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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
    Can you tell me if the cost of my subscription could be increased if I ask one of your dentolegal advisers for advice on the telephone?
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    02 July 2015

    We actively encourage members to contact us for advice to provide peace of mind and to help prevent a concern or problem escalating. Dental Protection does not, and never has, used the number or content of a telephone call from a member seeking advice as part of its risk assessment of a member. The number, or content, of an advice call does not have any impact on the subscription rate that a member is 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.

    Whilst we cannot supply details of the specific risk indicator methodology as this is commercially sensitive, we can reiterate that calls to our advice line are not taken into consideration when assessing risks and we encourage our members to engage with us as early as possible to help manage and limit any potential problems they may face. We are well aware of the potential impact on our member’s career if they are deemed a significant risk and we do indicate the nature of our concerns to individual members and will try and work with them to reduce their risk, but this may not always be possible.

    • Calling Dental Protection has absolutely no adverse effect whatsoever on a member’s subscription.
    • We encourage members to call for advice sooner rather than later.
    • We consider calls to Dental Protection as being a positive element because it often allows problems to be resolved at an early stage.
  • 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?
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    30 June 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
    If a GDP refers a patient to me (a hygienist) and then subsequently leaves our practice, is the referral still valid? Or should a currently employed dentist rewrite the referral?
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    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.

  • Q
    I am running out of space. Where and how do I keep my records, particularly plaster models?
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    26 June 2015

    There is a view that working casts and models from routine crown and bridge work could be given to the patient for safe keeping and a note made in the dental records that this has been done. If they are presented to the patient in a protective model box, they are more likely to look after them and bring them back if required.

    While this approach can relieve an acute storage problem, the fact remains that the clinician loses control over what could prove to be a critically important part of the total record.

    Off-site storage is another solution but the problem with using alternative locations – apart from any cost involved – is that retrieval may take time, even when the contents of the containers are accurately indexed. 

    Commercial storage is available both for paper records and x-rays, artefacts such as working casts and study models as well as electronically stored data. Remember that it is important to always comply with the legal requirements for retaining and/or disposing of records in whichever jurisdictions you work.

  • Q
    What do I do about records when I move to a new practice?
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    16 June 2015

    If you are leaving an existing business arrangement in a practice and continuing to work reasonably close to the practice you have just left (subject to any contractual terms precluding this), it is quite likely that some of the existing patients will want to come to you for their ongoing dental care. In that case it may be possible to arrange with the original practice owner to forward the records for those patients who wish to continue treatment with you.

    Working from the original set of records would be in the patient’s best interests; it avoids the need to undertake new radiographs and also allows the clinician to monitor care and to review their historical treatment more accurately.

    Situations also arise whereby an assistant dentist may leave a practice and wish to take the patient records with them. While there is no statutory basis for it, it is the view of Dental Protection that unless agreed otherwise the records are owned by the practice. However, any departing practitioner should be given reasonable access to the records if required in the future, which would allow them to respond to any concerns later raised by patients. To avoid grounds for dispute on the departure of a practitioner, it is again recommended that reference to the ownership of records be made at the outset in a written contract between the practice owner and associate dentist.

  • Q
    Is it reasonable to take an extra x-ray just for the record?
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    09 June 2015

    Clinicians sometimes feel that in order to protect themselves dento-legally it would be useful to have an x-ray ‘just in case’. Orthodontists sometimes take a range of radiographs mid-treatment and again post-operatively. Hygienists have been known to take x-rays simply to check they have removed all the subgingival calculus following periodontal therapy.

    It is important when deciding to take a radiograph that a risk-to-benefit assessment is made. Every radiograph presents a radiation risk and any exposure of a patient to that risk must be offset against a reasonable clinical benefit. No patient should be exposed to an additional dose of radiation (and the associated risk) as part of a course of dental treatment unless there is likely to be a benefit in terms of improved management for that patient.

  • Q
    Can I withdraw from treating a patient?
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    02 June 2015

    Sometimes, for a variety of reasons, you may decide you need to withdraw from a patient’s treatment, or suggest they seek further treatment elsewhere. This has the potential to create a problem and it needs to be sensitively managed.

    Try never to lose your temper with a patient. Keep your cool and remain professional at all times, however testing it might be on occasions. If you are finding it difficult to treat the patient safely and to an acceptable standard, consider referring the patient to a suitably experienced colleague.

    You must never part company with a patient in anger. If for any reason you decide you cannot continue treating the patient, make it clear that you are withdrawing from the treatment in the patient’s best interests, not your own. Make the necessary referral arrangements, keep the patient informed and resist the temptation to insert any ‘one liners’ in the correspondence or in the clinical records, or worse still in any direct communication you have with the patient.

    Never give the impression that you are being arrogant, dismissive or petulant when deciding to end your relationship with a ‘challenging’ patient. A few ill-chosen words spoken in the heat of the moment can result in months or years of subsequent repercussions if you end up being sued or facing a complaint to the GDC or other agencies.

  • Q
    In order to extract a lower first molar it was necessary to repeat the ID block three times. The patient now has some residual numbness of the lower lip. How should I manage the situation?
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    26 May 2015

    When a patient reports a persistent loss of sensation, the clinician needs to be sympathetic to their concerns residual numbness could lead to a distrust of future dental treatment and a real fear of a similar problem arising again.

    Management usually involves counselling and medication for any pain. In addition the patient needs to be reassured and given realistic expectations of recovery. Referral to a suitable oral surgery facility for assessment is also desirable. An explanation of why they were not warned of this complication may also be required.

     The risk of damage can be reduced if the clinician can:

    • Avoid multiple blocks where possible.
    • Avoid using high concentration local anaesthetic for ID blocks (for example, use 2% Lidocaine as standard).

    Always document any unusual patient reaction during local analgesic blocks (such as sharp pain or an electrical shock-like sensation) and contact Dental Protection for advice if the patient’s loss of sensation persists and the patient has made a complaint as a result.

  • Q
    I’ve received a solicitor’s letter on behalf of a patient I saw at my old practice, claiming that I missed a fracture in her tooth which will cost several thousand pounds to rectify. Who is legally responsible?
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    19 May 2015

    Clinicians remain legally accountable for any treatment which they have provided regardless of whether or not they have left the practice where a patient was seen. Similarly, other clinicians who have been involved in the patient's care subsequently are accountable for their treatment. The dental records are fundamental in determining what treatment each dentist has provided and on what date. Only then can it be decided to what extent, if any, your own treatment for this particular patient might have contributed to the problem.

  • Q
    If I hold a practice open day providing free oral cancer screening, would I be responsible for the patients' dental needs or can I provide just the soft tissue examination and oral cancer advice?
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    12 May 2015

    The importance of good communication with members of the public who attend your open day cannot be overestimated. They should be made fully aware of the nature and limitations of the examination which is to take place both verbally and perhaps more usefully in written form.

    Since there are a number of techniques which serve as an adjunct to visual examination, and which may show up an early abnormality, patients should be advised of the scope and limitations of your examination depending on the technique you are proposing to adopt.

    Members of the public who agree to an examination of their mouth should be taken through the consent process before they are examined. They should be reminded of the scope and nature of your examination and whether you will be carrying out a full examination of their teeth and the gingival tissues.

    They should also be made aware at the outset that they may have to provide a medical history as well as a social history which may provide markers for an increased incidence in oral cancer. All this information should be documented in a clinical record for each person you examine. The record should also include personal details such as their name, address, date of birth, etc, together with the results of your examination. The records should be retained in the usual way.

    If your examination extends beyond the oral cavity and includes the face and neck, you should note both positive and negative findings.

    Your duty of care to each person you examine extends to whatever was agreed to be the nature of your examination – hence the importance of defining any limitations at the outset. It would also be desirable to advise patients of the importance of seeing a dentist on a regular basis especially if they fall into a high risk category.

    In the event of you discovering a suspicious lesion, you will need to discuss with the patient how this should be followed up. You should not follow this up with their dentist or doctor without the express consent of the patient, as you will still be bound by a duty of patient confidentiality. However, you should stress the importance of referral to a specialist and the need to involve their doctor and also their current dentist (if they have one).

    Dental members can save 20% on the two-hour interactive programme on oral cancer that has been produced by Smile-on