Elevating the Conversation: Safety and Risk Management in Dental Practice

ABSTRACT

Beginning in the 1970s and 1980s, risk management principles were adapted to healthcare from other industries to help address the proliferation of medical malpractice settlements and judgments. Efforts focused on Identifying and mitigating legal vulnerabilities. As dentists continue to refine and expand services offered to their patients, they must assess and proactively address potential risks for the benefit of patients and professional liability mitigation. This article will consider the recent past and status of patient safety and risk management in dentistry, as well as immediate opportunities for safety improvements and risk mitigation in professional dental practice. Although individual dentists and dental practices may identify and implement methods to improve safety and risk management, cooperative dental professional and cross-professional initiatives will help to foster change more broadly, benefitting both dental patients and all dental professionals.

KEYWORDS:

• Risk management
• safety
• professional liability
• malpractice
• claim

Risk Management and Patient Safety in Dentistry

A 52 year-old male patient sought care for a faulty bridge from tooth 29 to 31. The abutment teeth were non-restorable, and the patient agreed to implant therapy. After extractions and implant placement, the patient complained of pain and paresthesia. The doctor monitored the situation for two weeks, taking no other action. The patient then sought a second opinion and later filed a lawsuit asserting negligent care. Expert review indicated standard of care concerns including inadequate pre-surgical planning/imaging, no documented implant length planning, no intra-operative images, absence of follow-up diagnostic images, failure to remove implants to prevent permanent nerve injury, and missing treatment/follow-up care records. A CBCT image indicated clear evidence of mandibular nerve impingement. The patient suffered permanent nerve damage.

The case study demonstrates patient safety and risk management concerns that are all too common in dental professional liability claims.¹ Although professional malpractice involving serious patient harm may never be asserted during an individual dentist’s career, malpractice claims and lawsuits involving injuries (e.g., nerve injury, jaw fracture, laceration), and other adverse events (e.g., wrong tooth treatment/extraction, swallowed/aspirated objects, failed implants, failure to diagnose/refer for oropharyngeal cancer, or infection/sepsis) are reported frequently to professional liability insurers.

Similar to clinical, operational, and financial risks associated with dentistry and health care, errors, adverse events and undesirable outcomes are inevitable. Nevertheless, dental professionals must adhere to ethical standards – beneficence and non-malfeasance – as part of preventing harm.² Furthermore, all members of the dental community must challenge the status quo and continually improve both treatment quality and patient safety.

• The practicing dentist and all dental team members are critical to the delivery of safe patient care. Moreover, each dental team is responsible for sharing its experiences (both positive and negative) through networking, educational programs, adverse event reports, the dental literature and through other available mechanisms. These resources can enable dental professionals to learn from their peers about real-world risks and preventive measures without experiencing an adverse event or litigation.

• Dental researchers, academia, professional organizations, governmental agencies and others play a key role in funding and development/dissemination of evidence-based clinical guidelines, recommendations, and best practices to support safe and effective patient care.

• Governmental agencies, professional organizations, professional liability insurance companies, and others may provide information on, and analysis of, adverse events on an aggregate basis, quality and/or patient safety data and criteria.

• The dental products industry and the FDA are responsible for developing and assessing the safety and effectiveness of dental products – another important part of providing safe dental care.

Background and Status

Although many definitions exist that apply to specific situations, risk management and patient safety are complementary terms for purposes of this discussion. They share a common goal – preventing harm – as demonstrated in the following definitions

• Patient Safety- the absence of preventable harm to a patient and reduction of risk of unnecessary harm associated with health care to an acceptable minimum.³

• Risk Management- the attempt to identify, evaluate and deal with problems which may cause harm to patients, to file complaints about malpractice and to avoid unnecessary economic losses for health care providers.⁴

In today’s dental practice, implementation of strategies and processes that support the interrelated concepts of risk management and patient safety will help to ensure an environment in which to deliver safe, quality dental care that will benefit the patient and provider.

Beginning in the 1970s and 1980s, the principles of risk management were adapted to healthcare from other industries as a strategy to address the proliferation of medical malpractice settlements and judgments. The focus centered on identifying and mitigating areas of legal vulnerability, such as the absence of informed consent and professional negligence.⁵ A few years later, another perspective presented risk management as a unifying principle between legal responsibilities and sound clinical practice.⁶ Two common themes emerged in the reviewed cases. These factors remain at the core of dental risk management today: transparent communication and comprehensive documentation.

Notwithstanding the importance of communication and documentation to effective risk management and harm prevention over many decades, inadequate communication and documentation remain as key elements associated with patient harm and consequent malpractice claims, as in the following claim case study.

A patient with a history of oropharyngeal cancer treatment retired from work, moved to a different state, and sought dental care. Due to specific patient complaints, limited exams and treatment were performed at the new office. These visits led to a treatment plan for several implants and restorations, without benefit of a comprehensive evaluation. Extraction of a lower molar at the start of the planned case resulted in pain and delayed healing. Upon further questioning, the patient confirmed that he had previously received chemotherapy and radiation therapy to treat the oral cancer. The dentist then prescribed an antibiotic, which was ineffective. The patient then sought care from an oral surgeon. The diagnosis: osteoradionecrosis and infection. The patient’s disease course included multiple debridement procedures, pathologic fracture and eventually, reconstructive surgery. Concerns included missing records (including the medical history and letter regarding the patient’s cancer treatment from the prior dentist), inadequate informed consent and failure to initiate a timely referral for specialty care.

In this case study, transparent and effective communication may have prevented the oversight of the patient’s radiation therapy history. The patient and the dentist play an essential role in the communication process. Unfortunately, the patient failed to disclose this critical part of his medical history, and the dentist failed to probe for further details about cancer therapy. The office had recently implemented an electronic record system and had not yet established a procedure and audit process for the integration of external records. Otherwise, effective documentation management may have averted the adverse outcome.

Perea-Pérez et al.⁴ proposed a multi-part dental care risk management plan (Table 1), since “no available bibliography exists regarding any ‘plan for health care risk management’ specific to dentistry.” ^4(p806) Part of the plan proposes that measures be established to reduce risk, which may include sound clinical practice recommendations.⁴ Consistent with this proposal, a risk management plan should include the consideration of evidence-based clinical guidelines for the procedure at hand, if available.

Table 1. Components of “the Plan for Health Care Risk Prevention in Dentistry.”^4(p807)

Item	Comment
“…promote a culture of patient safety in dental care.”^4(p807)	“Culture of safety is the product of individual and group values, attitudes, perceptions, skills, and patterns of behavior which lead to commitment, style and ability in the management of the health and safety ….” “… organizations with a positive safety culture are characterized by communication based on mutual trust, by shared perceptions of the importance of safety and by trust in the effectiveness of measures for prevention.”^4(p807)
Promote an “increased awareness amongst dentists about the general aspects and basic measures involved in patient safety”^4(p807 and related research.	The authors propose an emphasis on dentists’ awareness of safety culture, but also among patients and others involved in the management/business of dental care, stating this “is absolutely fundamental.”^4(p807)
Create “an organizational structure for the management of dental care risks.”^4(p807)	The authors propose a structure consistent with the system in place in Spain.^4 In the U.S., this structure may involve local/state public health and/or professional organizations.
Develop “tools for the identification, analysis and assessment of risks related with dental care.”^4(p807)	Includes “a system for notification and recording of adverse events which take place in professional practice”^4(p807); classification of adverse events (AEs) “on the basis of a specific taxonomy”^4(p807; use of tools to study reported AEs (e.g., root cause analysis-RCA) and prevent future AEs (e.g., failure mode and effects analysis-FMEA).^4
Establish “lines of information on adverse events.”^4(p808)	Communication/information pathways will facilitate the sharing and consolidation of AE data. Information sources may include professional literature, PSOs and other practitioner/patient reporting sources, health departments, malpractice claims (insurers, courts).^4
Establish “measures to prevent health care risks by elimination or reduction.”^4(p808)	Measures may derive from and be used by an individual practice or be more general, based upon known risks. Examples include infection prevention and control recommendations or evidence-based clinical guidelines.^4
Implement “ongoing training of professionals on patient safety.”^4(p808)	Should include an urgent alert system and periodic update communications.^4 (Addition in the U.S.—Continuing Dental Education on patient safety and risk management.)
“Research in the field of Dental Patient Safety.”^4(p808)	Academic research and “any other applicable instrument of education or research.”^4(p808) (Such resources in the U.S. may include commercial product safety research, computer or other device hardware/software, electronic dental records systems, etc.)

In the absence of evidence-based clinical guidelines, practitioners should implement and follow clinical protocols and safety measures consistent with the principles of evidence-based practice, designed to meet the standard of care (Table 2). Although deviation from guidelines or protocols may be appropriate or necessary for an individual patient’s condition and circumstances, in the author’s experience as a risk control professional, a supporting rationale for deviation often fails to be reflected in clinical documentation.

Table 2. Standard of care in dentistry.*

Characteristic	Comment
What a reasonable and prudent practitioner would do under the same or similar circumstances.	Although the concept is widely understood, there are no definitions of what is, or is not reasonable and prudent for each dental procedure.
A reasonable and prudent dentist should act with skill and due care when treating patients.	Examples of exercising due care: informing the patient of the diagnosis; referring when indicated; obtaining informed consent before treatment; completing treatment that has been started; and following up on the patient’s care and status.
The standard of care is a dynamic concept, changing over time with new technology, research, and advancements in clinical methods.	Remaining current on evidence-based clinical guidelines, new methods, materials, and treatments (applying principles of evidence-based practice) is essential to meeting the standard of care.
In a malpractice action, the standard of care is articulated through the opinion testimony of expert witnesses.	Expert witnesses are professionals with background and training similar to the dentist defendant, typically from the same practice community.
The specialty standard of care typically applies to treatment ordinarily performed by a dental specialist.	The patient (plaintiff) customarily retains a dental specialist as an expert witness in such cases involving treatment that a dental specialist would ordinarily provide. Although there may be exceptions, the specialty standard of care would apply to a general practitioner defendant.

*Adapted from CNA Risk Control Resources (2023).

Essential risk management steps for today’s dental practice may be proposed that closely align with the Agency for Healthcare Research and Quality (AHRQ) elements of a patient safety initiative.⁷ Whether a practice plans to offer a new patient service or reevaluate current treatments and procedures, follow a methodical risk management/patient safety process that minimally incorporates these key points:

1. Identify and analyze potential risks/adverse events related to the treatment or process.

2. Evaluate possible risk management/patient safety methods or techniques.

3. Implement selected methods and techniques.

4. Track results, then reassess and improve methods and techniques, as necessary.

In addition to patient safety and risk management processes, an important third component of rendering safe and effective care is the quality improvement process (continuous improvement). A useful, dental practice-focused resource describes quality assurance and improvement in the context of dental clinic services.⁸ For example, the Plan-Do-Check (or Study)-Act quality improvement process (PDCA or PCSA cycle) aligns well with the steps described in a patient safety initiative and the risk management process.⁹

Consider the previous case studies. What risks and adverse events should be prioritized for mitigation for the procedures that were performed? Were sufficient risk mitigation and patient safety techniques considered and implemented to help ensure safe, quality patient care? What steps would a prudent dentist take to do so? What protocols and procedures does your practice implement to ensure safe, quality patient care?

Patient injuries and other adverse events may occur even when the standard of care is fulfilled. On the other hand, certain actions and decisions during the course of patient care may result from a number of factors that conflict with risk management and patient safety principles – as in the two case examples – potentially leading to patient injuries and adverse outcomes.

Are We Improving?

Researchers discovered that there were more than 1500 dental malpractice claims per year in the National Practitioner Data Bank (NPDB) dataset between September 1990 and December 2018.¹⁰ The majority of claims involved minor injuries. However, in the years studied, it was noted that minor claims decreased in number while claims involving major injuries increased.¹⁰

The NPDB online data analysis tool demonstrates that this trend continues, with data now available through December 2022. Less severe dental incidents with settlement payments below $100,000 (Figure 1) have trended down over three decades, while at the same time more severe incidents with payments of $100,000 or more (Figure 2) have increased in number.¹¹ Interestingly, the average dentist malpractice payment reported to the NPDB in 1991 was $23,178. Correcting for inflation, this amount represents approximately $49,800 in 2022 dollars. However, in 2022, the average dentist malpractice payment reported to the NPDB was $113,188, approximately 2.25 times more than in 1991.

Figure 1. Dental malpractice payments ≤ $99,999.

Figure 2. Dental malpractice payments ≥ $100,000.

Data from one insurer’s dental professional liability claim report comparing two datasets demonstrates a similar trend, with the percentage of claims over $100K on the rise and a decreased percentage for claims under $100K (Figure 3),¹

Figure 3. Paid indemnity range comparison: 2016 claim dataset vs 2020 claim dataset.

Other key findings of this claim report, which compared closed claims with settlement payments from $10,000 to $1,000,000 over two time periods, 2016 and 2020, include:

• The average total incurred (total of a settlement payment or judgment at trial, plus claim expenses) for dental closed claims increased more than 24% to $134,497 from the previous report.

• The top five dental procedures most often associated with malpractice claims all demonstrated increases in average total incurred since the previous report (Figure 4).

  Figure 4. Average total incurred of top dental procedures associated with all professional liability claims.

  

• Claims associated with nerve injury have increased and the average total incurred has risen by 43.6% to $210,568.

• Incidents of swallowed-aspirated object and wrong tooth treatment/extraction continue to be an important safety concern. In total, these claims have increased in frequency and now represent 8.6% of closed claims with settlements of $10,000 or more.

These findings help to clarify the types of dental procedures most often associated with costly malpractice claims in dental practice. Periodically publishing this information is intended to “help dentists enhance their practice and minimize professional liability exposure by identifying loss patterns and trends.” ^1(p5)

Only a portion of errors and adverse outcomes result in professional liability claims or lawsuits. Moreover, many near misses involve situations where the conditions indicated the likeliness of an error or injury, but none occurred. In the absence of these data over many years, it is difficult or impossible to state whether dentistry is improving with respect to risk management and patient safety. However, the question of progress and improvement is multifaceted for this complex topic.

On the positive side of the equation, the professional literature on dental patient safety and clinical guidelines is expanding. The resulting information and the development of associated tools will increase practitioners’ awareness and facilitate advances in dental-specific patient safety initiatives, including at the practice level.^12–18 Organized dentistry also is becoming proactive on policies, recommendations, quality of care and continuing education.^19–24 Dentistry has a patient safety organization (PSO) – the Dental Patient Safety Foundation (DPSF) – which meets the criteria established by the Patient Safety Rule of the U.S. Department of Health and Human Services.²⁵ Finally, dental licensing boards across the country exist primarily to protect the public. Licensing boards help to ensure the delivery of safe patient care through the promulgation of rules and regulations, as well as through their oversight and compliance activities.

Similar to any new clinical discovery, method or treatment, the progression from research to broad-based acceptance and implementation can be tortuously slow. Dentists must apply the principles of evidence-based practice and remain aware of advances as new information is validated, published, and disseminated. Moreover, participating in the dissemination process – and implementing strategies that will enhance safety – represent actions within each practitioner’s scope and ability. Now is the time to consider the steps that every dentist/dental team immediately may implement to advance patient safety, risk management and facilitate continuous improvement to make a difference in patient care.

Opportunities for Improvement

Understanding Obstacles

Modern society places significant demands on an individual’s time and attention. Dentists and their team members are not exempt from these pressures. Consequently, a perceived obstacle to re-thinking the approach of a dental practice to risk management and patient safety is the time necessary to do so. Dentists often ask patients who are grappling with a treatment plan decision about their personal priorities. Is their smile and oral function more important than other products or services competing for disposable income? Establishing priorities may quickly clarify a decision to proceed with dental care.

Similarly, every dental office has a philosophy, mission, and priorities, whether documented in writing or visible through its actions. Typically, risk management and patient safety activities are already consistent with the practice philosophy. Re-assessing philosophy and mission and, if necessary, making thoughtful adjustments will permit the practice to re-set its focus and integrate high-priority risk management and patient safety activities.

Other obstacles which may explain delays in the development of programs organized specifically for promoting patient safety have been described⁴ including:

• Relatively minor incidents. Dental adverse events and injuries are often minor and less severe compared to other healthcare settings. However, recall the trend toward more severe malpractice claims. Furthermore, consider an adverse event such as swallowed/aspirated objects in dental practice. Although most incidents do not result in grave outcomes, every such incident has the potential to cause serious morbidity, even death.

• Outpatient setting. In an ambulatory/outpatient setting capturing and following up on injuries and adverse events may be more challenging and inconsistent.

• Dental practice variety. Differences in size, complexity, business practices, computer systems and other factors present challenges to safety data collection/sharing.

• Reputational risk. In a competitive private practice environment, dentists may fear potential repercussions and reputational risks associated with reported adverse events. While reports to a PSO, such as the DPSF can be safely, voluntarily, and confidentially submitted, this concern persists.²⁵

These and other obstacles may be effectively addressed by collaboration with and understanding solutions implemented by our medical colleagues and other healthcare professions. In addition, working together as a dental community with government agencies, vendors, professional organizations, insurers, and others will help to address safety infrastructure requirements.

Risk Management and Safety-Focused Actions, Educational Opportunities, and Other Resources

Dental academic and continuing education involves didactic, experiential, and social/observational learning. Learning by doing (experiential) occupies the core of clinical education, whether in dental schools, community-based clinics/externships, or hands-on continuing education programs. However, there is no need to experience a professional liability claim or patient adverse outcome for effective learning. Seeking opportunities to learn from collective patient safety reports and/or claim data and individual adverse event experiences of other dentists will facilitate and improve the assessment, mitigation, and management of risk exposures in dental practice. Consider the following approaches to promote a culture of safety and expand your dental team’s awareness of and focus on risk management and mitigation.

• Importance of the dental team. The ability of staff to help manage risk is critical to an effective risk management and patient safety program.

  1. A team approach to corrective action development helps eliminate bias in the process and maximize effectiveness and buy-in for new or modified policies or procedures.

  2. Develop a culture based upon open communication and being receptive to constructive feedback and recommendations from team members, other providers, and patients. These tenets are critical to realizing procedural and patient safety improvements.

  3. Hold regular staff meetings and incorporate risk management/patient safety into the agenda of each session.

  4. Appoint a Patient Safety Officer to lead internal safety efforts, preferably, an individual other than the office infection control officer.²⁶

  5. Consider in-office or external educational and career-expanding opportunities for the Patient Safety Officer – and all team members. These may include: TeamSTEPPS®,^27,28 general patient safety and/or risk management courses, certificates, and certifications,^29–31 dental-specific risk management and safety courses/certifications.^32–34

  6. Establish team processes for identification and review of near misses and adverse events, development of corrective actions and ongoing monitoring, as well as for reporting incidents to the DPSF.²⁵ Readers may learn more about the reporting process and the DPSF Reporting Tool by accessing the organization’s website (https://www.dentalpatientsafety.org) and clicking on “Report An Incident”.

• Study club activities.

  1. Encourage the integration of risk management and patient safety programming at local study clubs.

  2. Start a new study club focusing on risk management and patient safety. Use this safe space to share information about adverse events, near misses and corrective actions. Consider periodic submission of study club-authored papers to professional journals.

  3. Encourage internal patient safety officers to share their expertise via local and regional study club or dental society meetings.

  4. Seek out cross-professional content for study clubs to learn from medical colleagues and other professionals. Medical providers, hospitals and other healthcare facilities have actively pursued safety improvements and initiatives for many years.²³ Brainstorm on strategies to leverage their knowledge to reduce risk and improve safety in the dental setting.

• Other educational activities and content.

  1. Seek out presentations, webinars and on-demand content related to risk management and patient safety available from multiple professional liability insurers.

  2. Teach others: share your knowledge via local, state, or national professional meetings.

  3. Learn more about staying up to date on evidence-based clinical guidelines; evidence-based dentistry and evidence assessment^35–47

  4. Regularly incorporate training focused on patient and team communications as part of risk management/patient safety CDE plans (workshop/role-play format preferred).

• Documentation best practices – paper or electronic records. Reassess office documentation practices and implement or enhance internal dental record audit procedures to improve documentation. Minimally, confirm compliance with state documentation requirements. This information should be readily available on state dental board websites as part of board position statements, the state dental practice act and/or in state board promulgated regulations. Assistance also may be available from state dental societies, external consultants and/or professional liability insurers.

• As part of assessing office communication and documentation practices, review and improve the office’s informed consent process (Table 3).

  Table 3. Informed consent^.

  All healthcare providers have a duty to obtain a patient’s informed consent before commencing treatment. The consent must be given without coercion or fraud, based upon the patient’s reasonable understanding of what will take place, including: the nature of the proposed treatment, reasonable treatment alternatives, and the foreseeable material risks and potential complications. Unauthorized treatment of a patient may constitute the crime of battery. Most patients have a reasonable idea of what will occur during a routine examination or treatment and give implied permission for work performed when they visit an office for such care. Implied consent, however, has serious limits as a legal defense, especially when more complex or risky treatment is involved. Dentistry is a highly technical profession, and patients often have a limited understanding of the procedures to be performed. Relying on implied consent minimally risks misunderstanding, and may lead to serious adverse events. Informed consent can be regarded as an educational process involving two main components: Discussion, including disclosure and patient education. Informed consent requires a verbal communication component, whether or not a written consent form is used. The informed consent discussion also helps to manage patient expectations with respect to treatment outcomes. Documentation in the patient record. Documentation often includes the use of a written informed consent form. (In certain states, a written form may be required for some procedures.) Documentation elements should include verification that the discussion occurred and evidence that the patient understood and agreed to proceed through an acknowledgment as signed by the patient or the patient’s authorized representative. In today’s healthcare environment, the informed consent process assumes ever-greater significance in terms of patient education, dentist-patient communication, risk management and patient safety.

  ^Adapted from CNA Risk Control Resources (2023).

• Accreditation by independent and recognized third-party organizations is customary and often required in healthcare fields other than dentistry. Although less common, dental practices may seek accreditation voluntarily from such organizations.^48,49 The accreditation process provides another opportunity for dentists and dental team members to remain focused on methods and practices to improve quality, reduce risk and promote patient safety.

Summary and Considerations

Dentistry is a fulfilling professional endeavor, leading to personal, professional, and financial rewards for dentists and all dental team members. Most importantly, millions of patients benefit from dental services through improved self-esteem and better oral/overall health. In order to deliver quality care and improve patient health, dentists routinely monitor patient home care, health/disease status, and recommend appropriate preventive actions and treatments, and assess outcomes. To help ensure a healthy dental business, they regularly monitor financial metrics, hire business and marketing consultants, implement financial improvement strategies, and determine results.

Similarly, in the interest of ethical care, patient safety – and in dentistry’s enlightened self-interest – the dental community must continue to improve and implement methods to collect, analyze and disseminate patient safety information to fully understand the scope and nature of errors, injuries, and other adverse events in dentistry. These data will help to expose gaps in safety systems, treatment protocols and office procedures to facilitate risk mitigation and reduce harm. Although dental researchers and organized dentistry have made progress to identify and overcome barriers, and to develop methods, strategies, and goals toward broad realization of a dental culture of safety, every practicing dentist and dental team member represents the catalyst necessary to accomplish this goal.

Practice reassessment and change implementation can be a daunting endeavor in the best of circumstances. Remember that a journey of a thousand miles begins with a single step. Choose one protocol or technique that your team can implement tomorrow, choose three protocols or techniques (or more) that your team can implement in the coming year. Take action and begin to establish a culture of safety in your dental practice and within the local/regional dental community. Then take a breath, assess, and recognize your successes. In addition, dentists and team members must understand and realize that risk management and patient safety are partners in a continuing journey—not a destination. In this journey, challenges will arise and errors will occur. Responding to these events with honesty, transparency, and empathy, rather than blame and shame, will help to ensure development and continuation of an effective culture of safety.

By carefully examining policies and processes, sharpening the focus on patient safety, and developing effective communication, documentation and risk prevention protocols, dental professionals can elevate their practice to the next level, benefiting all parties.

Acknowledgments

The author would like to recognize the efforts of Mr. Scott Sellers for management of the NPDB malpractice payment data and generation of Figures 1 and 2. Mr. Sellers also managed and analyzed claim data supporting publication of the CNA/Dentist’s Advantage Dental Professional Liability Claim Report: 2nd Edition, including exhibits 1 and 5 of the Claim Report which appear this manuscript as Figures 3 and 4, respectively.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Ronald R. Zentz

Ronald R. Zentz joined CNA in 2012 and serves as Consulting Director, Industry Leader, Healthcare Risk Control. His primary responsibilities include risk management resource development, customer support and continuing education for dentist and pharmacist professional liability programs. Dr. Zentz practiced pharmacy and general dentistry, followed by professional and clinical affairs positions with a major dental manufacturer. His responsibilities included product development, clinical research, regulatory affairs and continuing education for device and pharmaceutical products. Dr. Zentz later joined the American Dental Association (ADA) staff, serving as Senior Director, ADA Council on Scientific Affairs. The Council advances the science of dentistry through research, product evaluations and standards, and development of evidence-based clinical recommendations. His education includes a Bachelor of Science in Pharmacy (Butler University), Doctor of Dental Surgery (Indiana University School of Dentistry) and a General Practice Residency Certificate (Veterans Administration Medical Center, Indianapolis). Dr. Zentz is a member of the American Dental Association, the American Pharmacists Association, and is a Fellow of the Academy of General Dentistry and the American College of Dentists. He is certified in healthcare risk management (CPHRM) by the American Society of Healthcare Risk Management and has completed the TeamSTEPPS® Master Trainer program.