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Ask Dental Protection

We receive hundreds of enquires every week, and we publish some of the frequently asked questions on this page. These may not always provide the complete answer in your own situation, and members are invited to contact us for specific advice.

  • Q
    Do I need to record the batch number of every local anaesthetic cartridge that I use whilst providing dental treatment?
    09 November 2015
    The short answer is that there is no legal or regulatory requirement to record individual local anaesthetic batch numbers and members can rely on Dental Protection to support them in the event of a challenge to the contrary.

    To learn how confusion has arisen about this subject see the briefing document
  • Q
    My practice principal is reluctant to employ an agency nurse when my dental nurse is off sick, so I must treat patients on my own. How should I deal with this?
    15 September 2015

    To a large extent the problems you have are a contractual matter between you and the practice and therefore very much depend upon the associate agreement you were provided with when you started work.

    Assuming this is a standard associate agreement, you should find there is a clause within that agreement indicating that the practice is required to provide you with the services of a dental nurse on a day-to-day basis. The only time when this would not be the case is when exceptional circumstances exist (sudden illness, etc).

    The General Dental Council’s guidance clearly indicates that all clinicians should work alongside another team member (preferably a registered dental nurse) at all times. This is not necessarily a matter of chaperonage, but in fact relates to the provision of medical emergency care to patients.

    If one of your patients was taken ill during a treatment session and perhaps lost consciousness, you might find yourself facing the dilemma of either looking after the patient or going for help. You could not do both if you were working alone. If a dental nurse was working with you, this would not be the case.

    It follows that if such a situation was to arise, you might have to explain perhaps to the coroner, the courts or the GDC why a dental nurse was not present with you in the surgery, in accordance with GDC guidance. This would not be easy, particularly if it could be shown that the patient had suffered harm through lack of emergency care.

    You should discuss your concerns with the practice owner and practice manager and ask them what action they feel they can take to be of assistance to you. Your associate agreement likely contains a contractual obligation (to say nothing of an ethical obligation) on behalf of the practice to try to ensure a good working environment.

    If the problem continues or shows no signs of resolving, you may have to consider your position at the practice.

  • Q
    Is it okay for me to use an online radiograph interpretation service?
    08 September 2015

    As with any other referral, it is the responsibility of the referring dentist to establish the suitability of the person/service to whom/which the referral is made. Even though teledentistry relies on digital files being exchanged between colleagues, the principle is the same. It is important for you to know who will be responsible for interpreting the patient’s records, as well as establishing that they are registered and what qualifications they have to provide this service.

    To protect the patient, it is also important to know that the distant colleague is suitably indemnified. Dental Protection recommends that members should contact us first if they are considering using a teledentistry service situated outside the UK.

    In addition, Dental Protection recommends that:

    • All patients are made fully aware of the involvement of any other named person(s) in their care and treatment, through teledentistry, and also that they properly understand any constraints, limitations or risks introduced as a result
    • You establish written protocols between yourself and any other clinician/organisation with whom/which you have any kind of teledentistry relationship. These protocols should specify the parameters of the relationship, the role and responsibility of each party, the arrangements in place for data protection, and quality assurance
    Read our position statement on Teledentistry
  • Q
    Who owns a denture that is yet to be paid for?
    01 September 2015

    Generally speaking, the ownership of any item of dental treatment passes to the patient at the time the appliance is fitted. This is, however, not always the same time as the treatment is completed. It follows then that during the various stages of denture construction, a denture itself still belongs to the clinician.

    Once it is fitted, however, the patient then owns that denture, irrespective of whether or not a fee has been paid. Before demanding the outstanding fee, it is wise to check that the patient is happy with the denture. Allow them to express any dissatisfaction they may have and deal with this before deciding if you want to pursue the fee.

    If the situation cannot be resolved, you may want to acknowledge that no fee has been charged and leave the denture with the patient as gesture of goodwill, to potentially mitigate an escalation of the patient’s dissatisfactions.

  • Q
    When an orthodontist refers a patient back to me to extract healthy teeth as part of their treatment plan, can I decline and ask them to carry out the extractions themselves?
    25 August 2015

    Removing teeth for orthodontic purposes is very much part of what a referring dentist would be expected to do. Whether it is fair or not, the patient’s own dentist would normally be expected to provide any extractions requested within an orthodontic treatment plan.

    It may well be that you have a colleague who would be happy to carry out the extractions on your behalf. To expect the patient to see another practitioner simply because you are refusing to provide this service may be considered an inconvenience and could possibly even stretch to being a breach of contract if the extractions were associated with NHS treatment.

    To withdraw from providing a particular form of routine treatment may not be considered reasonable and in any of your patients’ best interests. Extractions would be considered part of mainstream dentistry and you should not decline to provide this element of treatment that is also in the best interests of the patient you originally referred.

    If you are uncertain about the reason for the extractions, you may wish to clarify this with the orthodontist.

  • Q
    How should I respond to a negative comment about me that has appeared on the NHS Choices website?
    18 August 2015

    An adverse comment placed on a website, be it NHS Choices or the practice’s own website can be upsetting, especially as it sits in the public domain for anyone to see.

    With regard to an adverse post left on NHS Choices, the website does have the advantage of allowing the practice to post a response. Whilst there is no requirement to respond to posts on this website and indeed it would be inappropriate to respond to a complaint in this way, it is advisable that a practice responds to such posts with a simple acknowledgment of the comments made and an invitation to the patient to make contact with a named person to discuss their concerns ​directly. This reassures both the patient who made the post and any other patients, potential patients and any others reading it that the practice takes patient feedback seriously and is keen to learn from patient experiences and to improve the service they offer. A suggested response is:

    Dear [name],
    I am sorry to read your comments posted on the website on [date] and to learn that you are unhappy with the service you received from the practice.

    We value patient feedback and welcome the opportunity to investigate and respond to any concerns. I would invite you to contact [named person] so we can fully investigate your concerns.

    I look forward to hearing from you.
    Yours sincerely

    Many practices have protocols for routinely reviewing posts left on NHS Choices and see them as an opportunity to improve services. Some practitioners also wish to thank those who have left positive feedback.

    A similar approach could be taken to comments placed on practice owned websites which have facilities for this, and sites such as Facebook. Practitioners could also consider inviting satisfied patients to leave positive reviews. These may be helpful in themselves and can also have the effect of balancing out and indeed outweighing any negative comments.

  • Q
    A new patient has registered with our NHS practice and has requested that she remains with the hygienist at her old private practice. Can I refuse or do I have to agree to the patient’s wish?
    11 August 2015
    It is clearly easier to look after a patient’s care when all the practitioners are located at the same address.

    However, there is no legal reason why you should not allow the patient to see her existing hygienist and indeed prescribe to a hygienist at another practice if you can satisfy yourself that the hygienist works in a way which is acceptable to you and they will co-operate with you in the patient’s overall treatment plan.

    It is possible that the patient has an issue with the dentist who was treating her at the old practice. Your prescriptions to the hygienist at the old practice could be criticised by the dentist there and of course that would be in nobody’s interest.

    It might be a good idea for you to write a gentle letter to the patient explaining why you would prefer the hygienist at your practice to carry out the treatment in accordance with your established team approach.

  • Q
    I find the advice that you offer over the phone useful and it supports my professional practice. However, I have heard that you may increase my subscription as a result of my calling for advice as you will perceive me as 'high risk'. Is this true?
    07 August 2015

    If you have concerns about, or need help dealing with a complaint, please contact us for advice to provide peace of mind and to help prevent a concern or problem escalating. MPS does not, and never has, used the number of telephone calls from members seeking advice as part of its risk assessment of a member. The number of advice calls does not have any impact on the subscription rate that you are asked to pay.

    Our approach to risk carefully balances the needs of individual members with those of the whole membership. Our aim is to identify risk early and to alert members when their risk profile differs from that of their peers. This ensures that we can provide the right support as early as possible to reduce their future risk profile. We are well aware of the potential impact on our member’s career if they are deemed a significant risk. Whilst we indicate the nature of our concerns to individual members and try and work with them to reduce their risk, this may not always be possible.

    Our focus is on protecting and supporting the professional interests of more than 300,000 members around the world. We believe that the interests of the majority of members should not be compromised by a very small minority. Those who have received a comparatively high volume of claims or other matters by comparison to their peers can adversely affect the mutual fund.

  • Q
    I run an implant referral practice and dentists sometimes ask if I will place implants for them so they can supply a coronal restoration. How should I deal with failures when the responsibility is shared?
    04 August 2015

    UK dentists who place and restore implants are expected to follow the training pathways recommended by the General Dental Council and the Faculty of General Dental Practice (UK). When more than one clinician is involved in providing implant treatment, it is important that there is the ‘team leader’ with overall responsibility for the treatment, and that both clinicians can work together, complementing each other’s skills.

    Implants can and do fail, and the criteria for reimbursing or compensating the patient depend on many factors, such as the discussion during the consent process, the standard of care and the length of time the implant was viable. Other factors such as patient co-operation and subsequent treatment by the referring general dental practitioner may also be relevant. Any subsequent failure might involve both the original placement of the implant as well as the restorative element.

    Ideally there should be a good working relationship and close liaison between the two clinicians involved, on the understanding that one will be placing the implant and the other placing the restoration. To obtain patient consent there may need to be separate input from the clinician placing the implant as well as the clinician placing the restoration. Once the patient has given their consent, the treatment can be carried out. It would be prudent to advise the patient that the success of implants, like any other aspect of clinical dentistry, cannot always be guaranteed.

    When it comes to the apportionment of responsibility (including fees), this is something which should be discussed and decided between the clinicians involved, without the patient being involved or indeed compromised.

  • Q
    Can you tell me if the dental nurses assisting with sedation in my practice need any particular training?
    28 July 2015

    It is every General Dental Council registrant’s duty to ensure they are competent and have received adequate training for the tasks they are to perform. Dental nurses certainly do need to be trained in sedation to be involved in its administration and all team members need to be fully up to date with their CPR training to deal with emergencies.

    The GDC refers registrants to the Department of Health’s guidance on conscious sedation and says it is important that all registrants intending to be involved with the provision of sedation are conversant with this. The guidance makes reference to suitable monitoring. Another source of relevant information would be the Resuscitation Council.

    It is worth regularly checking the GDC’s website or asking, via the website, to be sent regular email updates. In this way it is possible to keep abreast of all developments at the Council.