Ask Dental Protection

It is important to ensure that the patient cannot be identified from any image taken, stored on or sent from your mobile phone. This includes the face or parts of the face or other details that will allow a viewer to identify the patient. The GDC expects registrants to obtain consent from their patient when taking such images either with a mobile phone or with a conventional camera.

If possible you should seek parental consent for the disclosure of any information about a child. If parental consent is not available, as is often the case in this type of situation, it may be appropriate to disclose the information requested on a public interest ground, or in the patient’s best interests.

Each case must be judged on its own merits taking account of local child protection guidance, with which all clinicians should be familiar. If parental consent for disclosure cannot be obtained, for any reason, you should discuss the request with one of our dento-legal advisers via the member helpline.

Dental Protection is seeking clarification from the GDC as to their expectations in respect of sending patient information by email. Encryption will only work satisfactorily if both sender and recipient use the same encryption.

Password protection is an alternative, but relies on the original information and the password being sent to the same email address. If the email address is incorrect in the first instance the password will also go to the incorrect address.

Even posting patient information by special delivery cannot be considered entirely secure. Where possible you should try to remove sensitive patient information from communications between third parties. However Dental Protection will require some patient information, such as name and date of birth, in the initial correspondence, in order to be able to provide the most appropriate advice. On-going correspondence may be dealt with by the use of case reference numbers and patient initials. Please review this page for updated advice as it becomes available.

You may continue to keep paper records but they will need to be legible to any reader. Changing to computer records will solve the problem of legibility, but you could also consider training your dental nurse to write up the records if you really do wish to continue with record cards.

When referring to clinical records it means records made at the time the patient is treated. Records made contemporaneously will be more accurate, as there is less likelihood of something being forgotten or incorrectly recalled.

If made at the time of treatment, there is no risk that the records can be influenced by subsequent events, such as the patient making a complaint to the receptionist after treatment has been completed. Dental Protection interprets the time of treatment as the period whilst the patient is seated in the dental chair for a consultation, as well as when specific treatment is being provided.

Records made at the end of a session, or at the end of the day, are not considered to be contemporaneous. Working in a busy practice is not an acceptable reason for a delay in writing the records.

There is no definitive answer to this question because the consent process is ideally a detailed conversation between two individuals of sound mind. But the length of time needed for an individual patient to comprehend, weigh up and make an informed choice from their various treatment options will vary depending on the complexity of the treatment proposed and the risks and consequences of each procedure.

Plastic Surgeons, when offering elective cosmetic procedures, are expected to leave a two-week interval between the consultation and the treatment visit. It might be prudent for dentists offering elective cosmetic treatments to work to a similar system.

In the case of a patient seen in an emergency or on referral for the uncomplicated extraction of an infected/carious or broken tooth which is producing severe symptoms, any offer to press on with the procedure immediately means that the preceding consent process must be detailed.

It should also include the offer of a less restrictive option, such as treating the cause of the pain but not extracting the tooth at the initial visit.

The less well you know the patient, the greater the need for caution – but every patient needs sufficient time and opportunity to consider their options without feeling in any way pressured into making a decision before they have had sufficient time to consider.

Such an idea may seem impractical in the real world situation of a busy surgery where you are confronted with a patient who has been fitted in without an appointment because of their acute pain. The law, however, views such situations dispassionately and with a forensic mind set. The time that patients are given to consider their options is very likely to become a key issue in a nerve damage case, when the patient could have/should have had longer to think about the risks involved. In such situations the contemporaneous notes of the conversation will be invaluable evidence that the standard has been met.

In the case described above it might be sensible to offer the emergency patient a seat in the waiting room whist they consider the various options. The next patient can be seen before the emergency patient returns to say which treatment option they would prefer.

Whilst there is no reason why you should not employ a practice manager to correspond with your patients, this person would still be working to your instructions and it would be necessary for you to be able to check what has been written on your behalf to ensure that it accurately reflected what you were trying to communicate to the patient. We can all have trouble with spelling and grammar from time to time and help from a member of the team who can write good English can certainly be helpful in achieving a good professional standard.

If the communication is coming from you, then the signature on the communication should also be yours and not that of the practice manager (although the manager could sign it in your absence if this is stated alongside their signature). Ultimately you are responsible for all communications with the patient and you have a vicarious liability for the acts and omissions of any practice staff who are acting on your behalf.

The GDC requires that you must be sufficiently fluent in written and spoken English to communicate effectively with patients, their relatives, the dental team and other healthcare professionals in the United Kingdom. If you have any doubts in this matter there are recognised standards against which you can measure yourself

The Office of Fair Trade recently investigated the business of dentistry and recommended that consideration should be given to providing guarantees for dental treatment. The GDC has wisely recognised that when treating a disease process there are a number of variables at play (not least being the active participation of the patient).

Consequently the requirement for a guarantee is not mandatory - instead the GDC advises that you should tell patients whether treatment is guaranteed, under what circumstances and for how long. You should also make clear any circumstances under which treatment is not guaranteed (for example, a lack of care on their part which leads to recurring problems or if the treatment is undertaken as a provisional solution in response to an emergency).

Unfortunately, guarantees fundamentally alter the nature of the contract between practitioner and patient, and may leave the practitioner unexpectedly exposed from a dento-legal perspective.

It is implicit in any contract to provide dental services that the clinician will carry out treatment with reasonable skill and care, exercising a level of skill that could reasonably be expected of someone holding himself out as possessing those skills.

A general dental practitioner is therefore expected to exercise the skills of a reasonable general dental practitioner.

Conversely, if the patient contracts with a specialist in a specific branch of dentistry, then the patient has a right to expect the specialist to display a higher level of care than that of a general dental practitioner. The same would obviously apply if the patient is seen by a recognised consultant in a hospital post.

If a dentist fulfils his/her ‘duty of care’ as described above, then, this is generally sufficient to rebut any allegation of negligence - although ultimately this is for the courts to decide.

However, if treatment is unsatisfactory or a problem arises, not due to any negligence on the dentist’s part, but simply because an alleged breach of contract on the dentist’s part, then an action brought against the dentist can still succeed, even in the absence of any clinical negligence.

There are no hard and fast rules governing how long a particular treatment should last, and indeed it would be curious if there were, given the infinitely variable nature of the human body and its function. A guarantee, however, imposes rules and standards which then become an integral part of the contract between dentist and patient, so that a dentist might be obliged to replace, at no cost to the patient, treatment which was neither negligent, nor which had failed to meet the normal terms, implied or otherwise, of a contract to provide dental services.

It is entirely possible, therefore, that a claim could arise which could have been successfully defended were it not for the presence of the ‘guarantee’ given by the practitioner when the treatment was provided. In such a situation, Dental Protection may not be able to provide assistance, if the practitioner had effectively given undertakings which had unilaterally, and without the knowledge of Dental Protection, extended his obligations to the patient.

Clearly it would not be equitable in a mutual organisation such as ours, if an individual member were to give binding ’guarantees’ (with a view to promoting his/her own practice), while expecting the cost of any claim upon these guarantees to be met by other members who had given no such guarantees.

If, on the other hand, it is clear that the patient’s claim would have succeeded whether or not the specific guarantee had been given, then clearly the member’s entitlement to assistance would merit consideration.

The GDC says that you should recognise patients’ communication difficulties and try to meet their particular communication needs by, for example:

• not using professional jargon and acronyms;
• using an interpreter for patients whose first language is not English;
• suggesting that patients bring someone with them who can use sign language
• providing an induction loop to help patients who wear hearing aids

There is no mandatory need to provide an induction loop and provided that you are able to communicate with the patient by an alternative means (possibly by using digital tablet to write on) you should be able to demonstrate that you have made an adjustment to the patient’s particular needs.

By displaying a price list in the practice and on the website, patients can gain some idea about the cost of the initial examination. Indeed it is a good idea to tell all patients if the price list has been updated and to offer them a printed copy or indicate where it can be viewed.

The GDC says that a simple price-list must be displayed and that it must list basic items of treatment including a consultation, a single-surface filling, an extraction, radiographs (bitewing or panoral) and treatment provided by the hygienist. For items which may vary in cost, a ‘from - to’ price range can be shown.

Patients should be encouraged to review the price list before seeing the dentist. Although they can read the prices of an x-ray or other items of treatment they will not necessarily know how many x-rays and what sort of films will be required, or indeed what other treatments might be clinically necessary. Clarification of the cost needs to be done before starting the treatment in order to avoid misunderstandings about the cost of treatment and the nature of the contract (private or NHS) under which it will be provided.