Q1. What if my dentist wants to give antibiotic cover and I don’t agree?
Following the publication of the National Institute of Clinical Excellence (NICE) guidelines in March 2008, and its incorporation in the British National Formulary, antibiotic cover is no longer required for dental procedures. Each clinician however is entitled to their own clinical opinion. It would be best then to go back to the dentist and explain that the previous guidance has now changed, and that you do not feel comfortable providing treatment for this patient under antibiotic cover. If the dentist insists, then it might be best to ask the dentist to complete the treatment, rather than yourself. A clear contemporaneous note should be made in the records by you. In addition, you may wish to ask the dentist to contact his own defence society to ask for their advice. Top
Q2. What if I do not agree with the dentist’s treatment plan? Can I change it myself?
At present General Dental Council guidance (Principles of Dental Team Working, paragraphs 2.3 to 2.7) clearly indicates that a patient should have a full mouth assessment by a dentist and be provided with a treatment plan prior to the commencement of any treatment by a dental care professional. That treatment plan however is of course not always set in tablets of stone, and may in some situations be varied depending on a patient's needs. Be very careful that the changes you are proposing are in the patient's best interest and that your actions do not constitute an element of re-diagnosis.
Much depends on what is written in the treatment plan and to an extent how it is written. A very prescriptive treatment plan is unlikely to allow any variation (ie, please deep scale lower right incisors lingually and provide oral hygiene instruction using the modified Bass technique). A more general treatment plan allows the hygienist a degree of latitude that in dentistry is often helpful (i.e., please undertake all necessary scaling and polishing in the lower anterior sextant).
Major changes to a treatment plan should always be approved by the dentist (ie, where a tooth no longer appears suitable for a fissure sealant). Minor changes (ie, the number of appointments or what treatment is offered at any one appointment) may well be as a result of the patient's choice and therefore have no overall impact on the treatment plan itself. If possible however, it is always best to speak to the prescribing dentist before making any alteration. Any changes (and the reasons for those changes) should always be recorded in detail in the records. If you are at all in doubt then feel free to contact Dental Protection. Top
Q3. What if I am unhappy about the standard of cross infection control in the practice I work in?
It is the duty of any dental professional to put their patients' interests first and you should always act to protect them over any personal or professional loyalty. A poor standard of infection control in the practice is likely to put patients at risk and, if it can be shown that you have not acted appropriately or not brought the matter to somebody else's attention, then you too could end up in some difficulty. Initially it is best to speak to the dentist or your line manager if you have one and explain your concerns to them. In this respect it is best to be positive, rather than negative, and offer solutions to the problem, rather than being confrontational. If then you are still unhappy, it would be best to contact Dental Protection and ask for our guidance in relation to the specific issue. Top
Q4. Do I have to work with a dental nurse?
Paragraph 3.7 of the GDC's guidance document, Principles of Dental Team Working, makes it very clear that "when any clinician is treating a patient they should make sure that there is somebody else - preferably a registered team member - present in the room who is trained to deal with medical emergencies". A failure to adhere to this guidance, particularly if something goes wrong, could mean that it is difficult for Dental Protection to defend your actions. Working alongside a dental nurse makes good sense in any event as it improves patient care and makes the treatment more efficient. Top
Q5. I am self-employed. Do I need a contract?
To a large extent this relates to the business of dentistry and therefore is entirely a matter for the hygienist and the practice principal. Generally speaking a well worded contract protects both parties in the event of a disagreement, and therefore it is in everybody's best interests. It is however a matter of personal choice. Top
Q6. Am I allowed to get involved in tooth whitening?
The GDC's Scope of Practice document indicates the skills that DCPs are expected to have (by nature of their basic training) and the additional skills that they can develop during their career. In particular, the GDC has indicated that dental hygienists and therapists may become involved in tooth whitening, provided it is to the prescription of a dentist. The GDC make no reference to the technique to be used or favours in-surgery or home bleaching.
It is important to realise however that, as this is an additional skill, a DCP would need to be able to demonstrate that they have received the appropriate training and that they are competent to carry out the task. Unfortunately the GDC does not define what it would regard as "sufficient and appropriate" training. Indeed it leaves this decision to the DCP. That seems a little unfair particularly as the DCP's opinion in this respect may differ from the GDC's and the first time the DCP is aware of this is when it is being questioned perhaps at a conduct committee hearing.
Having said that it seems logical to assume that this training must be specifically designed with hygienists and therapists in mind (ie, it is not a course designed for dentists) and that the wider aspects of tooth whitening are considered (including the legal and ethical implications). Courses run by specific whitening companies may not necessarily comply, especially if these courses are in effect designed to promote a particular product.
If then you are at all in doubt in relation to your own personal circumstances, please feel free to contact Dental Protection. Top
Q7. Can I run a dental practice?
The Section 60 changes to the Dentists Act opened the door for all registered DCPs to own and run a practice. Please be aware however that at present a hygienist may only work under the prescription of a dentist who has previously undertaken a full assessment of the patient. Providing treatment directly to patients without a valid prescription could leave a hygienist open to allegations of the illegal practice of dentistry, the possibility of disciplinary action at the GDC and, in the most extreme of cases, the possibility of criminal action. If then you do wish to set up a practice, it would be best to discuss the matter with Dental Protection initially. Top