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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.
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  • 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 am a consultant maxillofacial surgeon and one of my cancer patients died unexpectedly two days post-operatively. There is to be a coroner's inquest
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    08 January 2015
    (or fatal accident inquiry in Scotland) and the Trust has appointed its own barrister. Can I assume that a barrister will act for me as well?

    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.

  • Q
    I have not paid my GDC annual retention fee. Can I still treat patients?
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    05 January 2015

    The Dentists Act requires that the ARF is paid in full on or before 31 December (for dentists) and there are no exceptions. Continuing to practise or to have an interest in the ownership of a practice while unregistered would be the illegal practise of dentistry and/or unlawful involvement in the business of dentistry and could in both respects result in a criminal prosecution and invalidate any professional indemnity held by the dentist in question.

    You will need to stop working and apply to the GDC for the restoration of your original registration . This involves providing a character reference and a health declaration. It is likely that processing an application for restoration will take some time, and you should make appropriate arrangements for the care of your patients in the meantime.

    Visit the GDC website to learn more

     

  • Q
    I am asking my nurse to write up the notes in the patients’ clinical records. Does she need to sign every entry on the record card?
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    11 December 2014
    Whilst a signature of a dental nurse indicates his or her presence on that particular day, it does not necessarily have to be an actual signature; it could just be a note of his or her name. 

     
    A signature itself does not necessarily indicate the original source of the information to which it relates because the records entered by the nurse will have been dictated by the dentist and s/he alone will be responsible for verifying the accuracy of what is written.

  • Q
    I've just started in a new practice that is owned by a dentist who belongs to a different defence organisation. He told me I need to join his organisation because my dental nurse will not have access to indemnity when I'm supervising her. Is that true?
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    02 December 2014

    No, it certainly isn't true. A dental member who is working in general or specialist dental practice could be held to be vicariously liable for the negligent acts and omissions of a dental nurse working under their direction and supervision even if they are not the actual employer of the dental nurse.

    Reflecting this, your membership already covers your potential vicarious liability for any dental nurse who is working under your direction and supervision. What makes our approach different from that of other defence organisations, however, is that we offer several additional categories of membership in which an employer/practice owner can provide access to indemnity up to five dental nurses or dental technicians employed by them, in respect of negligence claims, whether or not they are working with them or directing/supervising them at the time of an adverse incident. We believe this flexible approach is fairer to practice owners, associates and dental nurses alike.

  • Q
    Are there any limitations in the role of a treatment co-ordinator if the individual is not registered with the General Dental Council?
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    01 December 2014

    Some practitioners use the services of a treatment co-ordinator to provide the patient with information about their treatment and to answer their questions, although it would still be for the dentist and treating clinician to obtain consent rather than another member of the team. For obvious reasons, the treatment co-ordinator would not be in a position to provide any clinical advice.

    The role of the co-ordinator can sometimes be helpful in showing patients information about various treatment options which have already been discussed with the dentist. A treatment co-ordinator usually has more time to spend with the patient and some patients are more inclined to ask questions of a treatment co-ordinator than they are to ask questions of the dentist. However, there may be other patients who do not want to discuss any aspects of their possible treatment with anyone other than the dentist.

    If a patient brings a civil claim in negligence, a lack of detailed contemporaneous records of the consent process may mean a claim that could otherwise be defended has to be settled.

    Any practitioner planning to use a treatment co-ordinator will need to work closely with them to ensure there is no potential for miscommunication or misunderstanding and that everyone is aware that the ultimate responsibility for taking the patient appropriately through the consent process lies with the treating practitioner.

    Click here to see the benefits of DPL Xtra – an indemnity programme designed to protect the whole practice.

  • Q
    Can I take pictures of patients with a camera phone and send them to colleagues/specialists for an opinion or advice?
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    25 November 2014

    While it is tempting to capture various intra-oral situations with a handheld mobile camera phone, it is important to appreciate that the making of that image creates a record. This electronic record has the same quality of confidentiality as all other records and should be managed accordingly.

    Can you be sure that only the intended recipient will see the image? Unless there is encryption software on the phone, confidential material could be available to anyone who accesses the device especially if it is lost or stolen.

    The images, even on high resolution camera phones, may not be sufficient to make a diagnosis and may even lead to misleading advice being given. There is also the issue of storage since as a record it will require the same degree of permanence as other records. It cannot therefore simply be deleted.

  • Q
    My colleague has not yet recorded any continuing professional development. She says there is no requirement to undertake CPD every year and is prepared to do it all within the last six months of her five-year cycle. Can you reassure me on this subject?
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    18 November 2014

    The General Dental Council’s requirement is that registrants undertake a set amount of CPD within a five-year period and therefore if that registrant wishes to undertake all of that CPD in the last six months, then he or she is perfectly entitled to do this. That is not to say, however, that such an approach would be wise as this is an awful lot of CPD in a very short period of time. Simply trying to find courses that cover the core subjects within this brief window of opportunity might well be difficult. 

    Undertaking CPD in this way is not within the spirit of the GDC’s advice. Some patients might be alarmed if they knew the treating clinician held this view and was likely to be somewhat out of date at a given point in time.

    The role of the hygienist has changed significantly over the last few years and is likely to do so again. Your hygienist colleague is likely to be a long way behind the times and the provision of her treatment might well suffer accordingly.

  • Q
    If I don’t feel confident about undertaking a particular treatment for a patient, would I be vulnerable if I tell the practice owner about my reluctance to provide that treatment?
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    10 November 2014

    Even if it is within my scope of practice and I have appropriate training what should I do if I don’t feel confident about undertaking a particular treatment for a patient? Would I be vulnerable if I tell the practice owner about my reluctance to provide that treatment?

    Principle 7.2.1 of Standards states that you must only carry out a task or type of treatment if you are appropriately trained, competent and confident, and indemnified. Insertion of the word ‘confident’ is new and is a largely subjective judgement for each individual to make.

    The need to feel confident is likely to be particularly relevant to DCP/therapists and new dental graduates who may find they are asked to carry out something which, though falling within their scope of practice and trained to provide, they may lack the confidence to undertake. The introduction of the new wording legitimises the decision to decline to carry out the task. On the other hand it may well be possible to build a degree of confidence if it is possible to provide a mentor or supervisor on site who could assist and advise when needed and to help build confidence and ensure patient safety. This clause may also apply to more experienced clinicians learning a new technique who may also wish to use a mentor or to work with a degree of supervision.

    Paragraph 7.2.2 develops the situation further by stating: ‘If you are not confident… you must refer’. There is no choice; this is a ‘must’, not a ‘should’ and dignifies the referral process if the registrant considers they are not confident to carry out a particular treatment. A practice owner would need to recognise that by declining to carry out a particular treatment due to lack of confidence, the clinician is adhering to the GDC Standards.

  • Q
    I am a dental hygienist. I forgot and let my dental membership lapse. I've been sent a letter from the GDC saying that I am to face an Interim Orders Committee. What should I do?
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    04 November 2014

    I am a dental hygienist and have recently moved to a new town. While applying for jobs, I attended an interview with a dentist who asked to see my General Dental Council certificate of registration and some proof of indemnity. I showed the dentist my GDC certificate, but was unable to provide a current certificate of indemnity because I had let my subscription lapse a few years ago. I then forgot about it and failed to renew the subscription. The dentist subsequently notified the GDC that I was working without indemnity and now I have been sent a letter from the GDC saying that I am to face an Interim Orders Committee. Please can you tell me what this means and what I should do?

    The main function of the GDC is to protect patients and it is a requirement of being on the Dental Register that appropriate arrangements that provide  indemnity against clinical negligence need to be in  place so  that patients are protected. The GDC also has the power to convene an Interim Orders Committee if it feels that a registrant’s action is likely to put patients at risk.

    It appears that you have been working without appropriate cover for several years, which the GDC would consider a very serious offence. Although your membership has lapsed, this organisation has the discretion to offer assistance if it considers there to be extenuating circumstances which contributed to this situation. However, this would need approval from the Board of Directors.

    You can raise the matter at Board level by writing directly to the Chairman of the Board. It should be stressed that because you were not in membership at the time, there is no guarantee what the outcome will be. This would mean the prospect of you needing to make your own representations to the Interim Orders Committee. You would be invited to make submissions at the hearing. It would be similar to a situation where you represented yourself in a court of law without the benefit of any legal assistance.

    The Interim Orders Committee has the power to decide that a registration should be suspended, which means the registrant concerned is unable to work as a hygienist (or a dental nurse for that matter). Alternatively, the Committee may choose to impose conditions on your registration.

    However, to meet your obligations to have suitable indemnity arrangements in place, it is essential that your subscriptions are paid on time so that you can maintain your membership of Dental Protection.