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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
    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.

  • Q
    I have just seen a new NHS patient with a badly broken down dentition. He was extremely aggressive and rude to both me and the dental nurse and I would prefer not to see him again. Can I refuse to treat him?
    21 July 2015

    The provider holding the contract with the CCG should write and tell the patient that the practice will not tolerate rudeness or aggression from any patient. You may also feel there has been a breakdown in the relationship between yourself and the patient. If you feel it is not right to continue treating the patient, you should say you are ceasing to do so.

    If you have completed the patient’s treatment, then this is relatively simple to achieve and you should tell your staff not to book the patient in again. However, if you are halfway through a course, you should bear in mind what the patient’s current situation is, and you may wish to offer 30 days’ emergency treatment, perhaps provided by someone else in your practice, but tell the patient they should seek out another dentist as quickly as possible. You should also provide the patient with a list of any outstanding treatment.

    The CCG can provide a list of all the locally contracting dentists and it would be helpful to offer the patient their telephone number.

    Aggression and violence from patients is not tolerated by the NHS.

  • Q
    I fitted a set of dentures which the patient says are unsatisfactory, but he will not return the dentures so I can examine them.
    14 July 2015
    I fitted a set of dentures which the patient says are hideous and demands that I refund his money. However, he will not return the dentures so I can examine them, saying they belong to him. I am happy to refund the money but would like my work returned.

    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 at the same time as the treatment is completed.

    It follows that during the various stages of denture construction, the 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.

    If the patient is unhappy with the dentures and the clinician decides to refund the fees, there is no absolute right to demand the denture should be returned in lieu of the refunded fee.

    A patient who is unhappy with a denture for whatever reason would probably argue that the denture was not ‘fit for purpose’ as defined under contract law. As such the patient may ask for either a replacement item or their money back. On the basis that any replacement is unlikely to satisfy the patient (particularly if they have high expectations), the best option may be to refund the money.

    It is a simple matter to suggest to the patient that if they return the denture to the practice a full refund will be made. Most patients are happy to return the dentures as they are apparently of little use.

    However, if the patient insists they wish to keep the denture, a demand for its return could create an obstacle to the resolution of the patient's complaint. From a pragmatic perspective, whilst you may wish to ask for the dentures to be returned, if the patient remains unwilling to do so you may wish to refund the fees in any event.

  • Q
    How should I record a patient's consent for routine dental treatment? Does it have to be put in writing for the patient to sign?
    07 July 2015

    The concept of consent arises when a patient seeks advice, care and treatment from a dentist and that dentist carries out an examination of the patient and provides them with details of the treatment required together with the options, benefits and risks as well as the cost of that treatment. This is an on-going conversation that is picked up at every stage of the treatment being provided.

    Most dental procedures are carried out without the need for written consent but it is important that a record is made (either by the dentist or dental nurse) of the conversation during which the patient gave their consent.

    When seeing a patient for a dental examination there is likely to be implied consent that the patient wishes the dentist to look in their mouth and therefore opens it to facilitate this. When carrying out more invasive treatment such as taking radiographs and providing fillings, the dentist should obtain the express consent of the patient for each procedure.

    Certainly when carrying out fillings patients should be informed of the various options which are available to them, the costs of the treatment as well as the risks of not having a particular treatment carried out.

    In the UK, consent only needs to be obtained in a written form signed by the patient, when the treatment is being provided under general anaesthetic or sedation.

    Some employers make it a contractual obligation to obtain the patient’s signature on a consent form for a variety of procedures as well as anaesthesia. The employee has an obligation to respond to the terms of their contract. Indeed in complex cases it is a sensible precaution to have some form of written consent. This would apply to treatment plans for extensive restorative work or for patients undergoing treatment which could pose a significant risk, such as the removal of a lower wisdom tooth.

    The signature on a consent form does not automatically imply the patient has provided their consent to the treatment. All it means is that the patient has signed their name and may not in fact have understood the treatment which the dentist had discussed with them.

    The best way of ensuring consent has been obtained is to check with the patient if they fully appreciate the details of what has been discussed and to make good notes within the clinical records of both the discussion and the patient’s response.

    Read our region-specific advice booklets on consent in the UK

  • Q
    I'm a hygienist. If a GDP refers a patient to me and then leaves our practice, is the referral still valid? Or should a currently employed dentist rewrite the referral?
    30 June 2015

    The referral from the GDP is still valid in this situation providing there has not been an unduly large time lag between the referral being written and the patient being seen by you.

    At the time of creating the original referral, the patient would have been examined and the GDP would have made a referral on the basis of those clinical findings. Those clinical findings and any associated tests and investigations form part of the patient’s clinical record and this does not automatically leave the practice when the dentist in question moves on.

    There may, in rare circumstances, be a wide variation between what is written in the original referral and what the new dentist considers should be written. However, care plans are not set in stone and can be modified. A simple discussion (documented within the notes) between the hygienist and the new dentist should be sufficient to ensure continuity and appropriateness of care.

    It is important to remember that the patient is at the centre of the process and their consent is required for any changes which may arise in respect of the originally planned treatment.