There is often a degree of hesitation before any dentist proposes this course of action. Admitting to yourself that a particular treatment didn't achieve exactly what was intended can take a moment to accept. However, there is a common misconception that giving a refund to a patient should be avoided because it implies there has been a problem. In certain circumstances where the patient is disappointed with the look or the comfort of the final result (eg, dentures that the patient cannot wear or the degree of whiteness achieved with bleaching) dentists can give the patient a refund. This can often resolve difficult situations and avoid further hassle. Provided the refund is given with a clear indication, preferably in writing, that it is ‘a gesture of goodwill with no admission of liability’, it is unlikely to increase the risk of any further action and does not provide any additional grounds on which the patient might base a claim.

The nurses are unhappy about him doing this, particularly after giving an injection. Is this professional behaviour?

It is not uncommon for some dentists to administer local anaesthetic to a patient and then send them into the waiting room (where they may not be supervised or observed) whilst waiting for the local anaesthetic to take effect. Similarly some dentists work between two surgeries and may leave the patient in the chair either alone or with a dental nurse.

There are a couple of potential problems which could arise as a result of this type of practice. From a clinical point of view any patient may have an immediate or delayed reaction to the local anaesthetic and it is obviously important that the dentist is alerted and that if the patient is accompanied by a dental nurse, the nurse is able to at least start to deal with an adverse clinical scenario. The other issue at stake is whether the dental nurse’s position could possibly be compromised because there was not a third party to act as a chaperone.

The Dental Council’s ethical guidance strongly recommends that dentists have a third person present in the surgery and this could be interpreted to encompass the supervision of a patient after the administration of local anaesthetic.

The main concern here is why this dentist appears to be acting in this way on a reasonably regular basis. From a practice management point of view you may wish to set protocols within your practice to ensure patients are provided with a high standard of service and care and you therefore may wish to advise your associate that you would wish him to sit with the patient unless there were other acceptable reasons for leaving the surgery. You may need to take further advice if he fails to comply with your wishes.

Ultimately, the treating dentist will be responsible for the care of their patient and should the patient develop an adverse reaction while the dentist was not present then that dentist would have to provide a cogent reason why he believed it was in the patient’s best interests to leave them with the dental nurse. The training and experience of the dental nurse will also have a bearing on any decision made by the dentist. If a dental nurse feels that the patient could be at risk because of their own particular level of experience, then it is very responsible to have brought this to your attention.

The Dental Council has issued the Code of Practice relating to Display of Fees in Private Practices. This Code of Practice came into effect on 1 June 2011 and made it mandatory for dentists to display private fees in a place where patients can view them before consultation. The fee notice must be at least A4 size (29.7 x 21cm or 11.7 x 8.3in) and be legible, accurate and up-to-date. It must be prominently displayed in the practice and must be situated in a place where the patient could reasonably be expected to see the list before the consultation. It is recommended that the fee notice be displayed at any of the following locations:

• Entrance to the practice
• Reception area(s)
• Waiting room(s)

Dentists with websites must also display fees in a similar format. The fees displayed must be accurate, transparent and inclusive of all costs. Dentists must display a single fee only for the following treatments:

• Examination, diagnosis and treatment plan
• Hygiene treatment (hygienist) – per visit
• Hygiene treatment (dentist) – per visit
• X-rays – large (OPG)
• Prescription

Dentists must display fees for the following treatments and these may be displayed in the form of a range of fees. If displaying a range of fees, both the minimum and maximum fee must be shown. It is not permitted to set a minimum price only for any treatment:

• Advanced gum treatment
• Restorations – white (composite resin)
• Restorations – silver (amalgam)
• Acrylic-based dentures
• Metal-based dentures
• Root canal treatment
• Routine extraction
• Surgical extraction
• Core/post preparation
• Crowns

Further information and advice is available here