Many practitioners will have patients who are at various stages of the treatment plan. Some of these patients may have temporary and/or provisional restorations in situ.  
Members may wish to adopt a proactive stance and contact these patients to explain the current situation and offer advice and reassurance where appropriate. 

If one of these patients requires emergency care at an urgent dental care centre (UDC), a letter may be provided for the patient to take with them to the UDC which outlines the treatment plan, the current situation and future intent. The dentist can also offer to discuss any aspect of this directly with the clinician providing the urgent dental care.

As a result of the pandemic, and the anxiety about attending dental practices, members have found themselves in difficult positions where patients have been unwilling to attend appointments. As the clinician, patients might ask you to post their aligners and you need to carefully consider whether this is a sensible and safe approach to take; is this truly in the patient’s best interests or being done merely to satisfy a patient’s preference to proceed with treatment without having to attend?

The risks from providing aligners without being able to directly check any progress with previous aligners, tooth movement and fit would need to be taken into account and balanced against whether it may be safer at this time for the patient to simply continue with the current set of aligners to retain the tooth position. As the longevity of the restrictions on practice are currently unknown, it may become necessary to revisit this decision and how best to manage patient care in the longer term.

In the event there is clear justification that posting aligners is necessary and in the patient’s interests, the clinician would need to consider the best approach for assessing the fit of the aligners and these in turn are not risking any harm to the patient. A clear record would be needed to justify why it was felt appropriate and that the patient fully understood the potential risks of going down this route.

At a time when the majority of dental consultations are undertaken remotely, we are receiving an increasing number of enquiries about whether recording consultations is appropriate.

Firstly, any visual or audio recording would fall within the definition of data under the GDPR, as it contains details about an identifiable living person. Furthermore, it will inevitably contain details about their medical and dental health and is therefore classed as special category data which heightens the justification for its processing. Under GDPR, consent to audio and visual recording must not simply be assumed but must be obtained beforehand and documented, following a clear explanation as to its purpose.

These points are not to say recordings should not be made but they must be very carefully managed to avoid the situation where the interaction gets off on the wrong foot right from the very start.

There are several other things you need to consider relating to recordings. As data, they must be stored securely, and it is the right of patients to request copies. This may cause portability issues in providing copies in an accessible format.

Needless to say, any recording(s) would form part of the patient’s clinical record and therefore subject to the usual minimum retention periods and disclosure requirements such as in a claim or regulatory proceedings.

In summary, recordings can be made with appropriate consent, however we would advise members to proceed cautiously.

The UK Government has said that dentists may be asked to assist staff in NHS hospitals which could include administering injections and medication that would normally only be administered by hospital medics. We understand this work will be indemnified by state indemnity and members can look to us for additional advice and support. If you decide to take on this type of work, we will provide you with the protection you need without any additional cost, and you do not need to inform us. As well as increasing flexibility to make subscriptions more affordable, we will also provide support to dental members who choose to help medical colleagues on the frontline during the outbreak.

Before COVID-19, the transmission of blood-borne viruses during clinical treatment was the main cross-infection risk we considered in dentistry. Although claims were rare, the ones we did deal with usually related to alleged failings arising from the clinical aspects of care including the provision of dental treatment in the dental surgery.

In the context of COVID-19, airborne transmission is a risk in all settings.  Airborne viruses are the most contagious, and it is this aspect that is particularly concerning because it potentially increases the risk of transmission in dental practices.

Anyone who has attended the practice and believes they have developed COVID-19 as a result, could bring a claim irrespective of whether any face to face clinical treatment had been provided.  Claims may also arise from employees who allege that they have contracted COVID-19 during the course of their employment. 

Any claims relating to a failure to maintain and operate safe premises or allege the health and safety of employees or a member of the public was compromised are essentially business matters and should be directed to the practice Public Liability and Employers Liability Insurers. 

Where claims and allegations against a member relate directly to the provision of the patient’s clinical treatment, members can request assistance from Dental Protection in the usual way.  

From a risk management perspective, a claim arising from clinical treatment is more defensible where the practice is able to provide evidence of strict compliance with authoritative, evidence-based and current infection prevention and control guidelines. It would also be helpful to be able to demonstrate that regular audits are undertaken to ensure compliance.   

The same principles apply in relation to COVID-19. Practices must have written Standard Operating Procedures and protocols in place and these should reflect and be aligned with current guidance including reference to social distancing requirements and the recommended and relevant Infection Prevention and Control measures. This information will contribute significantly to preparing a robust defence against the allegations.

Please be assured that your membership and ability to request assistance is unaffected in these circumstances. 

There may be legitimate reasons why it is not possible to wear a fit-tested mask, including for health reasons or because it is not possible to achieve an adequate seal when wearing a mask. We recognise that for a variety of cultural and religious reasons, removal of facial hair and beards may not be an option, and therefore passing a fit-test is not possible.   
Please be assured that whatever the reason for not being able to pass a fit-test, your membership is unaffected and you can seek assistance from Dental Protection in the usual way.

The primary purpose of PPE – and in particular RPE masks – is for your own safety. If you are an employer, you would also need to consider the safety of your employees if they cannot pass a fit-test.  We recommend that you identify the overall risk to yourself, your team, and your patients in situations where the fit test has failed and ensure steps are taken to mitigate the risk.

Dental members who are deployed to provide NHS COVID-19 vaccination services and who benefit from state indemnity arrangements do not need to inform us of this work . Furthermore, as a benefit of your membership with Dental Protection, you can still request assistance with a range of non-claims matters should they arise as a result of this vaccination work, including dentolegal advice, complaint handling and regulatory matters, which are not provided as part of the state-backed indemnity scheme.

Practices must have written Standard Operating Procedures and protocols in place and these should reflect and be aligned with current guidance including reference to social distancing requirements and the recommended and relevant Infection Prevention and Control measures.

Where claims and allegations against a member relate directly to the provision of a patient’s clinical treatment, members can request assistance from Dental Protection in the usual way. From a risk management perspective, a claim arising from clinical treatment is more defensible where the practice is able to provide evidence of strict compliance with authoritative, evidence-based guidelines. It would also be helpful to be able to demonstrate that regular audits are undertaken to ensure compliance.

Dental services operating under contract to the NHS in England, Scotland, Northern Ireland and Wales should refer to the guidance and standard operating procedures produced by the governing bodies and regulators in their own country. The GDC have also advised they expect dental professionals working in private practice to review their national existing guidelines and standard operating procedures and take them into account when developing their own SOPs to ensure they meet the standards set in the prevailing geographical guidance. This is because each country within the UK is responsible for its own public health control measures and emergency powers to deal with the spread of infection which are set out in different pieces of legislation in the four nations. The standards for infection prevention and control (IPC) and PPE have been produced by Public Health England and should also be observed.

There is of course, other helpful clinical guidance for you to refer to such as guidance from the Faculty of General Dental Practice (FGDP) and the Scottish Dental Clinical Effectiveness Programme (SDCEP).

Claims that relate to failure to maintain and operate safe premises which allege the health and safety of employees or a member of the public was compromised are essentially business matters and should be directed to the practice Public Liability and Employers Liability Insurers.