Q. My dentist prescribes whitening treatments for me to carry out which I am happy to do as I have been trained and feel competent. When patients ask for a subsequent top up treatment (either in the surgery or at home) using a fresh supply of bleaching gel, does the original prescription cover this follow up treatment some months later or is there a limited life for the prescription?
The General Dental Council’s Standards Guidance is really the reference document which should be used when attempting to answer this question.
As you rightly say, every dental hygienist and dental therapist has to work to a treatment plan provided by a registered dentist who has previously seen the patient.
Historically such a treatment plan would normally only be valid for a single course of treatment, following which the patient would need to be examined again by the dentist before any subsequent treatment plan could be issued for the dental hygienist/dental therapist to follow.
The most recent guidance states that patients should have a full mouth assessment by a dentist following which the patient should be given either an outline treatment plan or a full treatment plan, depending on the individual patient’s needs. (Principles of Team Working - paragraph 2.3)
It goes on to say that the treatment plan could be a simple statement that the patient has good oral health and needs no more than routine oral care for the next three years, or a detailed plan for complex treatment and reassessment after three months.
The GDC also suggests that the treatment plan (whether an outline plan or full treatment plan), should include;
- Recall intervals (depending on the patient’s specific clinical needs)
- A date for a full mouth reassessment by a dentist.
The reassessment date is the date when the patient must return to be seen by a dentist for a full mouth examination and treatment plan.
The recall interval is the frequency with which the patient should be asked to return to be seen by a member of the dental team.
This recall visit might not necessarily involve an appointment with the dentist, and the dentist can ask the dental care professional to set the intervals.
In this context the provision of further bleaching gel could be interpreted as a continuation of the original treatment rather than the initiation of a separate course, provided of course the original treatment plan indicates this eventuality. If it does not, then it might be safer for the hygienist to ask the dentists to see the patient again and confirm that this further treatment is applicable.
It goes without saying that this assumes that the hygienist has checked to see that there have been no major changes in the patient’s oral health status in which case referral back to the dentist for a full mouth assessment would be necessary.