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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
    A patient who wears a partial denture has approached a clinical dental technician to have it re-made. I don't know the clinician and wondered about my situation if I supplied the prescription and the patient was unhappy about the new denture.
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    26 May 2015
    One of my patients who wears a partial denture has independently approached a clinical dental technician to have it re-made. The technician is asking me to provide a prescription for the patient. I do not know the clinician and wondered about my situation if I supplied the prescription and the patient was unhappy about the new denture.

    According to the General Dental Council’s Scope of Practice, a clinical dental technician (CDT) can provide complete dentures directly to a patient. However, patients requiring a partial denture must be seen by a dentist before a CDT can provide treatment and only then following the issue of a prescription.

    All appliances provided by a CDT are done so under private contract and therefore if the patient was in any way dissatisfied, the CDT would be expected to have a suitable process for handling complaints. The Dental Complaints Service is available to the patient. The dentist who provides the treatment plan could be challenged if the treatment plan was considered inappropriate.

    You would be entitled to refuse to provide the patient with a prescription if for some reason you felt a particular type of denture would not be in their best interest and could justify such a decision.

    In general terms a prescription request such as this can be treated in the same way as a referral for treatment; it is a correspondence between two professionals directly concerned in the provision of dental care to a particular patient. Under these circumstances, the patient’s consent would be implied by the professional relationship.

    A prescription request could also be seen as a request by the patient for a treatment plan. Following a full mouth assessment by a dentist, the patient should be provided with a treatment plan. The patient is at liberty to take this treatment plan to any appropriate registered dental professional who can, within the overall limits of the plan and their competence, treat the patient. Therefore, a patient would be entitled to take their treatment plan for a denture to a CDT.

    To be seen to be obstructive is likely to attract considerable criticism and possibly invite investigation from the GDC should the matter come to its attention.

    Who is responsible for the partial denture design?

    This is not an easy question to answer as the GDC’s guidance certainly does not make this clear. One could argue that as the dentist is providing the treatment plan and prescription, he or she should be the person to design the denture. Alternatively one could argue that as the CDT is the clinician making the denture, the design should really fall to them.

    In reality, however, it is likely to be a collaboration. The lead would depend on training and expertise. Either way, the records should reflect the discussions and decisions made.

    Who is responsible if something subsequently happens to the natural dentition as a result of the design?

    The responsibility will probably lie with the dentist who examined the patient and provided the treatment plan in the first place as it would be for them to indicate any areas of concern they might have clinically. The CDT would also be liable as although s/he is not trained specifically to identify caries and periodontal problems, they would be expected to recognise such problems and to raise any relevant concerns before the treatment begins. It would however be quite different if the CDT had not followed the advice of the dentist.

    Who is ultimately responsible for the patient?

    The ultimate responsibility for any patient’s treatment lies with the clinician who undertook that particular element of the treatment. That does not mean, however, that the dentist (who perhaps only provided the treatment plan) has no responsibility as this certainly would not be the case.

    Can a dentist refuse to provide a treatment plan?

    The GDC’s guidance makes it very clear that individual registrants should act together in the best interests of the patient and as a consequence a dentist would have to have a good clinical or ethical reason for failing to provide a treatment plan. If that refusal was simply as a matter of ‘protectionism’, the GDC would not be too impressed.

  • Q
    A patient has requested their dental x-rays because they want to have dental treatment provided abroad where it is cheaper. Can I give them to the patient?
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    19 May 2015

    We recommend you only allow the patient to take away copies of your radiography, retaining the originals yourself. The patient is of course entitled to copies but is liable for any reasonable charges incurred in doing so.

    You have obviously made the patient aware of the potential problems associated with seeking treatment abroad, especially the provision of follow-up care which may be necessary should the treatment not go according to plan. You cannot be held responsible for the outcome of another practitioner’s work.


  • Q
    I've been asked by another practice to supply the radiographs of a patient who has moved away, the request came from the practice manager. Do I need written permission from the patient and what fee can I charge for the service?
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    12 May 2015

    Owing to the confidential nature of dental records, it is best practice to receive verbal or written consent from the patient and this can be documented. Radiographs can be copied and handed to the patient or posted by secure delivery. A reasonable copying charge can be applied up to £50 as stated in the Data Protection Act. Digital images can be shared more readily than images taken on film and the copying charge can be reduced accordingly.

  • Q
    Can I send a recall appointment to a patient using a postcard or must the card be enclosed in an envelope?
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    05 May 2015

    All communications sent to your patients should be enclosed in an envelope to protect confidentiality. This applies to all correspondence in connection with treatment as well as recalls.

    Announcements that are not patient-specific – for example a practice open day or the opening of a new practice – can be sent on a postcard.

    Postal charge increases will clearly encourage more dentists and practice managers to seek permission from patients to send out appointment reminders by text or email.


  • Q
    A patient recently came to see me about his extensive dental problems. However, he has a strong and unpleasant body odour and I am reluctant to see him again. Can I decline to treat him?
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    28 April 2015

    Ethically you have a duty to ensure that the patient’s interests are put before your own. Certainly in the case of a dental emergency you are likely to be criticised for declining to treat a person on the grounds of their poor hygiene.

    There may be an underlying reason why this patient has body odour. It may be related to health issues (including mental health), genetic conditions or some learning difficulty. There is always the risk that a decision to decline treatment could be seen as discriminatory.

    The General Dental Council guidance warns registrants not to discriminate against patients on the grounds of their health. The NHS contract also prohibits discrimination on health grounds. If this is the underlying cause of the body odour, you could be exposed to a challenge both legally and by your regulatory body if you declined to provide treatment.

    However, if the smell is impacting on your ability to treat your patient in their best interests, you might wish to tackle the situation in a different way.

    You could discuss the body odour with your patient so that he has the opportunity to try to address this and seek medical support should this be necessary.

    Although it might be a somewhat difficult conversation, you could explain that the smell was sufficiently intrusive that it was distracting your concentration. Reduced concentration would naturally not be in his interests.

    You should document the discussion so that, should a subsequent challenge arise, you would be in a position to demonstrate you had taken all reasonable steps before considering declining to continue treatment.

  • Q
    I would like to employ an overseas-trained dentist to work as a dental nurse while my own nurse takes three months’ leave of absence. Is that possible?
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    14 April 2015

    All dental nurses in the UK need to be either in training, on a waiting list to undergo training, or be fully qualified and registered with the General Dental Council. As such, this is a protected title and the tasks of a dental nurse can only be carried out either by a registered dental nurse, a registered hygienist or dental therapist, or a registered dentist.

    If the overseas dentist is to work as a locum dental nurse, s/he would first need to be registered with the GDC as a dentist or dental nurse. If the prospective dental nurse was able to obtain appropriate registration with the GDC or demonstrate that s/he was ‘in training’, you would be able to consider offering him or her the role of a dental nurse.

    Before allowing the individual to carry out dental nursing duties, you need to ensure they have the appropriate immunisations, including Hepatitis B. Without satisfactory immunisation, you would be vulnerable to action under health and safety laws, as well as a potential civil claim from the dental nurse were he or she to contract Hepatitis B.

    You can discover more about the flexibility of our dental membership for all DCPS by clicking here [internal to main DCP indemnity page].

  • Q
    When my usual nurse is unavailable, the practice manager will often allocate a trainee nurse to work with me. The trainee nurse, however, has not completed her course of Hepatitis B vaccinations. Is this ok?
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    07 April 2015
    When my usual nurse is unavailable, the practice manager will often allocate a trainee nurse to work with me. The trainee nurse, however, has not completed her course of Hepatitis B vaccinations. Is it reasonable to request that chairside support is only provided by somebody who has completed the course of three doses of the vaccine?

     
    A dental nurse, whether qualified and registered or a trainee, working in a clinical setting should not only be Hepatitis B vaccinated but must have clear proof of antibody titre to confirm that s/he is appropriately protected from the virus.

    The reasons for this:
    • The individual must be protected (to protect themselves and their partner/family)
    • Without vaccination, the dental nurse runs the risk of becoming infected with hepatitis which could then put patients at risk, which would be entirely contrary to the General Dental Council’s ethical guidance

    Anybody working with you chairside must be able to demonstrate that their Hepatitis B immunisation has been completed and that they have the required antibody titre. If this is not the case, they should not be assisting you in the dental surgery. You should discuss an alternative solution (perhaps agency staff) with the practice manager.

  • Q
    What are the criteria for training a dental nurse to assist with sedation cases? Can I train my own nurse?
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    31 March 2015

    The General Dental Council considers that this skill is over and above the skills that would be expected upon qualification when a dental nurse first registers.

    Nurses who wish to undertake training in dental sedation must therefore be fully qualified and registered with the GDC. The National Examining Board for Dental Nurses certificate in dental sedation nursing is probably the easiest route to follow. However, there is nothing to stop you training your nurses in-house in terms of the equivalent of the course content, although it is very important that the training is appropriately planned and executed and thoroughly logged with clear aims and objectives and educational outcomes, plus case numbers. Essentially you would be duplicating the requirements of an external course, but there is nothing to stop you doing this.

    There is one caveat related to in-house training in that you would still be required to have an appropriately trained person present while the trainee was also undergoing training at the chairside.

    There might also be some difficulty in finding an appropriate number of patients undergoing this treatment and to co-ordinate their appointments to coincide with the availability of an appropriately trained assistant while the training of the dental nurse is taking place.

  • Q
    Can I accept a request for work experience from a school pupil who is interested in a career in dentistry?
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    24 March 2015

    It is not unusual to receive a request for work experience from a school pupil. Observing in a dental practice can enhance the pupil’s understanding of dentistry and can assist them in deciding whether or not dentistry is the career for them. Not only that, but some dental schools prefer applicants to have undertaken some type of relevant work experience.

    So what does a practice owner have to consider before agreeing to such a request?

    Health and safety

    Under health and safety law, a work experience student is considered to be your employee. You treat them no differently to other young people you employ. A young person is defined as anyone under the age of 18.

    As an employer you will already have carried out a risk assessment. Under Health and Safety law you must assess the risks to young people under the age of 18 before they start work experience and tell them what the risks are. Young workers may be particularly at risk from work place hazards because of their lack of awareness of existing potential risks, immaturity or inexperience.

    Health and Safety legislation addresses the protection of young persons at work in detail, and you should consider your obligations in this regard. The Health and Safety Executive guide, Young people and work experience: A brief guide to health and safety for employers, contains helpful information about these obligations.

    Assess the risk

    Before the young person can start work experience, the practice owner must carry out a risk assessment to identify any specific risks which they might face. The assessment must take into account the following:

    • The inexperience and immaturity of young persons.
    • Their lack of awareness of risks to their health and safety.
    • The fitting and layout of the practice and surgery.
    • The nature, degree and duration of any exposure to biological, chemical or physical agents.
    • The form, range, use and handling of work equipment.
    • The way in which processes and activities are organised.
    • Any health and safety training given.

    You should keep a record of the main findings of the risk assessment. This is good practice and it is a legal requirement if you have five or more employees (including young people on work experience). The risk assessment and any control measures taken should be shared with the parents of the work experience student. See the Health and Safety Executive's FAQs for more information.

    Once the young person is ready to commence their work experience it is important that you check that they have undergone and understood training which covers, for example:

    • The hazards and risks in the work place.
    • The control measures put in place to protect their health and safety.
    • A basic introduction to Health and Safety, for example, first aid and fire and evacuation procedures.

    In addition to this you may wish to check that your employer’s liability insurance and public liability insurance cover includes work experience students.

    Confidentiality

    Confidentiality is crucial and a clear induction is of paramount importance, as is the need to check the young person understanding of the subject. Confidentiality extends not only to the patient’s treatment, but also to the fact that someone is a patient of the practice. This might include some of the young person’s peers or teachers!

    Issues of confidentiality also extend to access to the dental records and to the appointment book and you would need to ensure that the student is fully aware of your confidentiality protocols.

    It would certainly be appropriate to check with each individual patient that they are happy to have a work experience student observing their dental treatment, and to emphasise that the patient can change their mind at any time.

    The Working Time Regulations 1998 apply to work experience students and you may wish to consult with the school concerning the hours which they wish the work experience student to attend your dental practice.

    Can I have a go?

    The days of work experience students mixing materials and assisting at the chairside are long gone! It is appropriate to manage the work experience student’s expectations so that they are fully aware of that their experience, whilst being very worthwhile, will be limited to observing.

  • Q
    I have elderly patients who come to me privately but who are eligible to receive free NHS prescriptions. Can I provide them with an NHS prescription?
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    17 March 2015
    An NHS prescription can only be written for a patient who is receiving an NHS course of treatment or treatment of an urgent condition under the NHS. If any of your patients are being treated on a private basis, and they require a prescription-only medicine, this must be prescribed privately, or dispensed at the practice.

     
    It is important when dispensing medication that the appropriate records are kept of what is given and the dosage, etc.

    Dental Protection has produced a risk management module, Drugs and Prescribing, which provides advice on prescribing, and is available to members from Prism, our e-learning learning library.