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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
    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?
    06 September 2016
    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, which should note both positive and negative findings. The records should be retained in the usual way. If you are using a special examination form this is part of the records and should be retained in the usual way.

    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, stressing stress the importance of referral to a specialist and the need to involve their doctor and also their current dentist (if they have one). A clinical photograph is often helpful to demonstrate the area of concern. In preparation for the open day you should identify the most appropriate referral pathway for your area.
  • Q
    When I am looking to purchase dental practice software, what risk management functionality do I need to look for?
    18 August 2016

    From a risk management perspective, you should look for ease of printing all relevant patient record information, ideally with a single click. Many current computer systems do not easily print out the whole record. It is also important to be able to print out historical information, such as earlier dental charts and periodontal records.

    Many systems currently only print out the most recent chart. As well as the accurate chronological reproducibility of the complete patient record you might also want to consider the ability to print out individual patient treatment plan summaries and pricing that can be offered to the patient to sign at the time of the initial examination.

    In addition the system needs to back up to a remote site to ensure data can be restored following an unexpected system failure or service interruption.

  • Q
    Why should I explain my infection control procedures to patients?
    20 July 2016

    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
    The Dental Council has produced a new Code of Practice Relating to Infection Prevention and Control. Do I have to comply with this new code?
    20 July 2016

    All dentists and their teams have a responsibility to protect their health and the health of patients from the risk of infectious diseases. Failure to comply with the Code of Practice Relating to Infection Prevention and Control may result in fitness to practise proceedings being taken under the Dentists Act, 1985.

    Dentists and their teams are advised to review the new Code and to assess their current procedures and any changes they need to implement to enable them to comply with the document.

    Although it is not yet clear how the Dental Council intends to review a Registrant’s compliance with the Code, all Registrants now have a good reason to ensure that they can demonstrate compliance.

    Some points to note:

    The practice principal or manager must nominate a Decontamination Lead to ensure that:

    • All staff involved in infection prevention and control are suitably trained;
    • The infection prevention and control system is established and monitored;
    • All roles and responsibilities are clearly defined. (para 7.1)

    All practices must establish and maintain:

    • Safety Statement;
    • IPC policy document. (para 7.2)

    All dental staff involved in patient care must receive appropriate and ongoing training in infection prevention and control. Details of this training must be kept on record. (para 5.1)

    All dental practices must have written protocols which establish and help maintain a safe, healthy working environment for all staff. (para 1.3.2)

    These protocols should include practice policies that must address the following separate and distinct elements:

    • Immune status 
    • The prevention of injuries that may expose those working in a dental environment to blood borne diseases. All dental practices must have a protocol for dealing with exposure prevention and post-exposure management.

    All dental practices must have a formal, written infection prevention and control policy document which is site-specific and which reflects European Union and national legislative requirements and practice guidelines. The policy should reflect the recommendations developed by Expert Groups and Competent Authorities (e.g. the Health Protection Surveillance Centre (HPSC) and the Health Service Executive (HSE)). It should address IPC education and training for all DHCWs. The written policies and procedures must include reporting, risk assessment and medical follow-up following occupational exposures (eg. percutaneous or needlestick injuries). (para 2.2)

    All current dental practices must have a suitable local decontamination area (LDA), while best practice requires that dental practices should have a separate local decontamination unit (LDU). (para 3.1.1)

    The LDA must allow for the separation of clean and dirty instruments, must be clearly zoned and must be as far as possible from the patient.

    All new dental premises opened after 1 January 2016 must have a separate decontamination room (LDU) and must at least be fitted out to provide for a washer-disinfector; also a separate decontamination room (LDU) must be included in the plans for the extension of any existing dental premises into a larger area.

    All existing practices should, where possible, have a plan to progress towards the establishment of an LDU.

    All practices must maintain the following documents for eight years:

    • Validation and service reports for decontamination equipment;
    • Log book for each autoclave, recording daily and weekly tests and, preferably, the cycle number and date of sterilisation of each load;
    • Waste transfer forms;
    • Staff training log;
    • Audit reports;
    • Pressure vessel tests.

    Read Dental Protection’s briefing document on the Sharps Regulations 2014 for more information.