At present General Dental Council guidance (Principles of Dental Team Working, paragraphs 2.3 to 2.7) clearly indicates that a patient should have a full mouth assessment by a dentist and be provided with a treatment plan prior to the commencement of any treatment by a dental care professional. That treatment plan however is of course not always set in tablets of stone, and may in some situations be varied depending on a patient's needs. Be very careful that the changes you are proposing are in the patient's best interest and that your actions do not constitute an element of re-diagnosis.

Much depends on what is written in the treatment plan and to an extent how it is written. A very prescriptive treatment plan is unlikely to allow any variation (i.e. please place MO restoration in upper right E). A more general treatment plan allows the therapist a degree of latitude that in dentistry is often helpful (i.e. please restore upper right E).

Major changes to a treatment plan should always be approved by the dentist (i.e. where a tooth that was previously treatment planned for restoration now requires extraction). Minor changes (ie. the number of appointments or what treatment is offered at any one appointment) may well be as a result of the patient's choice and therefore have no overall impact on the treatment plan itself. If possible however, it is always best to speak to the prescribing dentist before making any alteration. Any changes (and the reasons for those changes) should always be recorded in detail in the records. If you are at all in doubt then feel free to contact Dental Protection 

No. Your membership of Dental Protection as a clinical dental technician also provides access to indemnity for any acts or omissions as a dental technician.

Firstly you need to understand that NHS/Crown Indemnity is not insurance. It is a discretionary indemnity that exists primarily to protect the Trust itself, not the individuals working for the Trust. There is a widespread assumption that individuals are 'covered' automatically, but this is not necessarily the case. For a clinical dental technician or a dental nurse who is following the agreed internal procedures of the Trust, it is highly unlikely that the individual would be left to meet the cost of a negligence claim against the Trust arising from their own clinical acts and omissions. But the Trust, like any other employer, does have a legal right to seek 'contribution and indemnity' from the employee personally if the employee has not followed agreed procedures or has acted in a particularly reckless or irresponsible fashion against the employer's interests.

Having access to your own professional indemnity arrangements gives you the peace of mind of knowing that you have the right to seek help, advice and financial assistance with any costs or damages involved. In addition, once you are registered a patient (or your employer or even a former employer with whom you are in dispute) could make a claim against you to the GDC. NHS/Crown Indemnity gives you no protection or support at all in this situation. Having your own Dental Protection membership means that you will have access to personal advice, guidance and support (including a 24-hour emergency helpline of experienced dento-legal advisers), and the right to request that the cost of representation by specialist solicitors and barristers (where necessary) is met on your behalf.

It is highly unlikely that you would benefit from the dentist’s indemnity arrangements and you need to look at obtaining your own protection. The GDC guidance contained in Standards for the Dental Team (Standard 1.8) says 'you must have appropriate arrangements in place for patients to seek compensation if they have suffered harm'.

Access to a full range of professional indemnity for clinical dental technicians can be obtained through Dental Protection at a very reasonable and competitive cost.

Handling complaints is the responsibility of all members of the dental team although it is usually expected that the lead clinician or line manager will probably respond when the complaint is against an employed member of staff. Alternatively, and in particular if the complaint is clearly directed at you, you may feel that you would prefer to respond yourself. This is entirely up to you.

The most important aspect is that the complaint is acknowledged (usually within two days of receipt of the complaint) and a full and detailed response provided to the patient as soon as practically possible (usually with ten days of receipt of the complaint letter). In our experience the earlier a complaint is addressed the more likely the matter will be resolved.

That response does not have to be in writing and in some situations speaking with the patient directly or asking them to come into the practice to discuss the complaint may well be enough to resolve any issues. You may then choose to confirm that discussion in writing or simply respond fully in a letter. Before any response is made however you may well feel it would be helpful to obtain contact us for advice and ask for assistance with the written response.

Read our advice booklets on complaints handling

Orthodontic therapists are perfectly entitled to work on their own if they wish without a dentist on the premises. To a large extent this is a matter of personal choice, competency and experience. 

Contact Dental Protection for more guidance on this issue.