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.

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.

An adverse comment placed on a website, be it WhatClinic.com (or similar) or the practice’s own website, can be upsetting, especially as it sits in the public domain for anyone to see.

With regard to an adverse post left on a review website, most such websites have the advantage of allowing the practice to post a response. Whilst there is no requirement to respond to website posts, indeed it would be inappropriate to respond to a complaint in this way, and it is advisable that a practice responds to such posts with a simple acknowledgement of the comments made and an invitation to the patient to make contact with a named person to discuss their concerns directly. This reassures both the patient who made the post and any other patients, potential patients and any others reading it that the practice takes patient feedback seriously and is keen to learn from patient experiences and to improve the service they offer. A suggested response is:

Many practices have protocols for routinely reviewing website posts and see them as an opportunity to improve services. Some practitioners also wish to thank those who have left positive feedback.

A similar approach could be taken to comments placed on practice owned websites which have facilities for this, and sites such as Facebook. Practitioners could also consider inviting satisfied patients to leave positive reviews. These may be helpful in themselves and can also have the effect of balancing out and indeed outweighing any negative comments.

In practical terms it is good policy to take a full medical history every time a patient is examined and the use of a medical history form provides an excellent way of recording this information.

It is important, however, that the patient is not left to complete the medical history form; whoever is carrying out the examination should go through all the questions with the patient to ensure they fully understand them or indeed can actually read.

Such questioning should obviously be carried out in a manner that ensures patient confidentiality. If a practice wishes to become paperless, the medical history form can be scanned onto the computer. The hard copies should then be be shredded or incinerated.

When a patient attends for an appointment as part of a course of treatment, it is always worth checking to ensure they have not started on any medication or have suffered any relevant illnesses since their last visit. Some practices encourage patients to volunteer such information by placing a sign in the waiting room requesting patients to inform their dentist of these types of changes.

Taking a full medical history at each examination can be onerous, but it is certainly worthwhile both to protect the patient and the dentist’s own position. Having a written record of the patient’s medical history, signed by the patient, often affords protection to the dentist – particularly if an allegation is made that he or she had not taken the patient’s medical history into consideration when carrying out treatment, which subsequently resulted in the patient being avoidably harmed.