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Registrar’s Message
“If it looks like a duck, and quacks like a duck, we have at least to consider the possibility that we have a small aquatic bird of the family
Anatidae on our hands.”
-Douglas Adams
In dentistry, there is often little discussion or thought about our scope of practice - the set of activities, processes and responsibilities allowed to members of a profession. It is sometimes assumed that the ability to perform certain services is an inherent historical right of dentists or based simply on completing training in an activity. Some even believe that the scope of practice is determined by an outside local, national or international member advocacy organization.
The ability to practice as a profession is a privilege not a right granted - in its sole discretion - by the provincial government through legislation. Along with defining the scope, enabling statutes will delegate responsibility for ensuring members of the profession operate within that scope for the public interest. In Manitoba, the MDA is the authorized regulatory authority.
With a few exceptions, the overlapping knowledge requirements and continually evolving nature of dental practice precludes a prescriptive approach to regulating practice scope. Instead, certain overarching principles are applied to define the appropriateness of a member’s activity within the legislated scope of practice. The key principles being:
1. within the legislated scope of practice, a member must restrict his or her practice to their knowledge, skill and judgement; and
2. there must be a benefit to the individual patient and the overall public interest in a member providing a service.
Currently, most reviews of scope of practice are performed retrospectively through the peer review process. Beyond not meeting the standards of practice, a member may face regulatory sanction for failing to obtain the necessary level of training to be competent in a procedure.
Another legislated responsibility for the MDA is the identification of specialty areas of dental practice and the determination of the necessary training levels to be recognized as a dental specialist in
a particular area. The statutory authority for decisions on specialty recognition rests with the MDA. Recognition is based on a demon- strable benefit to the public that outweighs the associated costs to society related to that recognition.
The scope of dental specialists is limited to the scope of their specialty in Manitoba. That said, there is no regulatory document that prescribes the specific services of each specialty. As with the
profession in general, it is understood from a regulatory perspective that scope will evolve over time. Specific issues of a dental specialty scope of practice will be determined as the issue arises based on current knowledge.
The opportunity for endodontists to place direct final restorations or cores was raised this year. The request was based on concerns about developing evidence on coronal leakage and endodontic success. In reviewing the matter, the MDA executive balanced these concerns with the potential problems for patients. In accepting the placement of direct restorations and cores are within the scope of practice for endodontists, the MDA executive also outlined specific standards
of practice to ensure the interests of patients and the public are protected.
An endodontist may place a direct restoration or core under the following conditions:
1. prior to providing this service, the endodontist has acquired and maintains the necessary training for competency in the preparation of the tooth and placement of the materials to the same standards of the reasonable and prudent dentist;
2. if a patient is referred from a dentist, the endodontist will perform the restorative procedure after consultation and agreement about the preparation design, materials and any anticipated future restoration;
3. if a patient is referred from a dentist, both the endodontist and the general dentist are responsible for ensuring the patient receives full informed consent regarding the procedure and any anticipated future restoration;
4. it is expected the patient will not incur additional fees for the restoration above what the referring dentist would bill without clear informed consent of the patient.
The best interests of patients and the public is paramount. The intent of these practice standards is to avoid miscommunication, treatment delays, and unnecessary costs that may adversely affect the patient. It is expected members will be reasonable and prudent in their decisions.
I wish you all the best of the Holiday Season,
Marcel Van Woensel
Registrar, Manitoba Dental Association

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