A lecture delivered to the undergraduate dental students of College of Medicine, University of Ibadan in Dental Public Health

1. By
DR ME OSUH; BDS, FMCDS, MPH

2. At the end of the lecture, students should be able to:
Define dental jurisprudence
Familiarize themselves with related terminologies
Understand what constitutes dental malpractice
Know about risk preventive practices
Understand the importance of records keeping
Know the various forms in consent taking
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3.  The philosophy of law or a system of laws.
 Laws are the minimum standards established by the state
 Embraces all the laws enacted by the legislative body of the
state, all rules and regulations promulgated by those in
authority, court decisions and formal principles upon which
laws are based.
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4.  The system of law applied to dentistry.
 The dentist, and the practice of dentistry are controlled
by many laws at the federal, state, and local level.
 Is the science of systematic study which deals with all
the laws, rules and regulations as well as legal principles
and doctrines governing and regulating the practice of
dentistry.
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5. DENTAL JURISPRUDENCE: The application of the principles of
law as they relate to the practice of dentistry;
-to the obligations of the practitioners
-to their patients, and
- to the relations of dentists
- to each other and
- to the society in general.
This term and forensic dentistry are sometimes used as synonyms, but
some authorities consider the first as a branch of law and the second as
a branch of dentistry.
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6. Conduct may be unethical and still
be legal. But it cannot be illegal and
still be ethical.
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7.  Plaintiff (accuser) is a person bringing the legal action which accuses another
of wrongdoing.
 Defendant (accused) is a person whom legal action is being brought against.
 Judge – A person in a court who has the authority to make decisions on cases
brought before a court of law.
 Jury – A body of persons legally selected and sworn to inquire into any matter
of fact submitted to them and to give their verdict according to evidence
 Tort is a wrongful act that results in injury to one person by another.
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8. • Tort Law – division of civil law covering the rights and duties of people
toward each other and wrongs committed in violation of these rights
and duties.
• Assault ; A threat or attempt to touch or inflict verbal or
physical(without consent) attack on a person.
• Battery is the actual touching.- offensive touch or use of force on a
person without consent
• Defamation of character is injury to another by written/spoken words.
• Invasion of privacy is when patient records or any unwanted publicity
and exposure is given to the public.
• Fraud is deliberate deception that is practiced to secure unfair/unlawful
gain.
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9.  Admission against interest – statement made by an individual which
serves to defeat his or her own interests. “Oh, I’m sorry. It was my
fault.”
 Res gestae – Latin term meaning “Things done or part of the action”
Statements made spontaneously at the time of the alleged negligent
act are admissible as evidence.
A careless word or statement by an auxiliary can be just as damaging to
the dentist as his or her own admission against interest.
 Contributory negligence – failure on the part of the patient to follow
the dentist’s instructions during and after treatment.
 Malpractice – professional negligence. Failure to perform one’s
professional duties completely.
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10. NEGLIGENCE
07/01/2016LAWS AND ETHICS OF DENTAL PROFESSION BY DR ME OSUH; BDS, FMCDS, MPH 10

11. Negligence: Failure to do something which a reasonable
man would do or the doing something which a prudent and
reasonable man would not do.
Determining a “reasonable person” depends on a number
of factors:
 today’s standards for people (by society)
 professional standards (of conduct)
 local standards (varying by community)
 environmental factors at time
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12. REASONABLE (PRUDENT) PERSON
 A reasonable person is expected to do those things that
are appropriate in a given situation.
 This includes the use of sound judgment, so that these
actions are fair, proper, just, moderate, and suitable
under the circumstances.
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13. Negligence is a major area of tort law and is defined as:
 unintentional action
 unplanned action
 injuries result
In essence, negligence is carelessness that results in harm (injury or
damage).
Negligence vs. Intentional Torts
Negligence differs from intentional torts in that the actions are not
caused by someone deliberately wishing to cause harm
Intentional torts, by contrast, are matters such as assault, false
imprisonment, defamation, product disparagement, contract
interference or tortious interference, trespass, and the computer

14. Chapter 914
INTENTIONAL
False imprisonment
Intentional Infliction of
Emotional Distress
Invasion of Privacy
Defamation
Product Disparagement
Wrongful Interference
WHN Contracts
Trespass
Computer Torts
NEGLIGENCE STRICT LIABILITY
Duty
Breach of Duty
Causation
Damages
Inherently
Dangerous
Activities
Products
Liability

15.  Duty: Presence of a Duty of Care. The first element is establishing the
presence of a duty owed by one person to another. ...
 Breach: Someone Breached Their Duty. The second element is a breach of
the duty owed by one person to another. ...
 Causation: The Breach Directly Causes Injuries. ...
 Damages: Proving Monetary Losses.
Others include: Factual cause(Direct cause). Legal Cause
(Remote); intention/ malice; harm
Therefore
 A Plaintiff is owed a duty of care
 The Defendant breached duty of care
 While the Plaintiff suffered resulting harm or loss

16. ………
Negligence refers to a cause of action where a plaintiff may assert a civil
tort case against a defendant. In order to meet a prima facie (on its
face) case for negligence a plaintiff must definitively prove the
following four elements:
That there was a duty on the part of the defendant to conform
to a certain standard of conduct.
That that defendant breached that duty
The breach of duty was, not only the actual cause, but the
proximate cause of injury
There are damages
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17.  “Duty of care” is proved through legal obligations
 For example, if a mechanic neglects to tighten the bolts on a repair
of a car, causing a subsequent accident or injury, the plaintiff (the
driver) is owed a duty of care, and the defendant (the mechanic) has
breached their duty of care
 A breach of duty of care can only be determined (through
negligence) by examining the expected standard of care
 Standard of care is determined through the test of what a
“reasonable person” would have done in similar circumstances

18.  The defendant’s conduct violated that duty because:
 His or her conduct fell short of the standard of care.
 Or, in other words, he or she did not act like a reasonable person would have.
CAUSE
 Cause In Fact: The breach actually caused an injury.
 Can you trace the injury back to the defendant’s actions?
 Proximate Cause: The connection between the breach and the injury was
foreseeable and not too remote.
 Could the defendant have foreseen or guessed that his or her actions
would cause an injury?
DAMAGES
 The plaintiff suffered actual damages (medical costs, lost wages,
 pain and suffering, etc.).

19. COMMON TYPES OF NEGLIGENCE
 Gross Negligence – In these cases the negligence was so careless it showed a
complete lack of concern for the safety of others. Gross negligence is a much
more serious form of negligence that goes a step further than simple careless
action. Eg: Hospital staff does not change a surgery patient’s bandages for
several days, resulting in a serious infection.
 Comparative Negligence – This is where the plaintiff is marginally responsible for
the injuries to himself. The plaintiff may be required to pay a percentage of the
damages in a comparative negligence case. Eg: You sustain serious injuries from
RTA because you were not wearing a seatbelt.
 Contributory Negligence – In contributory negligence cases, if the plaintiff
caused his own injury in any manner, he cannot collect damages at all.
 Mixed Contributory & Comparative Negligence –Mixed Negligence is where if
the plaintiff is determined to be more than 50% responsible for his own injury,
they may receive only a percentage of damages, or none at all.
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20. Vicarious Liability – This is where the defendant is held responsible
of the actions of another person or animal. This form of liability is
often used in cases where young children or minors caused serious
injury, or a dog attack. The parent of the child and owner of the dog
will be held responsible for the damages because the child or animal
cannot be responsible for it themselves. Children < 7yrs of age are
considered incapable of negligence. VL can also be used when an
employer fails to properly oversee their employees, and is thus held
responsible for their actions.
Criminal negligence aka culpable negligence:
Failure to use reasonable care to avoid consequences
that threaten or harm the safety of the public and that
are the foreseeable outcome of acting in a particular
manner. e.g texting while driving or drunk/ tired
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21. Criminal negligence - Arises in case of death or serious injury to a
patient. The degree of negligence must be so grave as to go beyond a
matter of compensation. The doctor may be prosecuted by police or
charged in a criminal court for culpable homicide.
Contributory negligence- Concurrent negligence by the patient and
the doctor, resulting in delayed recovery or harm to the patient.
Burden of proof on doctor.
Professional negligence - absence of reasonable care and skill, or
wilful negligence of a medical practioner in the treatment of patient
which causes bodily injury or death of patient

22. Following conditions should be satisfied for proving liability of negligence-
1.Duty-existance of duty of care by the doctor
2.Dereliction-failure on the part of doctor to maintain applicable standard of
care and skill
3.Direct causation- any damage was caused by breach of duty
4.Damage – lost wages, medical expenses and mental duress
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23. Contributory
negligence
Comparative
negligence
Assumption of risk
Act of god
Sudden emergency
Improper supervision
Faulty instruction
Faulty facilities
Damaged/inappropriate
equipment
Failure to warn

24. 1. Does the defendant owe the plaintiff a duty of
care?
2. Did the defendant breach the standard of care?
3. Did the defendant’s careless act cause the
plaintiff’s injury or loss?
4. Was there a direct connection between the
defendant’s action and the plaintiff’s injury or loss?
Was what happened foreseeable?
5. Did the plaintiff suffer actual harm or loss?

25. Failure to use due care or lack of due care
An act or omission by a health care provider that deviates from
what is the accepted standards of practice in the medical/
dental community. This act or omission then causes injury to the
patient.
AKA dental malpractice
In laymen’s terms, dental malpractice is basically professional
negligence by a health care professional that leads to an injury
or complications on the part of the patient
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26. A legal doctrine that assigns liability for an injury to a per
son who did not cause the injury but who has a particular
legal relationship to the person who did act negligently.
Liability of employer for the negligent act of his
employees, within the course and scope of their
employment
It is also referred to as IMPUTED NEGLIGENCE
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27.  Let the master answer”
In addition to being held responsible for his or
her own acts, under the doctrine of respondeat
superior, the dentist/employer is also held
for the acts of his or her employees – if that
wrongdoing was committed within the scope of
employment.
 It is a form of STRICT LIABILITY
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28. • Subpoenas are court orders mandating that an individual
show up at a specific time and date and with a specific
reason to testify.
– Dental records can also be subpoenaed.
– Confidentiality must be kept.
• Statute of limitations defines the period of time in which
legal action can take place.
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29. When the patient consents
To medical colleagues
As a statutory duty (Re: Infectious diseases)
As information to relatives
In the interest of research projects
In disclosure to court
In the discovery of documents in court proceedings
In the public’s interest
Situations where it is ethically and legally required to
reveal information:

30. • Good Samaritan Law is protection for those individuals
who are not seeking payment but are rendering medical
assistance to the injured (emergencies).
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31.  The subject matter of the contract must be legal.
 The contracting parties must reach an agreement.
 There must be a consideration involved in the contract.
 The parties must have contractual capacity (legally
competent)
Types of contract: expressed (oral or written) in agreement
implied (through conduct)
Quasi-contract: a relief given by the court
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32.  New drugs are being used
 Experimentation or clinical testing is involved
 A patient’s photograph is being used
 General anesthesia is being used
 Minor children are being treated in a public program
 Treatment will require more than one year to
complete
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33. A dentist-patient relationship (legal duty) does not exist in
law until the patient seeks service from the dentist, and
the dentist, by some words or action, accepts to treat the
patient.
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34. Failure to perform where there is an absolute duty to do
so and no discharge has been effected. Either party fails
to keep their part of an expressed contract, either written
or oral.
When this happens the other party may sue for breach of
contract.
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35.  Agreement, compliance or permission given
voluntarily without compulsion
 Expressed - verbal - written
 Implied
• A voluntary approval / permission for an action to be
carried out by another person such as permission to
perform a therapeutic procedure or expt. by a
scientist/ physician/ dentist
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36. Withdrawal from a case or patient
 Written notification – containing the reason, the withdrawal date,
the need for further care, an offer of help or assistance, and
signature.
 Proof of mailing – letter must be sent certified mail with a return
receipt requested.
 Documentation on file – a copy of the letter and the signed postal
receipt are kept with the patient’s record.
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37. • Termination of a contract
– Patient discharges dentist or fails to return to office.
– Patient fails to follow instructions given by dentist.
– Dentist formally withdraws from patient care.
– Patient no longer needs treatment/all requirements
have been agreed on and met.
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38. The prosperity of Athens was due in large part to its stable and
effective government. That government was the world’s first
democracy, a form of government run by the people.
DRACONIAN LAW
Draco thought way to end unrest was through harsh punishment
Belief reflected in Draco’s laws
Harshness of laws worsened dispute between classes
Solon later overturned the draconian lawn
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39. -Believed to have created
Athen’s first code of law
-Law harsh and severe
-Any laws now considered
harsh today are referred to
as “Draconian”
-Draconian law did not settle
class disputes
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40. Draconian regulation is practiced in Britain.
- It makes it an offence for a parent not to consent to
school health services eg
vaccination
screening…
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41. -Overturns Draconian law in
590s BC
-Outlawed debt slavery
-Reduced poverty
-Allowed all men to serve in
Athenian Assembly
-Relieved some tension
www.nimispauci.com/ Laerce/SeptSages/Solon.jpg
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42. 14/01/2016DENTAL JURISPRUDENCE; A LECTURE DELIVERD BY ME OSUH BDS, FMCDS, MPH 42

43. Act involving ignorance, negligence, un-skillfullness or moral turpitude
resulting in some injury to the patient.
Makes dentist or doctor criminally liable.
Essential Elements of Malpractice
Acts of Omission: Failure on part of the dentist to properly perform his
duty due to his ignorance, negligence, unskillfullness or moral depravity
Acts of Commission: Performing that which a reasonable dentist would
not do which may result in injury to the patient
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44. Grounds for discipline
 Permitting unlicensed personnel to perform dental
procedures normally restricted to dentists.
 Failure to supervise personnel properly.
 Sexual advances toward or involvement with patients.
 False or inaccurate patient records
 Fraud involving reimbursement of patient expenses by
insurance companies of government programs.
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45. Grounds for discipline …
 Giving or receiving rebates related to patient fees.
 Transmission of disease by improper sterilization
procedures.
 Improper communication of confidential patient
information.
 Improperly prescribing, handling, or selling controlled
substances.
 Patient neglect or abandonment. 14/01/2016DENTAL JURISPRUDENCE; A LECTURE DELIVERD BY ME OSUH BDS, FMCDS, MPH 45

46. PROFESSIONAL MISCONDUCT
Conduct considered as disgraceful or dishonorable by professional
brethren of good repute and competency
Issue of false medical certificates
Covering up unqualified persons
Helping quacks
Canvassing
To personally open chemist shop
To prescribe habit forming drugs
Disclosing professional secrets of patients
Failure to notify
Treating patients under the influence of drink or drugs
Fee splitting/dichotomy

47. Criminal offense committed by a person
not necessarily dentist or by a dentist in
practicing the profession without first
being authorized in accordance with the
Dental Act
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48. 1. Person practicing without a certificate of registration
 Artisans
 Charlatans
 Dental Technicians
 Undergraduates of dentistry
 Foreigners not covered by reciprocity agreements
 Dentists with licenses suspended or revoked
 Person practicing but not lawfully authorized
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49. 2. Any person presenting as his own the certificate of registration
of another
 Principals
 Accomplices
 Accessories
Such as in:
 Any person who shall give any false or forged evidence to the Board in
obtaining a certificate of registration.
 Any person who shall impersonate any registrant of like or different name
 Any person who shall use a revoked or suspended certificate or registration
 Any person who shall use or advertise a title or degree without having been
conferred by a university
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50. • Done by duly licensed
professional
• Res Ipsa loquitor
(The thing speaks itself)
• Burden of proof in
showing negligence of
defendant
• Committed by a
person who
practices the
profession without
the professional
license issued by
proper authorities
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51.  A dental assistant who is guilty of negligence is
responsible for his or her own actions, and the injured
party may sue both the dentist and the assistant.
 The dentist’s liability insurance will not cover the
auxiliary if they are sued for negligence!!
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52. 1. Say Nothing
2. Be supportive
3. Be cooperative
4. Ask before acting
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53.  The steps taken by dentists to prevent a patient from
bringing legal action against them.
 As the dentist’s employee, you have an important role in
important role in preventing or causing a lawsuit!
lawsuit!
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54. “Happy patients
don’t sue
their doctors.”
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55. The best defence against malpractice. It includes:
 Start with people working with you: competent and
responsible
 Adequate practicing facilities
 Establish a good rapport with the patients
 Consider the WHOLE PATIENT and not only the TEETH
 Maintain accurate, complete and legible PATIENT’S RECORDS
(they are the dentist’s best defense!) 14/01/2016DENTAL JURISPRUDENCE; A LECTURE DELIVERD BY ME OSUH BDS, FMCDS, MPH 55

56. Keep all of your skills up-to-date
Always perform all of your duties to the best of your
ability
Never say anything that implies a guarantee or that will
give the patient unrealistic expectations as to the result
which the dentist can achieve
Never comment on the quality of care provided by your
employer or any other dentist
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57. Commonly referred to as “the chart”.
Provides a chronological detail of, the clinical procedure,
justification for, treatments received and post-op
findings of patients.
These records are important legal documents.
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58.  To monitor patient’s progress
 For teaching
 For research
 Medico-legal reasons
 Forensic reasons
 Factual witness
 For improvement in dental practice
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59. Content
Histories: detailed hx with dates, address, abbreviate wt caution
Thorough examination
Investigation detailed as required
Consent form: there is an IMPLIED CONSENT as soon as a patients
enters a dentist’s surgery
VERBAL CONSENT may be acceptable but a WRITTEN CONSENT is
preferable.
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60.  A patients right to self determination
 Must be informed and voluntary
Information to be given:
- Diagnosis
- Alternative methods of tx
- Treatment plan chosen and why
- Risks, complications and benefits involved
- Prognosis of the treatment
- Consequences if treatment is not done
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61. Actual/ expressed: Written
Verbal
Partly written
Partly verbal
Apparently implied by law
Implied by the actions of patients
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62. Consent given by a patient/volunteer who has proper
understanding of the nature of the procedure/
experiment to be performed and have a full knowledge
of the possible risks and complications involved in all the
processes both socially and medically.
It involves filling an informed consent form
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63. Consent is implied and by law in the various conditions:
 If a patient enters a dental clinic, sits on the dental chair and
opens his/her mouth, consent is implied and by law.
 Emergency: where postponement of tx will jeopardise life or
wellbeing of patient and pt is unable to give consent.
 Under GA: Unanticipated need for more extensive surgery, no
relative around and postponement is risky.
 Accident scene: when consent is not obtainable and immediate
action was deemed necessary.
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64. A patient below the statutory age of a major (usu. 18yrs) in a specific
country
 Emancipated minor- not subject to parental control or regulation
 Mature minor rule: consent (written) from a minor who is capable of
appreciating the nature, extent and consequence of procedure (usu
minor) to be done on him/her - wt inaccessible parents
 Dental emergency situations – exceptions (<14yrs)
 Emancipated (minors away from home)- boarding school-loco parentis
 Child of divorced or separated parents
 Responsibility for payments
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65. A form designed to fully inform in non technical terms about the
nature, potential risk and specific therapeutic procedure or
research to be carried out.
 In researches, information on rights of the participant is also
included.
Content include:
 Name of Doctor
 Name of patient / participant
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66.  Record or serial number
 Date
 Description of procedure
 Purpose of procedure
 Expected benefit
 Possible risks associated with the procedure
 Area for signature of pt/ guardian/ loco parentes
 Area of signature for the doctor and or consultant
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67. 1. INFORMED CONSENT(BRAND)
Benefits of treatment
Risks of treatment
Alternatives (other treatment options)
No treatment (risks of)
Documentation + signature(patient, doctor, independent
witness)

68. 2. INFORMED CONSENT based on information about:
The name of the operation
The nature of the proposed treatment
What the operation involves
The potential complications
The special precautions required postoperatively
The limitations of treatment
The success rate of the operation
How the patient will feel after treatment
What happens on admission

69. 1. What is implied consent ?
2. At what point does an implied consent start and end ?
3. When do you say a dentist is negligent ?
4. Who owns the record ?
5. What are the functions of the dental record ?
6. What are the types of consent ?
7. What is vicarious liability ?
8. What is Good Samaritan law ?
9. What do you understand by draconian regulation ?
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70. Google
Wikipedia
Textbook of Community Dentistry with multiple choice
questions (JAYPEE)
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