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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
    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.

  • Q
    Do I need to take a new medical history every time I examine a patient?
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    10 March 2015

    The current guidance from the General Dental Council and from the Faculty of General Dental Practice of the Royal College of Surgeons of England is that a patient’s medical history should be checked and updated at every treatment visit.

    In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

    It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

    Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

    When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

    Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.

  • Q
    Why should I explain my infection control procedures to patients?
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    10 February 2015

    Patients are likely to be a lot more aware of infection control issues following the recent publicity surrounding a look back exercise involving 20,000 dental patients in the UK. If the cost of their dental care increases, patients are likely to be more critical in their choice of dental care provider. Choice and quality are two of the most important components of consumerism.

    Patients who have come to appreciate the steps that are being taken by a practice to ensure their safety will be far less likely to move to another practice where it is not immediately obvious that the same standards of infection control apply.

    Many of those patients who move from one practice to another never tell the original practice why they have left. They often have unspoken concerns and dissatisfaction and these can include doubts over infection control and the quality of care generally. A visible infection control policy and a willingness to explain to patients what is being done for their safety, and why, can address concerns and reinforce the patient’s decision to stay with the practice.

    A deliberately high-profile and visible commitment to infection control can also help to justify a patient’s perception of value, especially if they have just agreed to pay privately for their dental care.

    There are many different ways to get the point across – a poster in the waiting room or a page on your website can outline the basic principles. You can also reinforce the message every time you open bagged instruments from the steriliser or a new set of instruments by mentioning that they have just been sterilised. Disposable, single use items can also be pointed out to patients instead.

    It is paradoxical that patients may be questioning standards of cross infection control in dentistry at a time when they are generally higher and safer than ever before.

    Topics of inadequate infection control make good stories and help sell newspapers. Take the initiative and get your own story out there first.

    With the help of the rest of the dental team, share the evidence of your own infection control measures with patients before they even have to ask. Whether it is new gloves or the large quantity of disposable item that are used – each of these topics can be turned to a marketing advantage. 
  • Q
    I am a hygienist with a Diploma in Dental Hygiene and want to print some business cards. Can you advise me please?
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    10 February 2015

    The General Dental Council’s advice indicates that however a clinician is being promoted, either inside or outside of the practice, the wording of that promotional material must be legal, decent, honest and truthful. Business cards would be regarded as promotional material and therefore must comply.

    Assuming that your Diploma in Dental Hygiene has been registered with the GDC, you are entitled to use the shortened version of this diploma on your business cards. Similarly, if you have any additional advanced qualifications (BA, BSc, etc.), these may be included too. However, you need to be careful not to potentially mislead patients by including details of qualifications that are unrelated to dentistry.

    It would also be advisable to indicate that you are a dental hygienist as part of your job title, simply to avoid any misunderstanding.

  • Q
    The practice owner has told me to economise the use of local anaesthetic by using it only in those cases where the patient will be in extreme pain. How can I decide what I should do?
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    13 January 2015

    Most patients have an expectation that their dentistry will either be pain-free or that any pain will be managed effectively. Therefore, the provision of a local anaesthetic for a given procedure will initially involve a discussion with the patient about the nature of the procedure being contemplated and what they may expect.

    This is an issue of consent. As a clinician, you should not impose your views and provide treatment without local anaesthetic simply because you have considered the matter (as requested by the practice owner) and concluded that the procedure will not be painful and does not require local anaesthetic. It is incumbent upon clinicians to respect patient autonomy and an individual’s right to make decisions about their treatment and this would extend to a decision about local anaesthetic.

    In any case, the patient’s medical history initially needs to be checked and updated before considering the type of local anaesthetic to be administered.

    Our advice booklet on consent is available here 
  • Q
    I work for a trust and one of my patients died unexpectedly. Can I assume the barrister for the Trust will represent me at the inquest?
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    08 January 2015
    The barrister will have been instructed by the Trust's solicitors to protect the Trust's own position and its interests. It may be that questions will be asked at the coroner's inquest about the role of the theatre or nursing staff who were responsible for the deceased's care. The barrister will normally be instructed to deal purely with the reputation of the Trust and other members of staff and may not be there to protect your own position particularly if there is a conflict between you and the Trust about the events leading up to the death of the patient.

    In cases like this, Dental Protection’s solicitors have instructed an experienced barrister to work with our solicitors, the dento-legal adviser and the consultant to prepare for the Inquest. The barrister would normally attend the Inquest and look after the interests of the consultant oral and maxillofacial surgeon during the hearing, especially where the consultant’s care of the patient is likely to be subject to detailed investigation by the coroner and/or the deceased’s family.