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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 dental nurses assisting with sedation in my practice need any particular training?
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    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?
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    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.
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    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
    I am a provider/contractor and have received a letter from NHS Business Services Authority (BSA) indicating that they are reviewing repeat claims that have been submitted to them within a 28 day period. What does this mean?
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    07 July 2015

    It is normal for the BSA to scrutinise the performance of individual performers (and the contract as a whole) and to compare different elements of a performer’s profile against a series of standardised values that have been collected from their wider database.

    In this way, unusual patterns of claiming stand out and may prompt the BSA to find out why. The term 'outlier' is sometimes used to describe the contract of a performer with an unusual claims profile.

    An audit of the cases involved ‒ either by yourself or the BSA ‒ will help to establish the reason for the outlier profile. It doesn't imply that there is anything wrong with the pattern of claiming; indeed there are a variety of valid reasons why clinicians will occasionally have different profiles.

    The important thing is that the associated notes about treatment should contain sufficient detail about, amongst other things, the treatment that was undertaken and should demonstrate the reason for any repeated claim that might be queried.

    Dental Protection has been advised that the BSA has written to practices about their prescribing profile in relation to claims repeated within a 28 day period. The national average for such claims is 2.5% of all claims.

    You can request a copy of your own data via the BSA website  

    We understand that approximately 1,000 practices are 'outliers' above the national average for repeat claims within a 28 day period.

    Three-hundred practices have received a letter with a Code C. These practices are 50% above the national average in relation to the aforementioned repeat claims. The BSA is due to be writing to all three-hundred practices asking for records but in the meantime have suggested an audit should be undertaken by the practice.

    Seven-hundred practices have received a Code B letter where they are above the national average, but to a lesser degree. It has been suggested that you audit all your claims for the past year. This is a vast job and we suggest that you audit claims that are under one month apart in the first instance

    The remaining practices will receive a Code A letter, meaning they are not 'outliers'.

    Whichever category of letter you receive about your contract, it would be sensible to periodically review your claiming procedures and making sure that you, as provider, are not claiming improperly, as you are responsible for what you claim. The review should involve your performers and other staff in order to ensure that the legitimacy of all the claims made by the practice.

    Although the business of running a dental practice is outside the remit of Dental Protection’s advisory service, members are welcome to contact the telephone advice line if they need to discuss any correspondence they might have received from the BSA in this regard or if they would like advice about how best to undertake an audit.

  • 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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    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 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?
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    02 July 2015

    No. We actively encourage members to 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 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 advice calls do 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'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?
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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.