an approximate cost of $17,842 per patient.

The article notes that, despite strong evidenceto the contrary, some general practitionershave the misconception that surgicalintervention should be delayed in the presenceof dentoalveolar infection to prevent life-threatening complications and allow for betterlocalization of the infectious process.

However, studies have demonstrated that earlysurgical drainage is associated with fasterresolution of infection and decreased use ofantibiotics. The delay of definitive care oftenresults in worsening of the patient’s condition.The use of antibiotics in these circumstancesmay predispose to the development of a severeodontogenic infection.

…SOME GENERALPRACTITIONERS HAVE THEMISCONCEPTION THATSURGICAL INTERVENTIONSHOULD BE DELAYED INTHE PRESENCE OFDENTOALVEOLARINFECTION TO PREVENTLIFE-THREATENINGCOMPLICATIONS…

MAILBAG

IN THE

College Mailbag

COLLEGE CONTACT Peggi Mace – Director of Communications 416-934-5610 1-800-565-4591

[email protected]

We want to hear from

you. We welcome your

feedback on anything

that you read in Dispatch

or on any of the College’s

policies, programs and

activities. Sometimes a

letter may not be printed

with the author’s name

either on request or due

to its confidential nature.

All letters printed in

Mailbag are used with

the author’s permission.

The College reserves the

right to edit letters for

length and clarity.


36

FAIRNESS COMMISSIONER

Dear Dr. Trainor,

Thank you for your letter regarding theOFC’s report, A Fair Way to Go, andyour ongoing support for the work ofmy office.

I recognize the great efforts made by theRoyal College of Dental Surgeons ofOntario to not only embrace theprinciples of fair access legislation inOntario, but to work towards seeingthem demonstrated at the national level.It is a pleasure to work with you and theCollege and I appreciate yourcommitment to future progress.

HON. JEAN AUGUSTINEOntario Fairness Commissioner

PET ASSESSMENT

Dear Sir,

As a relatively senior practitioner andpracticing in a limited area, I must say that I received the “invitation” to do this test with more than a little apprehension.

I must say that it was quite challengingand interesting and I used the Internetand other reference material a lot. Onbalance I found it to be a most thoughtprovoking exercise. It forced me to thinkabout a lot of things I had no encounterwith in many years.

I realized that it forced me to look at x-rays differently and approachsituations in a more organized fashion. I realized that a lot of terms andclassifications had changed in areas thatI do not involve myself with since I wasin dental school. I had to relearn themand appreciate them. It reduced mycomplacency.

I hope that in my years of practice that I did not miss some of the situations inthe questions.

I must say that I learnt much, muchmore in doing this assessment than Ihave learnt in hours and hours ofcontinuing education courses.

I am sure that educators will say bothtypes are necessary, but personally thiswas far more valuable as a learningexercise. I for one much prefer thismethod along with the DVDs the Collegehas produced.

I must admit that I pushed the finalbutton with anxiety and waited withgreat trepidation for the results!!!!

In closing, thanks for the exercise.

DR. STEPHEN GOLDMANToronto,Ontario

*

*


37

MARK YOUR CALENDAR… 2013 COUNCIL MEETINGS

Thursday, November 14Sheraton Centre Toronto, 123 Queen St. W., Toronto

Council meetings are open to the public. The only exception is any in camera portion of the meeting dealingwith personnel matters or other sensitive or confidential items.

Meetings usually start at 9:00 a.m. The agenda is available either at the meeting or in advance on request.

PLEASE NOTE: Seating is limited so if you wish to attend, please contact Angie Sherban in advance.

Calendar of Events

COLLEGE CONTACT Angie Sherban – Executive Assistant

416-934-5627 [email protected]

While the world changes around us, whatdoes not change is the importance ofgood professional practice. Support ofgood professional practice is the bedrockof how we work with the dentalprofession to act in the interest of publicsafety and protection.

That’s the core message of the 2012annual report.

Read more in the annual report that isavailable online on our website atwww.rcdso.org. A paper copy is availableon request by e-mailing [email protected].

The annual report also contains the year-end report of all the statutorycommittees and the Professional LiabilityProgram committee, plus the year-end financial statements and the auditors’ report and other informationsuch as the distribution of dentists by county and by College electoral district.

Strengthening Good ProfessionalPractice Spotlighted in 2012 Annual Report

HHonourable Jean Augustine, Ontario FairnessCommissioner, praised the College for “being onboard with fairer access to the profession ofdentistry” during her address to Council at itsmeeting in Toronto on Thursday, May 9.

“We boast about the work that you do and weboast about the emphasis that you do place oninformation, transparency, impartiality andopenness because we know that those areimportant principles and that you as Councilsupport those principles,” said Augustine.

As the Commissioner explained, her office is veryproud and pleased when it can say the College andits Registrars and Presidents support them.

She commended the College for its work on anational level and with the National DentalExamining Board. She also thanked the College for its help in improving the OFC assessmentprocesses.

The Commissioner put the responsibilities of herOffice and the College into an internationalperspective. “It is indisputable that Ontario andCanada’s future is tied to the success of immigrantsand newcomers. We are competing for highlyeducated newcomers with many other provincesand with many other countries,” she outlined.

This is the second time that the Commissioner hasspoken at an RCDSO Council meeting since thecreation of the Office of the Fairness Commissionerof Ontario in April 2007.

The Office of the Fairness Commissioner is anindependent agency of the Government of Ontario.The OFC assesses the registration practices ofcertain regulated professions and trades to makesure they are transparent, objective, impartial andfair for anyone applying to practise his or herprofession in Ontario.

The office requires the bodies that regulate theprofessions and trades to review their ownregistration processes, submit reports about themand implement the commissioner’srecommendations for improvement.

Under the Fair Access to Regulated Professions and Compulsory Trades Act, the Commissionerreports directly to the Minister of Citizenship and Immigration.


38

Fairness Commissioner praises College for its good work

Ontario Fairness Commissioner, the Honourable JeanAugustine (left) and RCDSO President Dr. Peter Trainor afterthe Commissioner’s address to Council at its meeting onThursday, May 9.

FFor the first time, on May 9, Tom Corcoran, chair ofthe Health Professions Regulatory Advisory Council,addressed a RCDSO Council meeting. “On behalf ofthe Minister and as an Ontarian, I’d like to thank youall as Council members for the time and energy andeffort that you put into your roles to improve healthcare in Ontario,” said Mr. Corcoran.

Mr. Corcoran commended the College for taking thelead in seeking an outside party knowledgeable inregulation to assess its performance following aproven framework of international standards. “It is abrilliant move,” said Corcoran. “Kudos to you forcommissioning the Cayton study.” (See pages 4 and44 for more details on the Cayton study.)

Mr. Corcoran spoke about the history of theRegulated Health Professions Act passed nearly 25years ago and the need now to look at revisions. “Itwas really well thought out at the time and seems tohave struck a good balance between safety on theone hand and the freedom to act on the part of thehealth professional on the other. On the other hand,in the 21st Century two decades is like an eternity.Nothing can stand still and frozen in time for twodecades,” said Corcoran.

He went on to explain that the College, with thepositive review of its performance measured againstestablished international standards, will be wellplaced as discussions occur about RHPAamendments.

The Health Professions Regulatory Advisory Council(HPRAC) is established under the Regulated HealthProfessions Act, 1991 (RHPA), with a statutory duty

to advise the Minister on health professionsregulatory matters in Ontario.

The Minister relies on recommendations from HPRACas an independent source of evidence-informedadvice in the formulation of policy in relation tohealth professional regulation in Ontario. HPRAC isindependent of the Minister of Health and Long-TermCare, the regulated health colleges, regulated healthprofessional and provider associations, andstakeholders who have an interest in issues on whichit provides advice. This ensures that HPRAC is freefrom constraining alliances and conflict of interest,and is able to carry out its activities in a fair andunbiased manner.


39

HPRAC Chair thanks theCollege for its leadershipin self-regulation

Tom Corcoran (left), chair of the Health Professions Regulatory AdvisoryCouncil, joins RCDSO President Dr. Peter Trainor (right) at the close ofhis address to College Council on May 9 in Toronto.

And finally, we wanted to hear from someone who had the knowledge and expertise to take our thinking to new places. That is why we engaged Harry Caytonand the Professional Standards Authority for Health and Social Care in London, England(www.professionalstandards.org.uk). Mr. Cayton and PSA are recognized as the world experts inregulation. We wanted to see how we measured upagainst international standards.

As you know, this review was entirely based inempirical evidence. Harry Cayton came to Toronto thispast April.

He interviewed numerous senior staff, he meet withsome public members of Council and with ExecutiveCommittee. He even sat in on a panel meeting of theInquiries, Complaints and Reports Committee. He alsoselected some of our own members to interview.

He also spoke with a number of external people,including HPRAC Chair Tom Corcoran, senior staff at theOffice of the Fairness Commissioner, and the supervisorof the College of Denturists of Ontario who is appointedby the Minister.

In addition, he had at his disposal literally a mountain ofdocumentation, including decisions of the ICRC panels,Discipline Committee panels, and minutes of statutorycommittees.

He was also given volumes and volumes of materialsitemizing in detail our committee orientations and all ofour processes, all requested by him as part of theprocess.

So how did we do?

It is with tremendous pride that I tell you that theCollege met or exceeded international standards in everysingle category. That’s right, we are right up there withother regulatory bodies on the world stage.

You can find a copy of the full report on our website atwww.rcdso.org.

The results are beyond doubt and irrevocable.

This College understands its mandate of regulating in thepublic interest. We live true to that mandate ineverything we do.

There can be no doubt that dentists, the public andgovernment should have confidence in us. We stand byour brand of “Ensuring Continued Trust.”

Of course, it wouldbe no surprise toknow that thereport outlines afew areas wherewe can makeenhancements. Wewill adopt thosechanges as quicklyas possible.

One of ourstrengths as anorganization is thatwe are alwaysopen to learn andgrow and tocapitalize on ourstrengths. As Winston Churchill once said: “To improveis to change; to be perfect is to change often.”

For after all, part of good risk management is the desireto learn from events. The risk management processbecomes a cycle where experience and knowledgeprovides key information for new decisions and actions.

I believe that this is a powerful moment in the history ofour College.

It is proof positive that all the hard work and courageousleadership of this Council and ones before us has meantsomething. It has kept us on the right path to developinto a world leader in health-care regulation.


40

Self-regulation can and does work – and work well

Continued from page 5


…ALL THE HARD WORKAND COURAGEOUSLEADERSHIP OF THISCOUNCIL AND ONESBEFORE US HAS MEANTSOMETHING. IT HASKEPT US ON THE RIGHTPATH TO DEVELOPINTO A WORLD LEADERIN HEALTH-CAREREGULATION.


41

C’est dans l’ordre des choses, car notre organisme faitconstamment l’objet d’une surveillance rigoureuse.

Par exemple,

• le Bureau du commissaire à l’équité procède àl’examen constant de nos pratiques d’accréditation.

• la Commission d’appel et de révision des professionsde la santé supervise et examine les décisions de noscomités de discipline.

• La ministre de la Santé surveille de très près lescollèges de réglementation. Elle a le pouvoird’intervenir directement dans leurs affaireslorsqu’elle a perdu confiance en leur conseild’administration en nommant un superviseur. Elle adéjà exercé ce pouvoir.

• Nos opérations financières sont assujetties à unexamen annuel par des auditeurs tiers qui fontdirectement rapport au conseil par l’entremise ducomité d’audit.

• Finalement, il y a notre réputation. C’est là l’un denos principaux actifs. Nous détenons une image demarque digne de confiance qui est synonyme dequalité, mais notre réputation est sans cesse remiseen question.

Jusqu’à présent, notre Collège s’est remarquablementbien comporté dans tous ces domaines.

Bien sûr, nul organisme n’est parfait, mais il peut êtremaître de la situation.

Pour ce faire, il doit aborder les enjeux avec sérieux. Ildoit assurer une gestion dynamique et ne pas secontenter de réagir à la situation.

Nous désirons savoir à quel point nous parvenons àprotéger le public et à promouvoir la confiance envers lesdentistes et dans notre rôle d’organisme deréglementation.

Si quelque chose cloche, nous voulons le savoir. Si nouspouvons nous améliorer, nous tenons également à lesavoir.

Nous souhaitions obtenir une preuve empirique de lapart d’un organisme indépendant à l’effet que le modèlede réglementation ontarien actuel peut fonctionner etqu’il fonctionne vraiment.

Nous sommes d’avis que ce serait là un outil importantpour combattre les nombreux adversaires qui remettenten question la valeur de notre modèled’autoréglementation.

Finalement, nous désirions obtenir l’avis de quelqu’undisposant des connaissances et du savoir-faire nouspermettant d’orienter nos idées vers de nouveauxhorizons.

C’est pourquoi nous avons retenu les services d’HarryCayton et de la Professional Standards Authority forHealth and Social Care de Londres, en Angleterre(www.professionalstandards.org.uk). M. Cayton et laPSA sont reconnus mondialement comme experts enmatière de réglementation. Nous désirions savoir où

L’autoréglementation, c’est possible et ça fonctionne bien

CHRONIQUE DU PRÉSIDENT

C’EST LA PREUVE QUE TOUT LE DURLABEUR ET LE LEADERSHIPCOURAGEUX DE CE CONSEIL, AINSIQUE DE CEUX QUI NOUS ONTPRÉCÉDÉS, N’ONT PAS ÉTÉ VAINS. ILSNOUS ONT PERMIS DE DEMEURERSUR LA BONNE VOIE ET DE DEVENIRUN CHEF DE FILE MONDIAL ENMATIÈRE DE RÉGLEMENTATION DESSOINS DE SANTÉ.

Suite de la page 5

Suite à la page 42


42

L’autoréglementation, c’est possible et ça fonctionne bien

CHRONIQUE DU PRÉSIDENT

Suite de la page 41

nous nous situons par rapport aux normesinternationales.

Comme vous le savez, cet examen reposeentièrement sur des preuves empiriques. HarryCayton est venu à Toronto en avril dernier.

Il a interviewé plusieurs cadres supérieurs, il s’estentretenu avec certains membres publics du conseilainsi qu’avec le comité exécutif. Il a même siégé àune réunion du comité des enquêtes, des plaintes etdes rapports. Il a également rencontré certains denos membres.

Il a aussi discuté avec des personnes externes,notamment avec le président Tom Corcoran duconseil du Conseil consultatif sur la réglementationdes professions de la santé (CCRPS), des cadressupérieurs du Bureau du commissaire à l’équité et lesuperviseur de l’Ordre des denturologistes del’Ontario, qui est nommé par la ministre.

Il avait en outre à sa disposition une montagne dedocuments, en particulier les décisions du comitéd’examen des collectes de renseignements et ducomité de discipline, ainsi que les procès-verbaux descomités légaux.

On lui avait également fourni, à sa demande,quantité de matériel détaillant les orientations denotre comité et tous nos processus.

Et alors?

C’est avec une très grande fierté que je peux vousaffirmer que le Collège a rencontré, voire dépassé, lesnormes internationales dans chacune des catégories.Oui, nous n’avons rien à envier aux autresorganismes de réglementation partout dans lemonde.

Vous trouverez un exemplaire du rapport complet surnotre site Web www.rcdso.org.

Les résultats irrévocables ne font pas l’ombre d’undoute.

Ce Collège comprend son mandat de réglementationdans l’intérêt du public. Nous sommes à la hauteurde ce mandat dans tout ce que nous accomplissons.

Il ne fait aucun doute que les dentistes, le public et legouvernement peuvent avoir confiance en nous.Nous respectons notre image de marque : « Assurercontinuellement la confiance ».

Bien entendu, le rapport décrit quelques aspectspouvant être améliorés. Nous mettrons en œuvre lesmodifications nécessaires aussi rapidement quepossible.

L’une des forces de notre organisme, c’est d’êtretoujours ouverts à l’apprentissage et au progrès et de tirer parti de nos forces. Comme l’a dit un jour Winston Churchill : « L’amélioration découle du changement et la perfection d’un changementrépété ».

Car après tout, bien gérer les risques, c’est aussichercher à apprendre de nos expériences. La gestiondes risques devient alors un cycle où l’expérience etles connaissances fournissent des renseignementsessentiels pour les nouvelles décisions et les mesuresà prendre.

Je crois que c’est un point tournant de l’histoire denotre Collège.

C’est la preuve que tout le dur labeur et le leadershipcourageux de ce conseil, ainsi que de ceux qui nousont précédés, n’ont pas été vains. Ils nous ont permisde demeurer sur la bonne voie et de devenir un chefde file mondial en matière de réglementation dessoins de santé.

FROM THE REGISTRAR


43

They wisely assessed the current environment. We have agovernment impatient and frustrated with some regulators whohave not displayed initiative in meeting the requirements foraccountability and transparency and in regulating in the publicinterest. Consumers are rightly demanding more information tomake decisions about their choice of health-care provider.

Instead of moving cautiously, Council reframed thesituation. They didn’t focus on the minefields butinstead on what they might lose by not taking thatrisk. They saw that what could be at stake is self-regulation as we know it.

And how right they were. As the President explains inhis column on page 4, this proactive decision byCouncil to open our doors to an world expert onregulation to come in and see how we measure up tointernational standards has proven to be the right one.

We now have validation by an authoritativeindependent third party that the course we are on is correct. Wehave the proof that we do meet all international standards.

This kind of organization is not built overnight. During the pastdecade or so, whenever Councils have faced a major decision,they did not act timidly. Council after Council has acted with boldleadership and wisdom, supported by our wonderful staff.

The latest creative risk was to engage Sir Harry Cayton, chair ofthe Professional Standards Authority for Health and Social Care ofthe United Kingdom, to assess our work.

As Tom Corcoran, chair of the Health Professions RegulatoryAdvisory Council, said at our May Council meeting, it was abrilliant move. (See page 39 for the full story.)

Whatever comes next, the College is in a strong position. Ourvoice will be backed by evidence that we understand self-regulation. The results of the review are also an overwhelmingvote of confidence in the model of profession-led self-regulationthat we know here in Ontario.

Taking smart risks means findingsomething worth fighting for

Continued from page 44

WE NOW HAVE VALIDATION BYAN AUTHORITATIVEINDEPENDENT THIRD PARTYTHAT THE COURSE WE ARE ON ISCORRECT. WE HAVE THE PROOFTHAT WE DO MEET ALLINTERNATIONAL STANDARDS.


44

FROM THE REGISTRAR

TThe playbook for the regulator of today has changeddramatically in the last little while. We are not independent. We are not in business to represent the profession but we mustbe fair to membership. We have accountability to governmentand the public. We have an obligation to be accessible, toprotect the public in a transparent way.

At its first meeting in January our new Council immediatelyunderstood and appreciated that landscape.

They took the bravest action imaginable and unanimouslyagreed to engage an outside party to come in and evaluate how we are doing our job as a regulator against recognizedinternational standards. Now that took courage!

They understood the danger of playing it safe, of staying in the comfort zone.

As author Doug Sundheim describes in his book, Taking SmartRisks, there is a danger in playing it safe. He calls it a silentkiller. As he says, like a slow leak in a tire, it can be destructive.

Of course, you don’t plunge wildly into the danger zone. Instead you look for a middle ground, what Sundheim calls the smart-risk zone.

This Council knew that the profession-driven model of self-regulation that we enjoy here in Ontario is worth fighting for.They were aware that it is under fierce scrutiny and criticism.And they also quickly recognized the cost of doing nothing. This was a risk worth taking.

Taking smart risksmeans findingsomething worthfighting for

IRWIN FEFERGRAD

Continued on page 43

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