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.