This minimalist Audit 100% PROVES in SECONDS that Dentist ALLEGED a DIAGNOSIS & Unethically Prescribed an EXTRACTION or RCT ULTIMATUM + Endodontist (Past Ottawa Dental Society President) without an Obligatory Referral Note...did a CARTE BLANCHE ROOT CANAL at the Consultation, Far from scored MB1 APEX PATENCY, and FALSIFIED RECORDS. Royal College of Dental Surgeons of Ontario ruled the Patient Complaints 100% in favour of Dental Colleague Members. One wonders if this RCDSO Judgment is typical of how Patient Complaints are reviewed by Dental Associations globally... Thank You for likably appreciating this Patient-Driven public Dental Ethics Enhancement Audit. All feedback is much appreciated!

1. DENTAL ETHICS LANDMARK FORENSIC AUDIT
Auditor: Michael Pastien [July 2021]
Outside Audit of Royal College of Dental Surgeons of Ontario Issues Judgments
21st
Century Minimalist Audit 100% PROVES: Dentist Alleged Diagnosis + Unethically Prescribed Extraction/RCT Ultimatum;
Endodontist did Carte Blanche Root Canal at Consultation...Far from Scored MB1 Apex Patency + Falsified Records
 RCDSO Judged this Case 100% in Favour of Colleagues 
Patient booked Dentist Exam for Tooth 15 area Sensitivity
* Oral sensitivity may be due to such things as acidic food reactions, teeth grinding, excessive brushing, recessed gums, plus sinus tract issues…
If Diagnosis can’t be made at Exam, it’s common to send Patient home on wait & see basis...Symptoms ‘may’ never return in lifetime
* Dental Assistant’s Progress Notes seem serially detailed with Specific Cold Test Results, BWs & Depth Probing etc. through the Exam
(Relevant Progress Notes like those above should typically be shared with Referral Specialist)
Teeth 15/16/17 Cold Tests had no reaction + took 4 Bitewing X-Rays & UR Periapical
Dentist Alleged an ‘Abscess Shows’ in Periapical X-Ray
* Couldn’t specify abscess site...or what type
Probing at Tooth 15 of 3-4 mm
Dentist Prescribed an Extraction or Root Canal/Crown
* Extraction Prescriptions (notably this one’s 1-2 order…no node) must be Quantified in Records
Symptomatic Patient felt ‘Extraction Ultimatum’ would occur instantly…leaving a Professionally Embarrassing ‘Healthy Smile’ Tooth Gap
Tooth 15 ‘Consultation’ Set Up…with Only this X-Ray
Dentist later struck through 15 in Progress Notes & added 16
* 1st
Visits with Specialists are typically a 5-10 minute Consultation…the Patient was 100% Asymptomatic by then...Yet,
Endodontist Performed ‘Carte Blanche’ Root Canal at Tooth 16
Endodontist with No Referral Note ‘somehow’ assumed before May 3rd
a Root Canal would be done then, & scheduled (1 hour) for it
* Dentist may have told Endodontist in a Pre-Endo (Off-the-Record) Dialog that Patient had Tooth 15 area Sensitivity…
Upon Prescribing an Extraction Root Canal (Ultimatum)…Patient chose RC
ROYAL COLLEGE of DENTAL SURGEONS of ONTARIO
Referral Obligations of the Dental Specialist
The Dental Specialist has a responsibility to provide consultation and treatment for Patients, while ensuring that the procedures performed are
in compliance with the Overall Treatment Plan and Goals established by the General Practitioner and Patient. Treatment provided by the
Specialist should be limited to the issues outlined in the referral. If the Specialist determines that additional or alternative treatment is
recommended or required, these issues should be discussed with the Patient and the referring Dentist before proceeding with treatment.

2. Patient Registered Complaints vs Dentist & Endodontist at RCDSO
* Endodontist provided ‘most’ Records + X-Rays beforehand…but ignored Patient’s inquiry of why Referral ensued as it did
Endodontist’s ‘Uneventful’ Records = Unbelievable  Under-Obturated MB1 2 + ½ mm is Notably Fake
Transcript
* Content by Patient, Dentist, Endodontist, & RCDSO is justly formatted with names redacted for this Minimalist Audit
MB1 C&S + Obturation misses Apex Patency in all 3 X-Rays
Endodontist’s account of far from scoring MB1 Patency must be noted in Records + Post-Endo Report to Dentist
(Dentist & RCDSO Panel should have brought it up)
 Endodontist’s Consultation / Postop Report arrived at Dentist’s Office 17 Days Later
Endodontist RCDSO Responses
Patient was referred by his general dentist. Although the initial referral indicated tooth 15, I always clinically assess the area of
concern to confirm a diagnosis before any treatment is prescribed or rendered. The patient seems to feel the radiograph provided
by the dentist is of poor quality. In my professional opinion, the pre-operative radiograph provided was of fine diagnostic
quality that allowed me to confirm a diagnosis; and it would be unprofessional to take an extra film that would be no benefit to
the patient & expose him to further radiation.
Patient informed me he was no longer symptomatic. The clinical exam revealed that 17 responded normally to cold, 16 and 15 had
no response to endo ice, and no tooth was percussion sensitive at the time. The radiograph provided by the dentist showed deep
restorations at 16 and 17 & a conservative one on 15. Radiolucency was evident at the apex of 16 & no endodontic pathology at
15 and 17. Based on my exam & review of the radiograph, a clear diagnosis of pulpal necrosis with periapical involvement was
made at 16. Patient was explained the nature of root canal therapy with respect to options, procedure, prognosis, & was offered the
chance to ask any questions before signing a consent form. The tooth was anesthetized & endodontic care was initiated. Upon
access I made a notation that the pulp chamber & canal space were dry. This is another confirmation beyond the pre-op exam of
pulp necrosis within the tooth. This is the basis on which I wrote 16 was necrotic as “expected” in my post-endodontic treatment
report to the referral dentist. The patient feels for some reason this is “outrageous”.
Endodontic therapy was performed uneventfully & the tooth was sealed with a temporary restoration until his dentist could
restore it permanently. Two intra-operative films were taken (file check and gutta-percha check) as well as a final radiograph.
05/03/10 2 scand/lid (SCANDONEST/LIDOCAINE) (inf) (INFILTRATION) Examined URQ (UPPER RIGHT QUADRANT). Rx'd (PRESCRIBED) RCTx
(ROOT CANAL TREATMENT) on 16. Warned Px (PATIENT) of deep filling in 17 and (-ve) (NEGATIVE) response to cold on 15. CC/QA (CONSULT
AND CONSENT/QUESTION AND ANSWER). C&S (CLEANED AND SHAPED) 4 canals OBT (OBTURATED) w/ (WITH) GP (GUTTA PERCHA) &
Kerr cavit seal. f ck (FILE CHECK), GP ck (GUTTA PERCHA) and final rad (RADIOGRAPH.)

3. Dentist did Core before Endodontist’s ‘Necrotic as Expected’ Postop X-ray Photocopy Report arrived
 May 20 Received Endo Consultation / Postop Report – RCT #16 was completed. X-Ray returned
 May 25th Signature is Dentist’s 1st
Endodontist Reply Record since April 22nd ‘Consultation’ Referral
Oct 30th
’15
Dentist Response to Patient
Q: If the option of Extracting Tooth 15 had been chosen…would it have been done at that visit?
Answer: Although you indicated on April 22 ’10 a pressure sensitivity on the upper right in the area of tooth 15 there were no clinical
or radiographic reasons to treat or extract tooth 15. There was tooth 16 periapical radiolucency…all treatment was directed toward it.
* (Periapical Radiolucency Diagnosis in 2015 is far too broad...No quantification ever given for an Extraction Prescription)
* Jan ’16 reply to RCDSO, the Dentist added: Periapical pathology present on palatal root of tooth 16
Jan 16th
’16
Dentist Response to RCDSO (and Dental World)
“ I take pride in building a relationship of trust and understanding with every patient.
I feel it is a lost opportunity that a patient of mine expressed such a lack of trust in dentists, and that I was unable to rebuild that trust.
I hope that thru this process, the patient finds some measure of trust in dentists and the dental profession.”

4. RCDSO ruled 100% in favour of Dental Colleagues…At least one of them: Past Ottawa Dental Society President
* Legal Fact – Dental Records are what is alleged a Dentist saw or did. i.e. Dentist Treatment Plan Note ‘Dated’ April 22 is zero proof of when it
was written (It’s also the only Note on entire Treatment Plan Page not co-initialed by Dental Assistant).
* Panel falsely stated: April 22 Chart Entry notes Periapical Pathology on Palatal Root of Tooth 16 (it’s truly Dentist’s 2016 RCDSO Reply)
Tooth 14 Radiolucency was ignored by Dentist, Endodontist, + RCDSO
RCDSO ‘snow job’ (15 vs 16) ignored obvious Ethics Abuses (Extraction Ultimatum) while mostly echoing Colleagues Records with partial insights
RCDSO declared Case Closed…Notably never admitted on any occasion their Colleagues failed living up to Ethical Standards.
Patient requested a Review from the Health Professions Appeal Review Board of Ontario (within 30 day deadline)
* Patient advised HPARB that RCDSO Judgments should be nullified due to notable false data & procedures
Dec 11th
2017 HPARB Approved RCDSO Decisions to take No Action vs Dentist & Endodontist
How could any Dental Association so partially Favour Colleagues? Historic Pre-Internet built-up Systemic ‘Public Immunity’ laxness
knowing 99% of Patients had zero Dental Knowledge + nearly no way of freely accessing quality data & images at Libraries or Stores.
20th
Century Pre-Internet ‘Old School’ Days of Dental Patient Issues Whitewashed by Review Boards into Oblivion are fading
DEC 6th
2016
RCDSO COMPLAINTS PANEL JUDGMENT re DENTIST
File - C150616T
With respect to the endodontic treatment performed on tooth 16, the panel can see from the member’s response, that the April 22
2010 chart entry notes periapical pathology present on the palatal root of tooth 16. This pathology is clearer on the original
radiograph than the duplicate sent to the endodontist. The panel notes that while this chart entry also contains a reference to tooth
15, this reference has been struck out. To corroborate that tooth 16 was the tooth intended to be referenced, the panel notes that on
the treatment planning page of the chart, the endodontist referral is noted as being to tooth 16. Accordingly, the panel accepts that
the reference to tooth 15 was an error which was corrected in the chart entry.
In the panel’s opinion, the member’s diagnosis and treatment recommendations for tooth 16 were appropriate; there is no notation
of a diagnosis or treatment for tooth 15. Regardless as to whether the patient was referred for tooth 15 or 16, the panel is aware, as
would the dentist, that the endodontist would conduct his own exam and form a diagnosis prior to initiating treatment. It is clear
from the radiograph that tooth 16 has periapical pathology, and that endodontic treatment is needed. This is further confirmed
when the tooth is accessed, as it is clearly necrotic.
DEC 6th
2016
RCDSO COMPLAINTS PANEL JUDGMENT re ENDODONTIST
File - C150575T
As part of its investigation, the College obtained records from the referring general dentist. The member’s records showed that on
April 22 2010, the patient complained about pressure in the upper right area around tooth 15. Cold testing on teeth 15, 16, and 17
elicited no response. He took radiographs which showed an abscess. Probing of tooth 15 was 3-4mm. He recommended root canal
therapy and a core and crown. The patient was referred for an endodontic consultation. In the original chart entry, tooth 15 is
struck out and replaced with tooth 16.
DECISION
The patient complained that the endodontist did not obtain a diagnostic quality pre-operative radiograph, and provided treatment
on tooth 16 without justification. The member responded that the pre-operative radiograph the dentist provided was of diagnostic
quality, and testing he performed and the condition of the pulp chamber confirmed that tooth 16 required endodontic treatment.
In the panel’s opinion, the film is of diagnostic quality & sufficient for the endodontist’s purpose.
The panel reviewed the Dentist’s record, to determine whether it was tooth 15 or 16 that was the source of the referral. The panel
can see that in the Dentist’s record, the treatment planning page contains a note “22 April 10, (initials) 16 RCT referred (initials) 3
May 10.” In addition, while tooth 15 is struck out in the records, Dentist’s chart entry contains a notation that the complainant was
referred for an endodontic consultation about tooth 16. Endodontist’s chart entry dated May 3 2010 indicates that tooth 15 was
referred. There appears to be conflicting information about which tooth was the source of the referral.
The panel notes from the radiograph that the deep restoration on tooth 16 approaches the pulpal chamber as compared to the
restoration on tooth 15 which shows that the thickness of the dentin is much more substantial. The thickness of the dentin on tooth
15 is a sign that it is not likely the source of the pathology in the upper right. In addition, there is a radiolucency around the apices
(mesial and buccal roots) of tooth 16. Further, the panel notes that even though tooth 17 had a large filling, it responded normally
to cold testing which indicates that this tooth is also not the source of the pathology in the upper right. The panel agrees with the
member’s diagnosis of tooth 16 based on his exam & the x-ray. Further the member correctly noted that upon opening the tooth, it
was necrotic as expected, based on the pre-treatment assessment diagnosis. Accordingly, the panel accepts that the treatment
provided by the endodontist was appropriate & reasonable.
The panel was pleased to note that while the patient may have been referred for endodontic treatment on another tooth as noted
above, the endodontist took time to perform his own exam in order to make a diagnosis and recommend treatment. The panel notes
that the patient was informed about the member’s diagnosis and recommended treatment, to proceed as confirmed by the consent
form which clearly indicates that tooth 16 is to be treated. The panel also looked to the dentist’s records, and notes that when the
plaintiff returned to have a final restoration and crown placed on the tooth, there were no chart entries to indicate any discussion or
concern expressed by the referring dentist or complainant about which tooth was treated.
In conclusion, the information before the ICR Committee does not support taking any action, and is satisfied that there is no risk to
patient care or safety or the public interest. Accordingly, the panel has decided to take no action in this matter.

5. * The following Referral Obligations ‘should’ be Practiced...Regardless of if Dental Associations list them on their website
 There must be Open Sourced Specific Penalties for Practitioners not complying with Defined Minimum Obligations 
* RCDSO Dentist & Specialist ‘Obligations’ echo ‘should’ instead of must
Should = Desired Goal (Open to Alibis); Must = 100% Definite
 Thank You for likably appreciating this Patient-Driven public Dental Ethics Enhancement Audit 
© M.Pastien@Yahoo.Ca
ROYAL COLLEGE of DENTAL SURGEONS of ONTARIO
Most Responsible Dentist
General dentists are usually responsible for providing comprehensive dental care and creating and maintaining long-term relationships with patients.
The relationship begins with an initial assessment, examination, development of a treatment plan, and initiation of treatment within the practitioner’s expertise, as
determined by their education and experience.
Treatment plans are often influenced by the patient’s attitude to dental care, financial resources & existing conditions of the dentition & periodontium.
In some instances the treatment plan will require a referral to a dental specialist for consultation and/or treatment.
Where referrals to specialists are involved, it is important that all practitioners strive to maintain the continuity and quality of patient care. As such, the general
dentist should remain the primary coordinator of care for the patient.
As in many aspects of dentistry affecting patient welfare, communication is critical to solving problems and avoiding complications arising from treatment
provided by more than one practitioner.
Each dentist involved in the patient’s care should have a clear understanding of the other treating dentist’s role. Communication and collaboration are
imperative in providing optimal patient care and treatment outcomes. With the patient’s consent, the general dentist and specialist should develop a mutually
agreeable protocol to ensure continuity of care for the patient. Under these circumstances, it is reasonable for the specialist, patient and the general practitioner to
acknowledge that the general dentist is “the most responsible dentist” or “coordinator” in the patient’s ongoing care. This responsibility remains even during a
phase of treatment when the patient is undergoing care from a dental specialist to whom the general dentist referred the patient.
In some instances, a general dentist may choose to refer a patient to a more experienced general dentist for consultation and/or treatment. It is understood that the
principles and protocols in this Practice Advisory should also apply in these situations.
Obligations of the Referring General Dentist
Patients may need to be referred to a specialist for a variety of reasons. The general dentist is expected to recognize when specialist care is more appropriate for the
patient’s needs and completion of the treatment plan and refer appropriately.
Reasons for a referral to a specialist may include, but are not limited to, the following: • the referring dentist’s skill and comfort levels • the complexity of the case
• the treatment plan objectives • the patient’s medical condition • specialized equipment and/or tests • staff training and skill level • the patient’s wishes
In order to facilitate a smooth transfer of a patient from a general dentist to a specialist the referring general dentist should observe the following steps:
1. Upon a decision to refer a patient to a specialist, the general dentist has an obligation to inform the patient of the rationale for the referral and the procedures
and protocols involved. These include the reason and purpose of the referral, the expected nature and scope of the procedures involved, and the anticipated
outcome of the referral and treatment.
2. Referrals from a general practitioner to a specialist may include, but are not limited to, the following documentation: • Patient’s name and contact information
• Relevant treatment and background information • Relevant medical conditions or concerns
3. Referral instructions should note the referral treatment required and that, on completion of the services requested in the referral, the patient be encouraged
to return to the general practitioner for continuing comprehensive care.
Obligations of the Dental Specialist
The dental specialist has a responsibility to provide consultation and treatment for patients, while ensuring that the procedures performed are in compliance with
the overall treatment plan and goals established by the general practitioner and patient.
The following protocols should be followed in order to deliver optimum treatment and provide continuity of care for the patient while maintaining professional
etiquette between dentists who share responsibilities for patient care.
1. Treatment provided by the specialist should be limited to the issues outlined in the referral. If the specialist determines that additional or alternative
treatment is recommended or required, these issues should be discussed with the patient and the referring dentist before proceeding with treatment.
2. If the specialist, upon reviewing the referral note and patient consultation, feels the treatment outlined by the referring dentist is not in the patient’s overall
best interest, then this should be communicated with the referring dentist and the patient to resolve the issue.
3. The specialist should not duplicate and charge for procedures already performed adequately by the referring dentist.
4. The specialist should provide the referring dentist with a detailed consultation report, including a diagnosis, treatment options, and an account of all
treatment rendered or recommended. Reports should be provided in a timely manner.
5. The specialist should provide the referring dentist with relevant diagnostic quality copies of radiographs or digital images taken by the specialist.
6. The specialist should provide the referring dentist with relevant copies of any diagnostic test results, consultation letters or other information obtained.
7. If the specialist believes that continued treatment over the longer term is necessary or desirable, the general dentist should be consulted about this decision and
receive regular treatment updates and reports. The specialist should also discuss with the referring dentist when the patient is expected to return to their practice for
continued treatment or maintenance.
8. If the specialist believes it is necessary for the patient to be seen by another dental specialist, the general dentist should be consulted prior to the referral being
made and, when appropriate, be involved in the choice of the specialist who will conduct the proposed consultation and/or treatment.
9. In cases of inter-specialty referrals, the general dentist should receive detailed consultation reports and an account of all treatment rendered or recommended
by the specialists.
10. When the requested treatment has been completed the specialist should ensure there is provision for the patient to return to the referring general dentist,
unless the patient expressly requests differently without prompting or persuasion from the specialist.
11. Self-referrals by patients to specialists may occur without the oversight of a general dentist. When this occurs, the specialist should take reasonable steps to
ensure that the patient is aware of the pitfalls of not having a general dentist oversee their comprehensive dental care and try to direct the patient accordingly.
Dentists should recognize that there are many specific circumstances when patient needs, convenience and resources must be taken into account as part
of the referral process.
It is understood that the relationship between general dentists and specialists should be governed by mutual respect and professional etiquette.
Trusting relationships should be fostered between the general dentist and specialists who treat their patients.
In all instances, general dentists and specialists should have the best interests of their patients as their primary concern.