Dental Chair Maintenance

Running a dental practice isn’t just about the clinical care of patients.  Without a doubt, the treatment of your patients is of utmost importance.  However there are other areas you need to focus on to be sure you’re running a successful business and doing right by your staff and patients. One of these areas is the maintenance of your equipment as you can’t run your business without it!

Guild Insurance is noticing a claims trend in the area of faulty or damaged dental chairs, and this is quite often due to the chairs not being maintained as they should.  These claims are often very costly due to the sometimes extensive damage to more than just the chair.

Example of what can go wrong:

The pipes inside a dental chair burst and flooded the practice.  This happened overnight; by the time it was found in the morning there was significant damage to the floors and furniture.  Insurance covered the cost for the additional damage to the practice.  However, insurance can’t fully compensate for the period of time the practice couldn’t operate due to the damage.  In that time some patients went elsewhere for treatment and others expressed frustration with what they saw as a poorly maintained practice.

Key points regarding dental chair maintenance:

  • You can’t operate your business without your dental chairs. If they break down and aren’t functioning normally, this is going to impact your ability to treat your patients.
  • If the chair isn’t operating as it should, this has the potential to be a safety issue for your patients who sit in it.
  • Follow manufacturers’ guidelines regarding chair maintenance.
  • Consider what may happen if your patients need to go to another practice to receive treatment due to your chair or business being out of operation; will they come back to you later?
  • Don’t assume that insurance will cover any breakdowns and therefore maintenance isn’t needed; this won’t always be the case. Accidental damage to equipment or faulty equipment may be covered in an insurance claim, however wear and tear due to poor maintenance won’t be.

Poor maintenance of your chairs or other pieces of equipment can affect more than just that piece of equipment, it can affect your professional reputation and the running of your practice.  Don’t underestimate the importance of your chairs and other equipment; be sure you maintain them as needed.

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    Property maintenance - could your property cause an injury?

    Guild Insurance sees many insurance claims which have come about due to poor maintenance of a property.  In too many of these cases, the poor state of the building or its grounds is obvious and it’s quite surprising, as well as disappointing, that repairs haven’t been carried out before an incident has occurred.

    What can go wrong?

    There are a range of incidents which can occur due to poor maintenance of a property.  Staff can be injured leading to a worker’s compensation claim as well as staff being absent from work for an extended period.  Visitors to the premises, such as customers, clients or contractors, can also suffer injuries leading to public liability claims.  As well as the insurance claims which need to be managed, there’s the added stress of knowing that someone has been injured while at your premises.  Some of these injuries can be very serious and life changing.  Unfortunately, the hazards which lead to these injuries are often not viewed as seriously as they should be.  Yet with appropriate property maintenance many of these injuries could be avoided.

    Case 1

    A client entered a building and tripped over an edge of carpet which was ripped and curled up.  The client sustained a fractured wrist when they landed.

    Case 2

    An awning out the front of a building was old and worn out.  During heavy winds it broke off from the building and hit a person walking past at the time.

    Case 3

    While walking through the carpark of a premises, a staff member has tripped on a large crack in the asphalt which had caused the surface to be uneven.  They fractured their ankle as they fell.

    Case 4

    Poor maintenance doesn’t just lead to people suffering injuries, it can also lead to further damage to the property.  An old deteriorating roof collapsed when hit by heavy rain as it no longer had the strength to support the weight of this rainfall.  This led to excessive water damage within the building.

    Property maintenance tips

    • Have a documented maintenance program in place. This requires a schedule for regularly checking the property to identify hazards as well as details on what needs to be serviced, repaired or replaced and when.
    • Be aware of the out-of-sight, out-of-mind hazards. Many properties have roofs, guttering and downpipes in poor condition due to a lack of maintenance as no one has thought to get up on the roof and inspect it. Include the less obvious hazards in the maintenance program.
    • Have a maintenance budget. Some maintenance work can be planned, other work will come up unexpectedly when something breaks down. You need to be able to find money to fix hazards when identified.
    • Be sure to use qualified tradespeople to undertaken maintenance work. While it can be tempting to undertake some DIY and save money, the risk of things not being maintained or repaired correctly will not be worth the savings in the long term.
    • If you’re a tenant, be aware of what you’re responsible for maintaining and what’s the responsibility of the landlord. Not all tenancy agreements are the same, so you need to be across the details of your agreement.
    • Don’t wait to undertake maintenance till a more convenient time. There are many cases of injuries occurring due to hazards which had been identified but not yet acted upon, usually due to costs, time or not acknowledging the risk of the hazard.
    • All staff have a responsibility to create and maintain a safe workspace. Some hazards will be identified through regular property inspections, however, you can’t rely solely on these inspections. Therefore, encourage all staff to continually be on the lookout for hazards and to speak up when they see something.
    • Don’t think it won’t happen to you and your property. These incidents are a lot more common that many people realise.

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    Orthodontic and third-party agreements: risks and concerns.

    In recent times, there has been a growing number of companies on the internet offering orthodontics like braces, aligners, and other products that people can use at home. While the convenience is very appealing for patients, the same can’t be said about the risks and concerns that come with partnering with foreign-based aligner companies. With the recent demise of two overseas aligner providers, some dentists have not been able to continue patient care in the middle of a course of orthodontic treatment. This has resulted in patient complaints against dentists, who had no part in the companies’ collapse but are left to manage the fallout and develop a re-treatment plan with another aligner provider.

    Another recent development is that patients are asking dentists to place attachments for “at-home, do-it-yourself” aligner treatment. Seeing that this is a complex issue, the ADAVB has approached their advisors at Meridian Lawyers to make general comments about the pitfalls for dentists undertaking either of these two types of treatment. Their advice is that the provision of aligners and/or attachments may make the dentist liable for any adverse treatment outcomes and possibly affect a dentist’s professional indemnity (PI) cover.

    The ADAVB recommends that any member undertaking orthodontic treatment with third-party aligner providers familiarise themselves with the risks and ensure that they are not exposing themselves to additional liability, which may place them in a precarious position when defending a claim.

    Major concerns 

    Treatment plans by aligner companies are often computer-generated offshore with some input from a technician. Blindly following these plans may result in a compromised outcome and potentially irreversible damage. Orthodontists often make changes before a satisfactory plan is reached and may even further modify plans during treatment, depending on the progress. As the clinician, you’re responsible for the treatment and any adverse outcomes, not the aligner company that generated the treatment plan.

    As a result, any claims by patients would most likely be against the dentist or the clinic. Contractual and duty of care considerations need to be taken into account. Even if the contract says the aligner company will cover your liability, that can’t be enforced. By Australian law, the dentist cannot delegate liability for treatment performed to another party. So, in the end, the problem comes back to bite the dentist.

    Fault by association

    A claim against the aligner provider would necessitate chasing shelf and overseas companies, making it almost

    impossible for the patient. The patient will turn to the only person they can reach and direct the blame to – their dentist. It should be noted that at present, there are two class action claims in courts overseas against aligner providers, but these may take years to play out, and it’s unknown if they will be successful.

    An insurer is not privy to the contracts dentists sign or warranties offered by aligner companies. This means warranties deflect back to the dentist and may not be covered under a professional indemnity policy. In Australia, health service providers cannot give warranties, so that part of the company’s “promise” is worthless unless it relates specifically to the aligners themselves (breakages, replacements, etc), not treatment outcomes. 

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    Informed consent is potentially lacking as most dentists are utilising documents supplied by the aligner company, which in many cases, are not comprehensive enough to satisfy the Australian Code of Conduct requirements.

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    > Products may not be TGA approved (as required in any PI policy): there is a high risk that the insurer may reject a claim when these devices are being used.

    > Australian Privacy Principles (APPs) may be broken by sending confidential patient information overseas: if there is a breach of privacy, the insurer can deny cover as the policy wording indicates the dentists must abide by the APPs in how they store patient information. Foreign companies are not bound by the APPs, so a dentist must weigh the risks and inform the patient about the potential breach of confidentiality before undertaking treatment. In saying that, the risk

    remains that an indemnity claim could still be denied.

    > Companies may offer incentives or discounts, equipment, etc: these all need transparent disclosure under Ahpra’s regulatory framework. If you don’t disclose these on all advertising and patient material, you could be in breach of Ahpra

    or TGA’s advertising standards and guidelines.

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    Australian Health Practitioner Regulation Agency (Ahpra) – Guidelines for advertising
    Therapeutic Goods Administration – The Therapeutic Goods Advertising Code:  tga.gov.au/about-tga/legislation/legislationand- legislative-instruments/therapeutic-goodsadvertising- code

     

    Office of the Australian Information Commissioner (OAIC) – Australian Privacy Principles: oaic.gov.au/privacy/australian-privacy-principles

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    Understanding social media risks

    Social media is an ever increasing form of communication for many people in both their personal and professional lives. It presents people with many benefits in allowing them to communicate a variety of messages to many people with great speed and efficiency. However, those benefits need to be balanced with the many risks social media presents.

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    6. Consider what messages should be shared using social media
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    7. Carefully consider the implications of engaging with clients on social media
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    Download PDF here


    Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791.  This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them    .

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