Q. A patient was obviously in pain whilst being treated by the hygienist but there was no prescription for local anaesthetic in the notes and no dentist on the premises. What should the hygienist do?

Any dental treatment provided by a dental hygienist must only be undertaken in accordance with a treatment plan provided by a dentist who has assessed the patient (Principles of Dental Team Working - Paragraph 2.3) The amount of detail contained within that treatment plan depends on the individual circumstances although good clinical practice would suggest that this should include details of the treatment proposed, together with details of any adjunctive treatments.

The Medicines Act 1968 provides the legal framework for the provision of local anaesthetic as a prescription only medicines and the hygienist must be supplied with a patient-specific direction (written instruction) from the dentist to administer the drug in any course of treatment. That written prescription must detail the type, amount, and route of administration for the local anaesthetic. To provide local anaesthetic without written instructions would leave both hygienist and referring dentist open to allegations of a breach of the Act and is likely to attract criticism from the General Dental Council.

The fact that no dentist is available is unfortunate but does not alter the facts. The only action open to the hygienist would be to postpone the treatment or secure additional written instructions from the referring dentist by fax or email. It would be difficult to argue that the patient's best interests override legislation as the treatment is most likely to be elective and the patient's general health would not be expected to significantly deteriorate with a short delay.

Download Principles of Dental Team Working.