Q1. What if my dentist wants me to undertake an item of treatment for which I do not feel I am trained?
Paragraph 3.4 of the GDC's guidance document, Principles of Dental Team Working" makes it very clear that any registrant (including a dentist) should only carry out a task (ie, an item of treatment) for which they are sure they are trained and are competent to do so. If then you feel uncomfortable about undertaking an element of treatment you should bring this to the attention of the supervising dentist immediately. It is unwise to allow yourself to be talked into providing this treatment against your better judgement. If you are in doubt feel free to contact Dental Protection.
Q2. What if I do not agree with the dentist's treatment plan? Can I change it myself?
At present the 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 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, place separators at upper left 5, 6 and 7 and fit bracket at UL5 and orthodontic bands at UL6 and UL7 on subsequent visit). A more general treatment plan allows the orthodontic therapist a degree of latitude that in dentistry is often helpful (i.e., please fit brackets or bands in upper left quadrant using separators as required).
Major changes to a treatment plan should always be approved by the dentist (ie, where a patient has previously been treatment planned for the use of headgear but refuses to agree). 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?
The guidance offered by the GDC is very clear in that it is the duty of all dental professionals to put their patients' interests first and always act to protect that patient over any personal or professional loyalty. For obvious reasons a poor standard of infection control in any practice is likely to put patients at risk and would be difficult to defend should the need arise. For any DCP it would not be appropriate or sufficient to simply ignore the fact on the basis that you are not the practice owner and would not wish to put your employment in jeopardy by complaining. Indeed if it could be shown that you have not acted appropriately or brought the matter to an appropriate person's attention, then you might well find yourself in some difficulty defending your inaction.
Initially you should speak to the dentist or your line manager 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 following this discussion 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 properly trained dental nurse makes good sense in any event as it improves patient care and makes the treatment more efficient. Top
Q5. Is it true that I have to have a dentist on the premises when I work?
Orthodontic therapists are perfectly entitled to work on their own if they wish without a dentist on the premises. To a large extent this is a matter of personal choice, competency and experience. Top
Q6. I am an employee of the practice. If I get a complaint against me whose responsibility is it to reply - mine or the practice principal's?
Handling complaints is the responsibility of all members of the dental team although it is usually expected that the lead clinician or line manager will probably respond when the complaint is against an employed member of staff. Alternatively, and in particular if the complaint is clearly directed at you, you may feel that you would prefer to respond yourself. This is entirely up to you.
The most important aspect is that the complaint is acknowledged (usually within two days of receipt of the complaint) and a full and detailed response provided to the patient as soon as practically possible (usually with ten days of receipt of the complaint letter). It is Dental Protection's experience that the earlier a complaint is addressed the more likely the matter will be resolved.
That response does not have to be in writing and in some situations speaking with the patient directly or asking them to come into the practice to discuss the complaint may well be enough to resolve any issues. You may then choose to confirm that discussion in writing or simply respond fully in a letter. Before any response is made however you may well feel it would be helpful to obtain Dental Protection's advice and ask them to assist you with the written response. Top