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According To “Dr. Wo” Wm. Randol Womack, DDS Editorial Director, Orthotown Magazine

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Are You a Careful Practitioner?


Wm. Randol Womack, DDS
Editorial Director,
Orthotown Magazine		 It’s no surprise to me lately that most of the meetings I attend and many of the articles I read are focused on cone beam computed tomography (CBCT) scans. CBCT is rapidly becoming one of the most influential technologies in orthodontics – even we at Orthotown Magazine have a hard time keeping up with its burgeoning advancements and effects. We are all becoming aware of the increase of information that is available via CBCT scans. There are advanced visualization software packages that enable us to see into, rotate, analyze and measure (1-1) internal anatomy in ways that were just not imagined a few years ago.

But what we cannot yet define with confidence is the responsibility (liability) that is associated with the use of this technology. Many experienced professionals in dentistry and the law infer that CBCT scans soon will become the “standard of care.” I agree that all indications point to this happening; we just don’t know when it might happen. But this begs the question, “How often do we give any thought to the meaning of and impact of the term ‘standard of care?’”
In doing some research in recently printed articles and within my family – (two attorneys and a physician who is on the BMEX). I wanted to clarify, in my mind, about how standard of care is defined.

Standard of Care
Legal Consensus: What a reasonable and prudent practitioner would do or should have done under the same or similar circumstances.

Negligence: Failure to use that level of skill, knowledge and care in diagnosis and treatment that other reasonably “careful practitioners” would use in the same or similar circumstances.

(Note: These definitions can vary from state to state)

Let’s examine this definition of negligence a little closer.

“Level of Skill, Knowledge and Care… Same or Similar Circumstances” includes the requirement of staying current in improvements and alternatives to traditional care.

What is traditional care? With traditional care, benefits and risks are present depending on:
  1. Treatment plans developed by doctor.
  2. Treatment plans presented to patient.
  3. Treatment options declined.
  4. Treatment options accepted.
So shall we summarize the above parameters and agree that the Standard of Care could be defined as the delivery of reasonable and up-to-date:
  1. Diagnosis
  2. Treatment Recommendations
    1. Treatment options
      1. Ideal plan
      2. Less than ideal plan
      3. Relative benefits
      4. Relative risks
    2. Documentation of Choice
      1. Acceptance of ideal
      2. Less than ideal
        1. Informed refusal
  3. Treatment performance
  4. Follow-up Care
If we are honest with ourselves, we probably seldom sit down and evaluate where the standard of care in orthodontics is today, 2010, in light of the technology that is dominating our profession. As technology is introduced, by necessity, the standard of care evolves and transitions at an ever-alarming rate. It is suggested that we will not know for certain the “rules” of utilizing CBCT scans in orthodontics until it has been tested and settled in the courts. In the meantime, what does a careful practitioner do in this exciting high-tech environment?

It is recommended that we orthodontists should evaluate our risk management efforts, review and refine our consultation and documentation protocols and stay current with new treatment developments. It is truly an exciting time to be an orthodontist but ponder the question, “Are you a careful practitioner?”
Orthotown Magazine
November 2025
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