Identalloy: Risk Management Tool and More

Most dentists take a great deal into consideration with every restoration they place. In addition to the occlusal and cosmetic considerations, they also ask themselves, “Am I sure there will be no adverse reactions to the restorative material?” “Was the restoration created using the alloys I requested?” “Will I be held liable if the patient experiences an adverse reaction?” “Do I have documentation to protect myself and my practice?”

Fortunately, one word can answer these questions and set their minds at ease: Identalloy. Since 1986, dental manufacturers, laboratories, and dentists have turned to the Identalloy Program to raise healthcare standards through the independent classification and documentation of restorative alloys. The program, which provides the only commercial oversight of restorative materials, uses the strict standards for dental alloy composition created by dental manufacturers and the ADA. The widespread success of the Identalloy Program lies in its ability to enhance and improve education and record-keeping, as well as serve as an effective risk management, patient management, and quality assurance tool.

About 90% of the precious metal alloys used in the United States are registered with the Identalloy Program. Each participating manufacturer supplies a two-part Identalloy Certificate sticker with the registered alloys it sells. Each certificate includes a statement of manufacturer compliance, alloy brand name, material composition, and the exclusive Identalloy certification symbol to identify the correct alloy category—high noble, noble, or predominantly base. High noble alloys contain at least 60% noble metals, two thirds of which much be gold (ie, at least 40% of the alloy must be gold). Noble alloys have a noble metal content of more than 25%. And alloys with a noble metal content less than 25% are considered predominantly base. 

Because the alloy manufacturers provide the stickers free of charge, the Identalloy Program is a simple and inexpensive way for laboratories and dentists to maintain accurate documentation. The dental lab keeps one portion of the sticker for its records. The dentist receives the remaining part to include in the patient’s permanent records.

IDENTALLOY AS A RISK MANAGEMENT TOOL FOR DENTISTS
For dentists, the Identalloy Program is not only a risk management tool that is easy and economical to implement, it also offers valuable patient care benefits.

Health History and Allergies
Dentists understand the consequences that can arise from failing to secure, update, or factor in all the aspects of a patient’s medical and dental history. In addition to considering the effects of the pharmaceuticals and other materials they use, they must choose restorative materials that do not contain base metals or alloys to which the patient is allergic. Failure to do so can lead to serious healthcare consequences for the patient, as well as serious legal consequences for the dentist. The Identalloy Program makes it easier for dentists to choose the ideal alloy, as well as maintain accurate patient records.

Informed Consent
Before any patient care can be given, dentists must provide sufficient information so patients can make an informed decision. This process, known as informed consent, contains three phases—necessity of treatment, alternative treatments, and risk of treatment—all of which can be made easier through the Identalloy Program. 

During the necessity of treatment phase, dentists are required to educate patients about the reasons behind the treatment. The information provided by the manufacturer on the Identalloy Certificate can make it easier for dentists to discuss choices of restorative materials with patients, as well as make it easier to justify reasons for selecting a particular alloy. 

With regard to alternative treatments, patients must be given a choice of clinically appropriate treatments. The Identalloy Program can simplify the process of choosing between laboratory-made restorations that include high noble, noble, and base metal materials versus non–alloy-based laboratory restorations and non-cast restorations, especially for patients choosing from a wide variety of restorative materials.

And finally, patients must be educated about the risks of treatment or those risks that have severe morbidity or mortality. This knowledge can be a life-saver, especially for patients with known allergies to certain alloys or metals. For patients unsure about their allergies or for those who are concerned about other issues involving certain metals, learning the risks of treatment helps provide the information they need to make an informed decision. Either way, the information provided by the Identalloy Program will be a valuable tool to help in the selection process. The choice of restorative materials must be documented in the patient record as part of the documentation of the informed consent discussion. Only when the documentation is finished is the informed consent circle complete—discussion, documentation, and verification. 

Standard of Care
The standard of care is defined as that which a reasonable dentist would do under the same or similar circumstances. It is difficult to predict what a jury would decide is the “standard of care” with regard to the identification of metal alloys in a dental restorative material. However, dentists must make an effort to identify possible patient metal allergies or galvanic reactions in order to meet the standard of care. Making such an effort does not guarantee a patient will not have an adverse reaction to the restorative materials; however, the Identalloy Program can help reduce the patient’s ability to prove their dentist violated the standard of care.

Transfer of Liability
In the event an adverse patient reaction is caused by a restoration made from the wrong alloy, a dentist could be held liable if it could be shown he/she should have known better (ie, the metal had the wrong color or was billed at the wrong cost). The Identalloy Certificate confirms and documents the materials in each restoration, making it easier for the dentist to be sure the restoration contains the correct materials. Most of the time, the dentist would be shielded from liability as long as he had made a reasonable effort to identify potential patient allergy issues, and had requested a specific alloy.

AN INSURANCE FRIENDLY SYSTEM
In addition to its risk-management benefits, the Identalloy Program can improve the timeliness and accuracy of insurance submissions. Often, the payment of many restorative cases is delayed as the insurance company representative writes back to the dentist inquiring about the materials used in the restoration vis-à-vis the coding used in the insurance submission. Dentists can simply include a photocopy of the Identalloy sticker with a completed case, thus eliminating the need for the inquiry letter. In addition, a copy of the sticker can be sent with pre-estimates to help expedite prior approvals.

A FINAL THOUGHT
Patients rely on dentists to look out for their safety and to guarantee quality care. Patients have no way of knowing what systems will guarantee better quality of care or when or where those systems should be used. Nevertheless, from the patient’s perspective, the little things dentists do to protect them and improve their quality of care means a great deal. Dentists owe it to themselves and their patients to implement a system like Identalloy, especially because it costs nothing and is so simple to use.
For more information about Identalloy, call (888) 577-2634, or visit www.identalloy.org.


Dr. Bloom is currently CEO of his consulting company, Injen, Ltd. He was formerly senior vice-president, Kemper Healthcare Professional Liability, in Chicago. He was an executive with CNA Insurance, assuming responsibility for the CNA National Dental Program and later served as senior vice president, National Programs Business Unit, CNA HealthPro. Dr. Bloom is a member of the Board of Overseers for Forsyth Dental Center and of the Board of Directors for the Oral Health America, America’s Fund for Dental Health. Dr. Bloom publishes and lectures regularly on professional risk management, OSHA compliance, the Americans with Disabilities Act, and ethics in healthcare. He has held an assistant clinical professorship at Northwestern University Dental School in Chicago since 1992.

Dr. Tocci practices full-time esthetic, cosmetic, reconstructive, and preventive dentistry. Dr. Tocci is affiliated with the American Dental Association, Academy of General Dentistry, Academy of Dental Science, Academy of Computerized Dentistry, Massachusetts Dental Society, Metropolitan District Dental Society, Charles River Dental Society, Academy of Pediatric Dentistry, Massachusetts Academy of General Dentistry, International College of Dentists, American Association of Dental Consultants, American College of Oral Implantology, and American College of Dentists. Dr. Tocci is an associate clinical professor at Tufts University School of Dental Medicine.

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