By Duane Tinker, The Toothcop
The Call No Dentist Ever Wants
Every dentist I know can tell you what keeps them up at night.
It’s not production.
It’s not collections.
It’s the phone call.
The one that starts with:
“Doctor, we had to send the patient to the hospital…”
—or worse—
“Doctor… the patient died.”
When a patient is hospitalized or dies following dental care—whether related to sedation, anesthesia, infection, medical emergency, or an unforeseen complication—the emotional toll is immediate and HEAVY.
But once the shock fades, something else follows.
The investigation. As a former dental board investigator, I know something about the investigation. It was my job to investigate these occurrences.
And no matter the state, specialty, or circumstances, dental boards almost always reduce their analysis to two fundamental questions:
The Two Questions That Decide Everything
1. Did the dentist and staff do everything they reasonably could to PREVENT the adverse occurrence?
2. Once it occurred, did the dentist and staff respond as a “reasonable and prudent” dentist—with similar training and experience—would have responded?
If the answer to either question is no, the Board’s next job is straightforward:
👉 Decide what to do about it.
That can range from education…
· to fines…
· to probation…
· to suspension…
· report to the national practitioner data bank…
· or loss of sedation permit…
· and/or loss of dental license.
Let’s break these questions down the way the Board—and their expert reviewers—actually do.
Question #1: Prevention — “Could This Have Been Avoided?”
This is where most cases are won or lost.
1. The Board is not asking whether you meant well.
2. They are not asking whether the outcome was rare.
3. They are not asking whether “this has never happened before.”
They are asking:
“Were reasonable safeguards in place before the procedure ever started?”
What Boards Look at Before the Event
Here’s what typically ends up under a microscope:
Patient Assessment
· Complete medical history?
· Updated on the day of treatment?
· ASA classification documented?
· Risk factors recognized and addressed?
Informed Consent
· Was it procedure-specific?
· Did it include sedation/anesthesia risks?
· Did it meet the requirements of informed consent?
· Was it signed before medications were administered?
Training & Credentials
· Were required permits current?
· Were staff certifications current (BLS, ACLS, PALS as applicable)?
· Was the provider trained for the level of care delivered?
Equipment & Drugs
· Emergency drugs present, unexpired, and accessible?
· Oxygen, suction, AED, monitors available and functional (do you have maintenance records)?
· Monitoring consistent with guidelines and state rules?
Policies & Protocols
· Written emergency response protocols?
· Sedation and anesthesia policies/procedures/protocols (did you follow them)?
· Infection control and patient safety procedures (again, did you follow them)?
Here’s the Toothcop truth:
Most adverse occurrences are not caused by one catastrophic mistake—they’re caused by multiple failures that stacked up quietly over time.
Question #2: Response — “What Did You Do When Things Went Sideways?”
Even when prevention is solid, bad things can still happen.
That’s why the second question matters just as much.
Did you and your team respond the way a reasonable and prudent dentist with similar training and experience would have responded?
This is not about perfection.
It’s about competence, judgment, and leadership under pressure.
What “Reasonable and Prudent” Really Means
Boards look at:
· Recognition
o Was the emergency recognized promptly?
o Were vital signs monitored and interpreted correctly?
o Did staff understand what they were seeing?
· Immediate Action
o What did you know and when did you know it?
o Were appropriate emergency protocols initiated?
o Oxygen administered?
o Proper positioning?
o Emergency drugs used correctly and timely?
· Team Performance
o Did staff know their roles?
o Was there clear leadership?
o Was help summoned early (EMS activation)?
· Continuity of Care
o Accurate handoff to EMS?
o Clear documentation of events, times, and actions?
o Post-event follow-up and reporting?
Here’s a hard truth I’ve seen repeatedly:
Boards are often more forgiving of an unavoidable emergency than they are of a slow, disorganized, or poorly documented response.
The Case Isn’t Decided by Outcome—It’s Decided by Evidence
This part surprises many dentists.
The Board does not decide cases solely on whether a patient was hospitalized or died.
They decide cases based on:
· Documentation
· Training records
· Policies
· Timelines
· Expert opinions
If it’s not documented, it didn’t happen.
If it wasn’t trained, it wasn’t reliable.
If it wasn’t practiced, it wasn’t predictable.
Why Preparation Is Your Only Real Defense
You don’t prepare for emergencies because you expect them.
You prepare because when they happen, you don’t get a second chance to show what kind of dentist you are.
Preparation answers both Board questions before they’re ever asked:
1. You can show you did everything reasonable to prevent harm
2. You can show your response matched the standard of care
That’s not fear-based compliance.
That’s professional survival.
Remember, in an emergency, people don’t rise to the level of their expectations, they fall to the level of their training. So, how much training is enough? What should you train on? Who should participate in the training? These are great questions for another blog.
Final Thought from The Toothcop
No reasonable and prudent dentist wakes up intending to harm a patient.
But intent doesn’t protect your license—preparation does.
When the worst happens, the Board will ask:
1. Could this have been prevented?
2. Did you respond like a reasonable and prudent dentist would?
Make sure your answer—on paper and in practice—is yes to both.
Because once that investigation starts, hope is not a strategy—but documentation, training, and readiness are.
Want Help Stress-Testing Your Office Before Something Happens?
If you want to know how your practice would hold up under Board review—before you’re forced to find out the hard way—I can help you evaluate:
· Emergency preparedness
· Sedation compliance
· Training gaps
· Documentation risk
Reach out. Let’s make sure the worst day of your career never becomes the end of it.