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New patient dental radiographs

I’ve worked with several dentists who say legally and ethically it is not required to take radiographs at first visit despite age as long as nothing clinically appears to be suspicious. Say the patient refuses or is pregnant. Young patient is uncooperative, contraindication etc. As long as you let the patient or parent know we are diagnosing only what we see with our eyes and in order to fully diagnose you we will need films at your next visit prior to prophy. In some cases I could understand this..say the patient is under 5 years old. Is what they’re saying true?



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I would argue it’s the exact opposite – it’s legally and ethically required to take radiographs at a first visit. I’m not a lawyer, but letting the patient know that “only what can be seen with the eyes is being diagnosed” wouldn’t stand up in court in a malpractice or neglect suit. It’s the same as why patients signing radiograph refusal forms don’t stand up in court. While patients do have the right to refuse treatment and diagnostic tools, they cannot consent to substandard care. Further, practices have an ethical responsibility to abide by the standard of care. Here’s an article with references for that: https://www.todaysrdh.com/ask-kara-rdh-is-the-office-legally-covered-with-signed-informed-refusal-forms/
 
Consider this scenario: If the doctor didn’t take the necessary radiographs, new patient or not, and there’s decay interproximally that the patient has no symptoms (pain, etc.) nor can a visual exam see this decay at that moment, without treatment that decay could reach the pulp and now the patient may need a root canal and crown, if the tooth can be saved at all. Suppose the patient sued the doctor and reported this to the dental board. In that case, I strongly believe the doctor would be held liable for not taking radiographs and informing the patient of their condition. It should also be noted that neglect and malpractice reported to the board, if found guilty, are public records, can result in fines, and even loss of license to practice may occur. I should also mention that dental hygienists can and have been named in lawsuits along with the doctor.
 
Or this scenario: What if the patient had an asymptomatic abscess? Though it doesn’t happen often, abscesses can land a patient in the hospital due to sepsis and can be deadly depending on the severity. Again, if it was found that a patient who landed in the hospital or died had seen a dentist recently, but this dentist never took radiographs, that wouldn’t be a good situation. This would also be a nightmare for the practice if the situation made the news.
 
Though the ADA uses passive and softer vocabulary such as “recommended” and “preferred,” instead of “required,” “needed,” or “necessary,” the ADA infers that new patients need radiographs. Here is the link to the ADA’s radiograph guidelines: https://www.ada.org/~/media/ADA/Member%20Center/FIles/Dental_Radiographic_Examinations_2012.ashx
 
We must remember, dental professionals are trained and educated on what diagnostic tools are needed to provide comprehensive care (radiographs, periodontal charting, etc.), whereas the general public does not have this same education. That’s why patients see and are treated by trained and educated professionals in the first place. Personally, as a hygienist, I would not feel comfortable treating a patient without the necessary radiographs, new patient or not. We are working blind without them, and that is substandard care. To answer your question, it is my opinion that what the doctors you are referring to are saying is not true.

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