Ethics & Law · patient case question
A different older adult living in a residential facility presents with rampant untreated caries, gross calculus and multiple abscessed teeth. The staff have never brought him for care. What is the dentist's obligation?
Patient case: Dependent older adult with a full-time caregiver
Patient: Male, 88 years old
Chief Complaint: Brought in by his caregiver for a check-up. He does not report any pain.
Background: Lives at home with an all-day caregiver. Takes eleven regular medications including an antihypertensive, an anxiolytic and a statin. He cannot brush effectively on his own.
Current Findings: Generalised cervical (Class V) carious lesions on the buccal surfaces of most remaining teeth. Marked xerostomia. Heavy plaque. He tires quickly in the chair.
Vital Signs: BP 142/84 mmHg · HR 76 bpm
Show answer and explanation
Correct answer: A. Report suspected neglect to the appropriate protective services agency
- A. CORRECT. Dentists are mandated reporters in every US jurisdiction. Gross, sustained neglect of a dependent adult's basic health needs is reportable to Adult Protective Services or the equivalent state agency. The threshold is REASONABLE SUSPICION, not proof — investigating and substantiating is the agency's job, not the dentist's.
- B. Raising it with the facility is reasonable in addition to reporting, but it cannot substitute for it — particularly when the facility is the likely source of the neglect.
- C. Treating the disease without reporting leaves the patient to return to the same conditions. The dental treatment addresses the consequence; the report addresses the cause.
- D. Dependent adults frequently cannot advocate for themselves, which is exactly why mandated reporting exists.