Notes
General Dental Council (GDC)
- Maintain dentists' and DCPs' register
- Setting standards of behaviour, education, ethics
- Concern about unfit to practise - poor health, misconduct, poor performance
- Determine which qualifications are recognized
Aims
- Protect patients
- Ensure dental professionals keep their knowledge up to date
- Help patients with complaints
9 Principles of GDC Standards
- Put patients' interest first
- Communicate effectively with patients
- Obtain valid consent
- Maintain and protect patients' information
- Have clear and effective complaints procedure
- Work with colleagues in a way that is in patients' best interest
- Maintain, develop and work within your professional knowledge and skills
- Raise concern if patients are at risk
- Make sure your personal behaviour maintains patients' confidence in you and dental profession
Professional Duty of Candour
- Tell the patient
- Apologize
- Offer and appropriate remedy or support
- Explain fully to the patient short and long-term effects
Specialist Lists
- Restorative dentistry
- Endodontics
- Periodontics
- Prosthodontics
- Orthodontics
- Pediatric dentistry
- Special care dentistry
- Dental public health
- Dental and maxillofacial radiology
- Oral medicine
- Oral microbiology
- Oral and maxillofacial pathology
- Oral surgery
2005 order → compulsory to have adequate and appropriate insurance to remain on Dentists' Register
Temporary Registration
- allow to teach, do research work, obtain post-graduate instruction in certain approved hospital posts
- limited period of time
- can only practise under supervision of a named, fully registered dentist of consultant status in UK
Dental Care Professionals (DCPs)
- Dental nurse
- Dental technician
- Dental hygienist
- Dental therapist
- Orthodontic therapist
- clinical dental technician
Scope of Practice
↓ read through ↓
https://www.gdc-uk.org/docs/default-source/scope-of-practice/scope-of-practice.pdf
Direct Access - giving patients the option to see a DCP without having first seen a dentist and without a prescription from a dentist
- Dental nurse can participate in preventive programmes
- Dental hygienists and dental therapists see patients directly
- Orthodontic therapists can carry out IOTN screening
- Clinical dental technician - provision and maintenance of full dentures
Continuing Professional Development (CPD)
- Dentist : 100 hr verifiable
- Hygienist / therapist / orthodontic therapist / clinical dental technician : 75 hr verifiable
- Dental nurse / dental technician : 50 hr verifiable
Core Topics
- Medical emergencies (10 hr)
- Disinfection and decontamination (5 hr)
- Radiography and radiation protection (5 hr)
- Legal and ethical issue
- Complaints handling
- Early detection of oral cancer
Complaints
Complaints should be made within 12 months of the event / 12 months realising that there is something to complain about
Acknowledgement of receipt of complaint within :
3 days (England, NI and Scotland) / 2 days (Wales)
Full response :
10 days (England, NI) / 20 days (Scotland) / 30 days (Wales)
Health Service Commissioner ('ombudsman') - completely independent of NHS and government, can investigate complaints about NHS services
Fitness to Practice (FTP) Investigations
- issue a reprimand
- suspension (up to 12 mths)
- condition (up to 36 mths)
- erasure (minimum 5 yrs)
Negligence
- owed a duty of care
- breach of that duty
- damage or suffering occurred
res ipsa loquitur = the thing speaks for itself (very obvious mistake / damage)
Contributory negligence = something occurs / made worse by an action / failure by the patient
Vicarious liability = as an employer, a dentist can be held responsible for any acts or omissions of his/her staff
Claim : within 3 years plaintiff aware of suffered damage / 6 years of incident / 6 years reaching age of majority (18 y/o)
The Bolam Principle Test
'doctor is not guilty of negligence if he has acted in accordance with the practice accepted as proper by a reasonable body of medical men skilled in that particular art'
Clinical Records - retained for at least 11 yrs / until patient 25 y/o, whichever longer
Consent
- Mental Capacity Act 2005 (England, Wales and NI) and Adults with Incapacity Act 2000 (Scotland)
- Right to refuse any treatment even during treatment for which they have previously consented
- Required for sedation, general anaesthesia, treatment carried out by students, complex irreversible form of treatment
Informed consent - given sufficient information with regard to benefits, risks, possible complications that they can come to rational decision
Minimum age for valid consent : 16 y/o → Gillick Competence
Adults lacking capacity : consent of patient's carer should be obtained AND 2nd opinion of a colleague that the proposed treatment is the most suitable for the patient / major treatment - agreement of 2 practitioners of consultant status
Montgomery v Lanarkshire (2015) : material risk to that patient has to be considered when consenting a patient
Minimal Legal Notice Entitlement
- 1 week - 2 years : 1 week
- > 2 years : 1 week for each year of employment, max 12 weeks
Clinical Governance = a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which high standards of acre wilt flourish OR corporate responsibility for the delivery of quality healthcare
Clinical Audit = the process of reviewing the delivery of health care to identify deficiencies so that they may be remedied
Peer Review = group of dentists (4-8) review aspects of practice
Health and Safety in Dental Practice
Health and Safety at Work Act 1974
Health and Safety Executive (HSE) - provide advice and guidance, ensure regulations by issuing improvement / prohibition notices
Care Quality Commission (CQC) - look after welfare of patients, providing safe working environment for staff → infection control
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) - require employers to notify HSE of injuries (incapacitated 7 days), occupational diseases and dangerous occurrences
Adverse incidents (breakages, malfunction affective patient care) involving medical devices should be reported to Medicines and Healthcare products Regulatory Agency (MHRA)
Regulatory Reform (Fire Safety) Order 2005 - electrical fire → CO2 extinguisher 🚒
Electricity at Work Regulations 1989
Health and Safety Regulations 2013 - sharp instruments in healthcare
Hazardous Substances
Control of Substances Hazardous to Health (COSHH) Regulations 2002
- identify all such substance within dental premises (microbes and vapours)
- review their use, storage
- minimize any risk to health
Waste Types & Classification
- mixed sharps, pharmaceutical waste (including teeth) → yellow-lidded sharps receptacle
- clinical waste (infectious) → orange bags
- medicines → blue-lidded yellow container
- offensive / hygiene waste → yellow & black bags
- amalgam waste → white container (containing mercury suppressant) 'Hg'
- study models → white container 'Gypsum'
- X-ray fixer & developer → leak-proof container
Store waste NOT longer than 12 months
Decontamination
Health Technical Memorandum (HTM 01-05)
Essential Quality Requirement
- cleaned instruments free of visible contaminants
- careful control of storage times
- audit decontamination process every 6 months
Best Practice
- automated washer-disinfector
- decontamination facilities separate from clinical treatment area
- reduce contamination of sterilized instruments
- easy identification / selection
Flooring in clinical care and decontamination areas : impervious
Autoclaves
Maximum safety examination period - 14 months
- Type N : air removal by passive displacement with stream, no-vacuum, for non-wrapped solid instruments
- Type B : vacuum, hollow, air-retentive and packaged loads
- Type S : specific load (not used in dental)
Storage time : wrapped 1 year, non-wrapped (non-clinical) 1 week, non-wrapped (clinical) 1 day
Sterilization time : 121℃ 15 mins / 134℃ 3 mins
↓symbol that identifies single-used items↓
Radiation Protection
Ionising Radiation Regulations 1999 (IRR99)
- protection of workers and public
- equipment aspects of patient protection
Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER) - patient protection
- Legal person : person / body corporate that takes legal responsibility for implementing both sets of regulations and good working practice
- Radiation protection supervisor (RPS) : ensuring compliance with IRR99, implementing Local Rules
- Radiation protection advisor (RPA) : provide advice on compliance with legal obligations of IRR99, routine radiation surveys of dental equipment, ALARP
- IRMER practitioner : justifying x ray exposure, ensure benefits outweigh risks
- IRMER referrer : refer individuals for medical exposure to an IRMER practitioner
- Operator : carries out all or part of the practical aspects associated with a radiographic examination
Radiation safety assessment every 3 years
Protection of Patients
Deterministic / Tissue effects : severity ∝ dose
Stochastic effects : probability ∝ dose (tumor-inducing)
Justification - prescription of radiographs must be of positive benefit to patient and influence their treatment
Dose Limitation
- Operating potential : 50-70kV
- Tube current-exposure time product (mAs)
- DC generators → fewer low-energy photons
- Aluminium filters
- Rectangular collimation : 35 x 45mm
- Image receptor speed
- Lead apron / thyroid shield
Optimization - ALARP = As Low As Reasonably Practicable
Quality Assurance (QA)
Protection of Staff
Radiation dose monitoring recommended for anyone taking > 100 intraoral / 50 panoramic radiographs per week
Faulty Radiographs
Bands of Treatment
- aged under 18
- under 19 and receiving full-time education
- pregnant or a mother who has had a baby in the previous 12 months
- staying in an NHS hospital and treatment is carried out by hospital dentist
- an NHS Hospital Dental Service outpatient
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