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Competence

  • Q
    As a dental hygienist with an interest in hypnosis, colleagues sometimes refer anxious patients to me.
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    17 May 2016
    Am I able to request assistance from Dental Protection in the event that a claim revolving around hypnosis is made against me?
    Does the referring dentist need to understand hypnosis and should they include the request for hypnosis in the patient's treatment plan?
    The practice of hypnosis for the provision of dental treatment attracts all the benefits of Dental Protection membership that would normally apply to your DCP membership category. Whilst hypnosis is not included in the current scope of practice for dental hygienists published by the General Dental Council (GDC), it is accepted that whilst hypnosis is not itself considered to be the practise of dentistry, it may be provided to facilitate other treatments that are recognised as the practise of dentistry.

    With regard to including details of the referral in the treatment plan, Dental Protection would recommend that the referring dentist should specify in the treatment plan that they are prescribing the patient’s treatment to be provided under hypnosis. As with any other clinical situation, the prescribing dentist would be expected to have some knowledge of the procedure being prescribed, although they need not provide the service personally.

    View the full benefits of membership for DCPs
  • Q
    As a practice owner I would like to offer work experience to final year pupils from the local school. Will this affect my membership?
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    11 May 2016
    Dental Protection takes the view that the provision of work experience opportunities is a recognised activity in many professional settings and no additional subscriptions are required by practice owners.  

    We expect that those on work experience placement will not undertake any clinical work but instead observe and shadow your professional practice. Members are welcome to contact Dental Protection for advice about obtaining patient consent and confidentiality agreements as well as other aspects of induction for a practice visit.
  • Q
    Can dental nurses see patients direct?
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    11 May 2016

    Yes, if they are participating in structured programmes which provide dental public health interventions.

    Dental nurses who wish to practise in this way should be sure that they are trained, competent and indemnified to do so.

    Training can be external and accredited, or could be carried out in-house. If training is not externally accredited in some way, it should be recorded and verified by the registrant providing the training, for example by completing a log book.

    If a dental nurse applies fluoride varnish to a patient as part of a structured programme, he or she should advise the patient to inform their dentist (if they have one) that they have been treated under the programme.

    Click here to read our briefing document on Direct Access.

  • 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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    18 August 2016

    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
    Can I train my own nurse to assist with sedation cases?
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    24 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 if you cover equivalent course content, although it is very important that the training you give is appropriately planned and executed and thoroughly logged with clear aims and objectives and educational outcomes, plus case numbers. Essentially you would be reproducing an external course, but there is nothing to stop you doing this.

    One caveat to remember when delivering in-house training is that you would still be required to have an appropriately trained person present while the trainee is undergoing training at the chairside.

    There might also be some difficulty in finding an appropriate number of patients to undergo 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 you tell me if the dental nurses assisting with sedation in my practice need any particular training?
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    18 August 2016

    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 resuscitation skills to deal with emergencies. It would be expected these skills would include elements of the immediate life support protocols relevant to the age group of patients being treated.

    It would be expected the GDC would refer registrants to the Intercollegiate Advisory Committee on Sedation in Dentistry report on April 2015 and says it is important that all registrants intending to be involved with the provision of sedation are conversant with this. The Standards report makes reference to suitable monitoring. Another source of relevant information would be the Resuscitation Council.

    Registrants can subscribe to regular email updates via the GDC website. In this way it is possible to keep abreast of all developments at the Council.

  • Q
    Does the practice receptionist need to be vaccinated against Hepatitis B?
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    27 August 2014

    Provided the practice’s cross-infection standards are within the normally agreed requirements, there is no reason why your receptionist should be vaccinated.

    The vaccination is only required for those clinicians who are likely to come into contact with Hepatitis B and the patients who carry the disease. As such it is usually recommended that only those individuals who work chairside are required to have the vaccination.

    If your receptionist is also registered as a dental nurse and helps in the surgery from time to time, vaccination would be mandatory. However, a dedicated receptionist whose work does not involve any clinical activity does not require vaccination.

  • Q
    How can I demonstrate that I have had the 'necessary training' and I am competent to undertake a particular task in the dental setting?
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    19 September 2014

    Looking to the future when revalidation commences, each registrant is likely to require a Personal Development Plan (PDP). Each learning event and episode of formal training should be anticipated, documented and a reflection on the learning experience kept in the PDP. This provides invaluable evidence of a commitment to lifelong learning.

    In the meantime, any in-house training offered to team members needs to be properly documented, with aims and objectives together with the learning outcomes clearly listed. Evidence of attendance should be kept with certification where appropriate (CPR training, for example).

    Where practical training is being undertaken, a log should be kept of the number of tasks undertaken in the three following categories:

    • Directly observed
    • Carried out under close supervision
    • Carried out unsupervised, but checked. This checking stage should be documented.

    Similarly with any course attended, certification and ideally a reflective record compiled by the participant should be kept.

  • 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 for the Dental Team 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 document.

  • Q
    I'm a dental hygienist with training in acupuncture. Am I allowed to use these techniques in the dental setting and do I need any additional indemnity?
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    27 August 2014

    There are some aspects of the provision of dental treatment that the General Dental Council’s Scope of Practicesimply does not cover. Acupuncture would be a good example. In the past the GDC has been a little cautious about its use in dentistry, presumably because it is not quite sure where it fits in. The use of holistic medicine and hypnosis would be other good examples. This lack of clarity from the GDC is not helpful, although it would probably argue that there does have to be a point where the scope of practice has to be at the registrant’s discretion.

    If a registrant is to consider using these techniques, they would need to demonstrate that they are competent to do so and have acquired the necessary training. A training course run for DCPs by a UK dental hospital would probably be regarded as appropriate training.
    The difficulty would be how you might decide to use this additional skill in the dental surgery. As a hygienist, using acupuncture as some form of relaxation technique would not seem unreasonable. If you intended using acupuncture for the treatment of TMJ dysfunction, this would be quite a different matter. For obvious reasons this type of treatment is a long way outside the scope of practice for a hygienist.

    The use of acupuncture for a condition that was unrelated to dentistry would also be unacceptable. Indeed it would be necessary to ensure that a clear distinction was made between this alternative practice and the practice of dentistry. You could not, for example, advertise yourself as being a hygienist and in some way give additional credence to the treatment you provide from your GDC registration. On these occasions you would need to obtain additional indemnity from another provider.

    There are overlaps which tend to complicate matters further. It is, for example, the duty of all clinicians to provide advice on smoking cessation and to encourage patients to give up the habit. In the past, acupuncture (rather like hypnosis) has been shown to be quite successful in this respect. It is debatable whether the use of acupuncture in such a way is part of the practise of dentistry, or outside the dental field.

    From Dental Protection’s point of view, provided you are using acupuncture as part of dental treatment, there is no particular difficulty accessing indemnity as a benefit of dental membership. This may change in the future if the GDC should decide it falls outside the scope of practice for a hygienist.

    Any DCP members finding themselves in a similar situation are invited to contact Dental Protection for advice during office hours on 0845 608 4000.

  • Q
    I'm studying to be a CDT and I have been asked to see patients in order to re-cement crowns and bridges that have become detached from implants. I am happy to help but feel that I might be slightly vulnerable.
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    27 August 2014

    Clinical dental technicians are permitted to provide certain types of treatment for patients who have implants, provided that treatment is within their training and competency and the clinician is in possession of a treatment plan that has been written by a dentist following an examination.

    In this respect the General Dental Council would normally expect a CDT to confine their clinical activities to the provision of an implant-retained denture and not to become involved in treatment of implant-retained crown and bridgework of any type, irrespective of their training as a dental technician or their past experience. Clinical dental technicians do not normally become involved with crown and bridgework other than its repair outside of the mouth. In that situation you would be acting as a dental technician, not a CDT.

    Read more about the flexibility of the indemnity arrangements that are available to clinical dental technicians through Dental Protection.

  • Q
    Our practice recently held a CPR/medical emergencies update session. It covered the administration of first-line drugs.
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    18 August 2016

    As a registered dental hygienist, I wanted confirmation that I am allowed to administer these drugs in an emergency. Is this also the case for dental nurses?

    A medical emergency can occur at any time and every member of staff, not just the registered team members, has a role to play if a patient collapses or if there is any other kind of medical emergency. The General Dental Council advises that all members of staff who might be involved in dealing with a medical emergency should be trained and prepared to deal with such at any time and practise together regularly in a simulated emergency so they know exactly what to do. There should always be arrangements for at least two people available in the practice to deal with a medical emergency when treatment is planned to take place.

    Any DCP involved in the management of a patient in an emergency should provide support to the patient working under the direction of the dentist. It is possible that a situation arises where a dental hygienist is working in the practice without a dentist being present. However, it would be expected that in such circumstances the dental hygienist would be accompanied by another member of staff who should be competent in assisting in the event of a medical emergency.

    In these circumstances the dental hygienist would need to make a clinical decision based on their own knowledge and competence on how to deal with the emergency. A hygienist would be expected to be competent in maintaining a patient’s airway and administering oxygen and to give directions if necessary to the nurse or receptionist to make a call to the paramedics. Whether or not a hygienist administers any form of drug therapy will depend on whether they are in a position to make a diagnosis and have the competence and experience in administering these drugs.

    Normally a dental nurse will have had sufficient training to be able to assist a dentist or dental hygienist in the event of an emergency and it is obviously incumbent on the practice owner to ensure that all members of staff have regular training in CPR.

    However, if the dental nurse has had previous training and experience in CPR and was the only person available to deal with a medical emergency, then as long as the nurse is working within their area of competence and expertise it would be difficult to criticise that nurse if they were genuinely acting in the patient’s best interests when no one else was available.

    The Resuscitation Council guidelines contain detailed information about basic and advanced life support for adults, paediatrics and the newborn. Also included are guidelines for the use of Automated External Defibrillators and other related topics.

  • Q
    What is the best way to deal with a situation in which you believe a colleague’s work is below standard?
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    19 September 2014

    Deciding what to do when you have concerns about a colleague’s behaviour is always uncomfortable. Your duty to raise any concerns you have, however, overrides any personal and professional loyalty.

    The guidance makes it clear that the safety of patients must come first at all times. This means that any dental professional who has concerns that a colleague may not be fit to practise must take prompt and appropriate action. You should explain your concerns clearly and honestly to an appropriate person from your contracting body or employer.

    Salaried employee
    If you are working as an employed dental professional, any specific local procedures should be followed (your contract may well define them). You should expect that your employer will promote and support a culture of openness and that you should be made aware of the local processes to follow. Your employer must support you if you need to raise a concern and take your concerns seriously, creating a culture where you should not fear reprisal.

    In such circumstances it would also be prudent to seek advice from Dental Protection about how to raise your concerns, to ensure that your own position is protected. Make sure that you keep a record of your concern and the steps you have taken to try to remedy the situation.

    Self-employed
    For those who are self-employed, if the dental professional is not appropriately receptive to constructive criticism or is not able to improve performance to a level that removes any risk to patients, paragraph 8.2.5 of the GDC’s guidance makes it clear that you must act on your concerns promptly.

    If local procedures have not resolved the problems, or the person to whom you would normally report your concerns is part of the reason you are concerned, you should refer your concern to the GDC.

    If you need to contact the GDC for this reason, it would be wise to contact Dental Protection and speak to a dento-legal adviser about how to take the matter further. To facilitate that conversation it would be helpful to have available a record of your concerns and the steps you have already taken to try to remedy matters.

    Although the decision to raise concerns is entirely personal and is not one that any other clinician can make for you, it is best to speak with one of our dento-legal advisers and ask for their guidance. Every case will be different and there is no one answer that will fit every occasion. If there are related professional issues that you think could leave you vulnerable to criticism during an investigation, Dental Protection will know how best to assist and support you. Doing nothing, however, in a situation where you have concerns about patient safety is not an option. Failing to act in such circumstances may put your own registration at risk.

    In summary, if in doubt, always raise a concern. Try to raise concerns locally first. If you have already done that, and no action has been taken, you must act on your concerns promptly. You should not be asked to prove your concerns although you might need to explain your decision.