maintaining standards

GeneralDentalCouncil

Maintaining StandardsGuidance to Dentists on Professional and Personal Conduct

GENERAL DENTAL COUNCIL

MAINTAINING STANDARDS

NOVEMBER 1997

GUIDANCE TO DENTISTS ON PROFESSIONAL AND PERSONAL CONDUCT

AMENDMENTS APPROVED BY COUNCIL IN NOVEMBER 2001

Contents Revised to incorporate new paragraph titles

Paragraph 4.7 Amended to include reference to emergency drugs

Paragraph 4.9 Amended to include reference to beforedeciding to refer

Paragraph 4.11 Amended to cover patients unable to respond to verbal contact

Paragraph 4.12 Amended to include reference to beforereferring for treatment

Paragraph 4.13 Widened to include techniques and drugs used in control of pain and anxiety

Paragraph 4.14 Amended to expand upon advice given in paragraph (iii) and to include a newparagraph (iv) about justifying the use of the method selected

Paragraph 4.16 Wording slightly amended

Paragraph 4.17 Amended to include the fact that generalanaesthesia for dental treatment should only beadministered in a hospital setting with criticalcare facilities and to include the need to avoidor reduce future episodes of general anaesthesia

Paragraph 4.19 Advice on decision to treat expanded

Paragraph 4.20 Section heading changed

Paragraph 4.22 Section heading changed

New paragraph (i) included and paragraph (iv)modified to include references to HDUs and ICUs

Paragraph 4.23 Amended to include the need to give post-operative advice

Bibliography Amended to include new publications and new addresses

GENERAL DENTAL COUNCIL: MAINTAINING STANDARDS

AMENDMENTS, NOVEMBER 2001

CONTENTS

All paragraphs are as approved in November 1997 unless otherwise indicated by means of

a numeric superscript, immediately following the paragraph number, which shows the

year of amendment (1999).

INTRODUCTION 2001

1: BEFORE BEGINNING TO PRACTISE NOVEMBER 1997

Registering with the General Dental Council 1.1

Obtaining indemnity 1.2

Keeping up-to-date 1.32000

The use of qualifications and titles 1.4

Specialist lists 1.51998

2: WHAT THE PUBLIC EXPECTS NOVEMBER 1997

Personal behaviour 2.1

Alcohol and drugs 2.21999

Improper statements or certificates and

misleading announcements 2.3

Protecting patients 2.4

Physical impairment 2.52000

3: WHAT THE PATIENT EXPECTS NOVEMBER 1997

Acting in the best interests of patients 3.1

Providing a high standard of care 3.2

Making a referral 3.31999

Accepting a referral 3.42000

Maintaining confidentiality 3.52000

Explaining treatment and costs 3.6

Consent 3.71999

Having a third party present 3.81999

Domiciliary treatment 3.9

Treating difficult patients and children 3.10


CONTENTS, NOVEMBER 1997, REVISED MAY 2001

Providing for dental emergencies and out ofhours care 3.11

Extended absence from practice 3.12Handling complaints 3.13Complaints of rudeness and discourtesy 3.14

4: WHAT THE PROFESSION EXPECTS NOVEMBER 1997

Dealing with cross-infection 4.1Dealing with transmissible disease 4.2Contemporaneous records 4.31999

Dental radiography and radiation protection 4.41999

Prescribing 4.51999

Misleading claims 4.61999

RESUSCITATION

Dealing with medical emergencies 4.72001

PAIN AND ANXIETY CONTROL

Duty and expectations 4.81999

Behavioural management 4.92001

Local anaesthesia 4.101999

Conscious sedation 4.112001

Assessment, consent and instructions 4.122001

Record keeping 4.132001

Responsibilities, education and skills 4.142001

Equipment, drugs and monitoring 4.151999

Fitness for discharge 4.162001

GENERAL ANAESTHESIA

Risks of general anaesthesia 4.172001

DUTIES OF THE REFERRING DENTIST

Decision to refer 4.181999

DUTIES OF THE TREATING DENTIST

Decision to treat 4.192001

Consent 4.202001

Instructions and records 4.211999

Responsibilities of those providing dental treatment under general anaesthesia 4.222001

Recovery and discharge 4.232001

Training 4.241999

5: THE DENTAL TEAM NOVEMBER 1997

Employing staff 5.12000


CONTENTS, NOVEMBER 1997, REVISED NOVEMBER 2001

Illegal practice 5.2Dental hygienists and dental therapists 5.3Delegation of oral hygiene instruction 5.4

6: PRACTICE ARRANGEMENTS NOVEMBER 2000

Professional responsibility 6.1Practice agreements 6.2Unreasonable financial pressure 6.3Leaving a practice 6.4Disposal of clinical and hazardous waste 6.5Dental records and radiographs 6.6Disposal of patient records 6.7Debt collection 6.8Bankruptcy 6.9Carrying on the business of dentistry –

restrictions 6.10Bodies corporate 6.11Companies to run the administrative side of a

dental practice/letting of premises 6.12Use of the words ‘dental’ and ‘dentistry’ in

company titles 6.13Practice titles 6.14Signs and professional plates 6.15Appearance of names other than a dentist’s 6.16Screening of windows 6.17Canvassing 6.18Incentives 6.19Product promotion 6.20

7: PROMOTING THE PRACTICE NOVEMBER 1997

Legal, decent, honest, truthful 7.1Name of dentist to be included 7.2Unacceptable content 7.3Clarity of treatment available 7.4Interactions with the media 7.5Specialist claims 7.6Clarity of information on fees 7.7

8: THE COUNCIL’S JURISDICTION NOVEMBER 1997

Jurisdiction 8.1

PROFESSIONAL CONDUCT

A dentist’s professional duty and liability 8.2Scope and definition of serious professional misconduct 8.3Extent of disciplinary jurisdiction 8.4



Undergraduate behaviour 8.5Sources of information 8.62000

Convictions 8.7

DISCIPLINARY PROCEDURE

Stages 8.8

PRELIMINARY SCREENING

Preliminary Screener 8.92000

Action 8.102000

PRELIMINARY PROCEEDINGS COMMITTEE

Meetings and membership 8.11Notifying the dentist 8.12Considering the information 8.13Notifying the decision 8.14Advice and warnings 8.15Interim suspension 8.162000

PROFESSIONAL CONDUCT COMMITTEE

Meetings and membership 8.17Notifying the dentist 8.18Notice of Inquiry 8.19Presentation of case and rules of evidence 8.20Finding of serious professional misconduct 8.21Disposal of case 8.22Immediate suspension 8.23Appeals and imposition of determination 8.24Restoration after suspension 8.25Restoration after erasure for misconduct 8.26

FITNESS TO PRACTISE

Information about a dentist 8.27Initial consideration of information 8.28Notifying the dentist 8.29Medical examinations 8.30Consideration of medical reports 8.31

HEALTH COMMITTEE

Meetings and membership 8.32Notifying the dentist 8.33Notice of Referral 8.34Conduct of hearing 8.35Information considered by the Health Committee 8.36Finding concerning fitness to practise 8.37Determination of Health Committee 8.38



Notice of Resumed Hearing 8.39Immediate suspension 8.40Conditions 8.41Appeals and imposition of determination 8.42Jurisdiction of the Health Committee 8.43

BIBLIOGRAPHY NOVEMBER 2001

INDEX NOVEMBER 2000



INTRODUCTION

The General Dental Council has a statutory duty to promote highstandards of personal and professional conduct within the dentalprofession. As part of that duty the Council has published MaintainingStandards as a set of ethical guidelines for the profession.

Maintaining Standards contains advice to dentists, dental hygienistsand dental therapists on principles of personal and professionalconduct, includes guidance on the expectations of the public and thepatient, and also explains the Council’s jurisdiction.

Maintaining Standards is not a set of rules and regulations coveringevery aspect of behaviour in every possible set of circumstances. Thepractice of dentistry requires the exercise of professional judgementand an acceptance of personal responsibility, informed by the Council’sethical guidelines and the principles on which these are based.

Whilst this document is primarily designed as constructive guidancefor the profession, it may be used to inform the Council’s fitness topractise procedures.

Maintaining Standards is regularly updated in the light of currentexpectations and is intended to be helpful advice to the professionrather than a statutory code of conduct. Members of the dental teamshould at all times behave reasonably and in the public interest.

INTRODUCTION, MAY 2001

1: BEFORE BEGINNING TO PRACTISE

REGISTERING WITH THE GENERAL DENTAL COUNCIL 1, 2

1.1 It is the responsibility of a dentist who intends to practise to registerwith the GDC before beginning to practise and to renew thatregistration annually. Failure to do so may lead to disciplinaryproceedings.

A dentist should not practise dentistry in a name other than that whichappears in the Dentists Register.

It is unlawful for anyone to give or to suggest that they are prepared togive any advice or treatment such as is normally given by a dentist,unless that person is registered in the Dentists Register or the MedicalRegister. Advice or treatment includes the fitting, insertion or fixing ofdentures, artificial teeth or other dental appliances.

Those who supervise students undertaking the dental treatment ofpatients must be on the Dentists Register.

Enrolled dental hygienists and dental therapists may only practise underthe direction of a registered dentist to the extent permitted by therelevant Regulations.

OBTAINING INDEMNITY

1.2 A dentist involved in advising or treating patients must either holdappropriate membership of a defence organisation or otherwise beindemnified against claims for professional negligence. This is in theinterest both of patients, who may have a right to compensation and ofdentists, who may require professional and legal advice. A lack ofappropriate defence organisation membership or adequate indemnitycover which includes professional and legal advice, would almostcertainly lead to a charge of serious professional misconduct.

KEEPING UP-TO-DATE 3

1.3 In the interests of patients, a dentist must continue professionaleducation on a regular and frequent basis throughout professional life.

The recording of all continuing professional development (CPD) activityis the responsibility of the individual dentist. Records must be accurateand must be retained, together with external verification whererelevant. Records and verification must be produced when requested bythe Council.

A dentist who fails to maintain and update professional knowledge andskills and who, as a result, provides treatment which falls short of thestandards which the public and the profession have a right to expect,may be liable to a charge of serious professional misconduct.


1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 2000

THE USE OF QUALIFICATIONS AND TITLES 4

1.4 A dentist may use in connection with dental practice only thosequalifications which are entered against that dentist’s name in theDentists Register and any specialist lists, and the description ‘dentist’,‘dental practitioner’ or ‘dental surgeon’.

A dentist who uses the courtesy title ‘doctor’ has a duty to ensure that itis not used in a way which misleads the public.

Additional qualifications which are generally recognised for inclusion inthe Dentists Register are listed in the preliminary pages of the Dentists Register. Further guidance may be obtained from the GDC’sRegistration Department.

SPECIALIST LISTS

1.5 Only a dentist whose name is entered in a specialist list is entitled to usethe title prescribed in connection with that list; no dentist should implypossession of specialist status in terms which could mislead patients. Seealso 7.6

Specialist lists held by the GDC are indicative, not restrictive. This means that holders of prescribed specialist titles remain free to practise across the whole spectrum of dentistry within theiracknowledged competence.


1: BEFORE BEGINNING TO PRACTISE, NOVEMBER 1997, REVISED NOVEMBER 1998

2: WHAT THE PUBLIC EXPECTS

PERSONAL BEHAVIOUR

2.1 A dentist must adhere to the appropriate standards of personal as wellas professional conduct.

Any behaviour or activity by a dentist which is liable to bring theprofession into disrepute or to undermine public confidence in theprofession may lead to a charge of serious professional misconduct.

Behaviour which reflects adversely on the profession such as dishonesty,indecency or violence, may also lead to a charge of serious professionalmisconduct even if such behaviour is not directly connected with thedentist’s professional practice.

ALCOHOL AND DRUGS

2.2 Complaints of drunkenness or the misuse of drugs, particularly if thisinvolves an abuse of a dentist’s prescribing powers, may lead to a chargeof serious professional misconduct, even if the offence has not been thesubject of criminal proceedings.

Problems with alcohol and/or drug dependency could lead to a dentistbeing referred to the Health Committee.

A dentist should prescribe drugs only in connection with the provision ofbona fide treatment. See also 4.5

IMPROPER STATEMENTS OR CERTIFICATES AND MISLEADING ANNOUNCEMENTS

2.3 A dentist should not make a statement or declaration that is untrue ormisleading or unethical, nor induce any other person to do so.

Any act or omission by a dentist in connection with dental practice whichis liable to mislead the public may lead to a charge of seriousprofessional misconduct.

A dentist should not, for example, demand or receive fees for whichthere is no entitlement nor persuade a patient to accept privatetreatment by giving incorrect information.

PROTECTING PATIENTS

2.4 A dentist must act to protect patients when there is reason to believe thatthey are threatened by a colleague’s conduct, performance or health.The safety of patients must come first at all times and should over-ridepersonal and professional loyalties. As soon as a dentist becomes awareof any situation which puts patients at risk, the matter should bediscussed with a senior colleague or an appropriate professional body.


2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 1999

2.5 A dentist who is suffering from physical impairment which mightjeopardise the wellbeing of patients should seek medical advice, and, ifnecessary, restrict the scope of his or her dental practice. The conduct ofa dentist who wilfully continues to practise when a physical impairmentmay be expected to prejudice the safety of patients may be regarded asserious professional misconduct.


2. WHAT THE PUBLIC EXPECTS, NOVEMBER 1997, REVISED MAY 2000

3: WHAT THE PATIENT EXPECTS

ACTING IN THE BEST INTERESTS OF PATIENTS

3.1 As a member of a caring profession, a dentist has a responsibility to putthe interests of patients first. The professional relationship betweendentist and patient relies on trust and the assumption that a dentist willact in the best interests of the patient. Abuses of this professionalrelationship may lead to a charge of serious professional misconduct.

PROVIDING A HIGH STANDARD OF CARE

3.2 A patient is entitled to expect that a dentist will provide a high standardof care. The Council takes a serious view of any neglect of a dentist’sprofessional responsibilities to patients for their care and treatment

MAKING A REFERRAL

3.3 When accepting a patient a dentist assumes a duty of care whichincludes the obligation to refer the patient for further professionaladvice or treatment if it transpires that the task in hand is beyond thedentist’s own skills. A patient is entitled to a referral for a secondopinion at any time and the dentist is under an obligation to accede tothe request and to do so promptly. See also 4.18

ACCEPTING A REFERRAL

3.4 It is the responsibility of a dentist when accepting a referral to ensurethat the request is fully understood. The treatment or advice requestedshould only be provided where this is felt to be appropriate. If this is notthe case, there is an obligation on the dentist to discuss the matter, priorto commencing treatment, with the referring practitioner and thepatient. See also 4.19

MAINTAINING CONFIDENTIALITY 5

3.5 The dentist/patient relationship is founded on trust and a dentist shouldnot disclose to a third party information about a patient acquired in aprofessional capacity without the permission of the patient. To do somay lead to a charge of serious professional misconduct. A dentistshould also be aware that the duty of confidentiality extends to othermembers of the dental team.

Where information is held on computer, a dentist should also haveregard to the provisions of the Data Protection Act. See also 6.5

There may, however, be circumstances in which the public interestoutweighs a dentist’s duty of confidentiality and in which disclosurewould be justified. A dentist in such a situation should consult a defenceor professional organisation or other appropriate adviser.


3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED NOVEMBER 2000

Communications with patients should not compromise patientconfidentiality. In the interests of security and confidentiality, forexample, it is advisable that all postal communications to patients aresent in sealed envelopes.

EXPLAINING TREATMENT AND COSTS

3.6 It is the responsibility of a dentist to explain clearly to the patient thenature of the contract and in particular whether the patient is beingaccepted for treatment under a particular scheme, including the NHS, orunder some other arrangement.

The charge for an initial consultation and the probable cost of thesubsequent treatment must be made clear to the patient at the outset.

A written treatment plan and estimate will avoid misunderstandingsand should always be provided for extensive or expensive courses oftreatment. A dentist who obtains the patient’s agreement to these termsin writing is better placed to refute an allegation that a patient has beenmisled with regard to the nature of the contract or the type or cost oftreatment provided.

If it becomes apparent to the dentist, after the estimate has beenagreed, that a modified treatment plan will become necessary theCouncil would expect the dentist to discuss this with the patient; obtainthe patient’s consent to the further treatment and additional cost; andprovide a written, amended estimate before proceeding further.

Patients are entitled to an itemised account of treatment received andshould normally be provided with one.

CONSENT

3.7 A dentist must explain to the patient the treatment proposed, the risksinvolved and alternative treatments and ensure that appropriateconsent is obtained.

If a general anaesthetic or sedation is to be given, all procedures mustbe explained to the patient. The onus is on the dentist to ensure that allnecessary information and explanations have been given eitherpersonally or by the anaesthetist/sedationist. In this situation writtenconsent must be obtained. See also 4.12 and 4.20

HAVING A THIRD PARTY PRESENT

3.8 A dentist should normally be assisted by a dental nurse. When attendinga patient, a dentist would be well advised to have a member of thedental team or other person present at all times in the operating roomand in the recovery room. When general anaesthesia or sedation isbeing used, such an arrangement is mandatory. See also 4.14, 4.22 and 4.23


3. WHAT THE PATIENT EXPECTS, NOVEMBER 1997, REVISED MAY 1999

DOMICILIARY TREATMENT

3.9 Dental treatment provided on a domiciliary basis should be appropriatewithin that setting, taking into account the nature of the problem, thefacilities available and the welfare of the patient. Having a third partypresent is particularly relevant in this environment.

TREATING DIFFICULT PATIENTS AND CHILDREN

3.10 There can be no justification for intimidation or, other than in the mostexceptional circumstances, for the use of physical restraint in dealingwith a difficult patient.

When faced with a child who is uncontrollable for whatever reason, thedentist should consider ceasing treatment, making an appropriateexplanation to the parent or representative and arranging necessaryfuture treatment for the child, rather than continuing in thesecircumstances.

PROVIDING FOR DENTAL EMERGENCIES AND OUT OF HOURS CARE

3.11 A dentist working in any branch of dentistry must make appropriatearrangements to ensure that patients, for whom responsibility has beenaccepted, have access to emergency treatment outside normal workinghours and that such arrangements are made known to those patients.

While a sympathetic response to patients in pain is to be expected, it isextremely difficult to define what constitutes a dental emergency. If apatient has an acute spreading infection, or a dental haemorrhagewhich is difficult to control, or has suffered damage to a tooth or jawsas a result of external trauma, it is the dentist’s duty to provide, or makearrangements for the patient to receive, advice or treatment within areasonable time.

EXTENDED ABSENCE FROM PRACTICE

3.12 If a dentist is absent from a practice for an extended period,arrangements should be made to notify patients and for them to receivecare as appropriate.

HANDLING COMPLAINTS 6

3.13 If a patient has cause to complain about the service provided, everyeffort should be made to resolve the matter at practice level. Thecomplaint may relate to the treatment provided or some other mattersuch as the payment of fees or the attitude of a member of the dental team.

The Council endorses the detailed guidance on handling complaintswhich has been issued by the NHS Executive and the British DentalAssociation and would expect compliance.



COMPLAINTS OF RUDENESS AND DISCOURTESY

3.14 The Council receives complaints from patients about rudeness anddiscourtesy on the part of dentists. While such behaviour may not, ofitself, amount to serious professional misconduct it is of concern. TheCouncil may, with the patient’s consent, seek the observations of thedentist on an informal basis.



4: WHAT THE PROFESSION EXPECTS

DEALING WITH CROSS-INFECTION 7, 8, 9, 10, 11

4.1 There has always existed the risk of cross-infection in dental treatment.Therefore, a dentist has a duty to take appropriate precautions toprotect patients and other members of the dental team from that risk.The publicity surrounding the spread of HIV infection has served tohighlight the precautions which a dentist should already have beentaking and which are now more important than ever. Detailed guidanceon cross-infection control has been issued by the Health Departmentsand the British Dental Association, and is endorsed by the Council.

It is unethical for a dentist to refuse to treat a patient solely on thegrounds that the person has a blood borne virus or any othertransmissible disease or infection.

Failure to employ adequate methods of cross-infection control would almost certainly render a dentist liable to a charge of serious professional misconduct.

DEALING WITH TRANSMISSIBLE DISEASE 12

4.2 A dentist who is aware of being infected with a blood borne virus or anyother transmissible disease or infection which might jeopardise the wellbeing of patients and takes no action is behaving unethically. TheCouncil would take the same view if a dentist took no action whenhaving reason to believe that such infection may be present.

It is the responsibility of a dentist in either situation to obtain medicaladvice which may result in appropriate testing and, if a dentist is foundto be infected, regular medical supervision. The medical advice mayinclude the necessity to cease the practice of dentistry altogether, toexclude exposure prone procedures or to modify practice in some otherway.

Failure to obtain such advice or to act upon it would almost certainlylead to a charge of serious professional misconduct.

CONTEMPORANEOUS RECORDS

4.3 A dentist must always obtain a medical history of a patient before commencing treatment and check the history for any changes atsubsequent visits. Changes must be recorded on the patient's notes.

Full contemporaneous records should be kept for all dental treatment.See also 4.13 and 4.21


4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED MAY 1999

DENTAL RADIOGRAPHY AND RADIATION PROTECTION 14

4.4 A dentist has a number of statutory duties in relation to radiationprotection during dental radiography.

A dentist who owns or operates an X-ray machine must ensure full compliance with the Regulations and safe radiological practice for theprotection of the patient, members of the dental team and others.Failure to do so may lead to a charge of serious professional misconduct.

A dentist who delegates the taking of dental radiographs must ensurethat the person to whom this task is delegated has received training inaccordance with the Regulations.

PRESCRIBING 15

4.5 The Council takes the view that a dentist should only prescribe drugs inconnection with the provision of bona fide treatment. The right toprescribe is a privilege conferred upon a registered dentist by legislationand should be regarded in that light. See also 2.2

A dentist should not self-prescribe.

MISLEADING CLAIMS

4.6 The Council takes a very serious view of any misleading claims made bya dentist in relation to treatment. This may be with regard to theefficacy of any treatment, or to misleading claims about a dentist's ownskill or expertise in relation to a particular treatment.

The Council is also concerned about forms of treatment or therapy notamounting to the practice of dentistry but which a dentist chooses to perform as ancillary aspects of dental practice.

A dentist should take particular care when employing techniques andforms of therapy which are unproven.

A dentist wishing to publicise views on a particular concept of dentistryshould subject those views to challenge and scrutiny by professionalcolleagues through the medium of professional journals and any otherforum of dental debate. See also 7.5


4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED MAY 1999

RESUSCITATION

DEALING WITH MEDICAL EMERGENCIES 13

4.7 A medical emergency could occur at any time in premises where dentaltreatment takes place. It is, therefore, imperative that a dentist ensuresthat all members of the dental team are properly trained, have availablethe necessary resources, and are prepared to deal with an emergency,including a collapsed patient. Training should include preparing formedical emergencies, including the use of emergency drugs, andpractice of resuscitation routines in a simulated emergency.

It is essential that all premises where dental treatment takes place haveavailable and in working order: portable suction apparatus to clear theoropharynx, oral airways to maintain the natural airway, equipmentwith appropriate attachments to provide intermittent positive pressureventilation of the lungs, and a portable source of oxygen together withemergency drugs15,43.

Practitioners have an obligation to be conversant with current guidelines such as those issued by the Resuscitation Council (UK)

PAIN AND ANXIETY CONTROL

DUTY AND EXPECTATIONS

4.8 Dentists have a duty to provide and patients have a right to expectadequate and appropriate pain and anxiety control. Pharmacologicalmethods of pain and anxiety control include local anaesthesia andconscious sedation techniques.

The provision of pain and anxiety control carries responsibilities and adentist who undertakes treatment on a patient without ensuring thatthe following conditions are met is liable to a charge of seriousprofessional misconduct.

BEHAVIOURAL MANAGEMENT

4.9 In assessing the needs of an individual patient, due regard should begiven to all aspects of behavioural management before deciding torefer, to prescribe or to proceed with treatment.

LOCAL ANAESTHESIA

4.10 Local anaesthesia is the mainstay of pain control during dentaltreatment. A dentist has a duty to use the most appropriate andeffective method of local anaesthesia for each patient. The techniquechosen must take into account the patient's medical and dental history as well as the physical and pharmacological properties of theagent used.


4: WHAT THE PROFESSION EXPECTS, NOVEMBER 1997, REVISED NOVEMBER 2001

CONSCIOUS SEDATION

4.11 Conscious sedation can be an effective method of facilitating dental treatment and is normally used in conjunction with appropriatelocal anaesthesia.

Conscious sedation is defined as:

A technique in which the use of a drug or drugs produces a state ofdepression of the central nervous system enabling treatment to becarried out, but during which verbal contact with the patient ismaintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.

The level of sedation must be such that the patient remains conscious,retains protective reflexes, and is able to understand and to respond toverbal commands. ‘Deep sedation’ in which these criteria are not fulfilled must be regarded as general anaesthesia.

In the case of patients who are unable to respond to verbal contact evenwhen fully conscious the normal method of communicating with themmust be maintained.

ASSESSMENT, CONSENT AND INSTRUCTIONS

4.12 A careful assessment of the patient, including a full medical and dentalhistory, must be made before the decision to treat or to refer fortreatment under conscious sedation can be taken. An explanation of theconscious sedation technique proposed and of appropriate alternativemethods of pain and anxiety control must be given.

In advance of the procedure the patient must be given clear andcomprehensive pre- and post-operative instructions in writing, andwritten consent must be obtained.

RECORD KEEPING

4.13 Careful contemporaneous records must be kept including details of thetechniques and drugs used in the control of pain and anxiety. See also 4.3

RESPONSIBILITIES, EDUCATION AND SKILLS

4.14 Dentists have a duty of care, in accordance with section 3.3, toadminister conscious sedation only within the limits of their knowledge,training, skills and experience.

A dentist who assumes the dual responsibility of sedating the patient aswell as providing treatment must:

(i) have completed relevant postgraduate education and training;



(ii) have a demonstrable commitment to relevant continuing education and training;

(iii) ensure that the method and nature of the conscious sedation chosen isthe most appropriate to enable treatment to be carried out for thepatient as an individual, taking into account specific factors such as age,state of health, social circumstances and special needs. The choice oftechniques and drugs used should be governed by the principle ofminimum intervention and the amount of any drug administered shouldbe the minimum necessary to achieve the desired effect. In general onlyone sedative drug (administered by the oral, inhalational or intravenousroute) will be necessary for the vast majority of patients. Combinationsof sedative drugs may only be justified in exceptional circumstances.Intravenous conscious sedation is rarely justified in children;

(iv) be able to justify the use of the method selected with reference tocurrent guidelines such as those listed in the Bibliography 41,42;

(v) have clinical experience of the particular conscious sedation techniqueemployed;

(vi) be assisted by a second appropriately trained person who is presentthroughout and is capable of monitoring the clinical condition of thepatient and assisting the dentist in the event of any complication.

Where a second dental or medical practitioner is providing conscious sedationfor a patient, the treating dentist must ensure that the person acting as thesedationist has undertaken relevant postgraduate education and training,accepts the definition of conscious sedation given in paragraph 4.11 and theprinciple of minimum intervention, and has specific experience of the use ofconscious sedation in dentistry as described above.

EQUIPMENT, DRUGS AND MONITORING

4.15 Conscious sedation must only be administered when suitable equipmentand adequate facilities including appropriate drugs for treatingcomplications are immediately available at the chairside.

All staff must be trained in the use of the relevant conscious sedationtechniques and must train as a team in the management of sedation-related complications. See also 4.7

Contemporary standards of monitoring must be adopted.

FITNESS FOR DISCHARGE

4.16 Patients who have received conscious sedation should be appropriatelyprotected and monitored in adequate and supervised recovery facilities.When, in the opinion of the sedationist, they are sufficiently recoveredto leave the premises, the patient must be accompanied by a responsibleadult. A dentist may exercise discretion as to whether an adult patientmay be discharged unaccompanied when nitrous oxide/oxygen sedationalone is used. Due regard must be given to both the pharmacology of



the drugs administered and the patient's response to the sedativebefore the patient is discharged.

All patients must be assessed for their suitability for discharge. Patientsand escorts must be given post-operative advice specific to the individualregarding after care arrangements. See also 4.12.

GENERAL ANAESTHESIA

RISKS OF GENERAL ANAESTHESIA

4.17 General anaesthesia is a procedure which is never without risk. Inassessing the needs of an individual patient, due regard should be givento all aspects of behavioural management and anxiety control beforedeciding to treat or refer for treatment under general anaesthesia.General anaesthesia for dental treatment should only be administeredin a hospital setting with critical care facilities.39

All dentists involved in arranging or providing treatment under generalanaesthesia should discuss with the patient advice and treatmentoptions to avoid or reduce future episodes of general anaesthesia.

A dentist who refers a patient for treatment or carries out treatment ona patient under general anaesthesia without ensuring that the relevantconditions set out below are met is liable to a charge of seriousprofessional misconduct.

DUTIES OF THE REFERRING DENTIST

DECISION TO REFER

4.18 The decision to refer a patient for treatment under general anaesthesiashould not be taken lightly. As part of this decision, a full medical historyof the patient must be taken and agreement to refer obtained followinga thorough and clear explanation of the risks involved and thealternative methods of pain control available. Clear justification for theuse of general anaesthesia, together with details of the relevant medicaland dental histories of the patient, must be contained in the referralletter. The referring dentist must retain a copy of this letter. See also 3.3

DUTIES OF THE TREATING DENTIST

DECISION TO TREAT

4.19 The decision to treat a patient under general anaesthesia should not betaken lightly. As part of this decision the treating dentist must satisfyhim or herself that it is necessary and appropriate to carry out theproposed treatment under general anaesthesia. Before carrying outtreatment under general anaesthesia the patient must be given a



thorough and clear explanation of the risks involved and the alternativemethods of pain control available. See also 3.4

CONSENT

4.20 When the decision to carry out treatment under general anaesthesia hasbeen finally agreed by the patient, dentist and anaesthetist, writtenconsent must be obtained. See also 3.7

INSTRUCTIONS AND RECORDS

4.21 In advance of the procedure patients must be given clear andcomprehensive pre- and post-operative instructions in writing. Carefulcontemporaneous records must be kept of all the proceduresundertaken. See also 4.3

RESPONSIBILITIES OF THOSE PROVIDING DENTAL TREATMENT UNDER

GENERAL ANAESTHESIA38,13

4.22 Dentists with responsibilities for the provision of dental treatment undergeneral anaesthesia must:

(i) ensure that the facilities and arrangements (including location) for thegeneral anaesthesia meet contemporary requirements.39,40

(ii) ensure that they have the assistance of an appropriately trained dentalnurse. See also 3.8

(iii) ensure that the general anaesthetic is administered by an individual who:

a) is on the specialist register of the General Medical Council as ananaesthetist. Such specialists are advised to comply with thevoluntary Continuing Medical Education requirements of the RoyalCollege of Anaesthetists,

or

b) is a trainee working under supervision as part of a Royal College ofAnaesthetists' approved training programme,

or

c) is a non-consultant career grade anaesthetist with an NHSappointment, for example staff grade or associate specialist, workingunder the supervision of a named consultant anaesthetist who mustbe a member of the NHS anaesthetic department where the non-consultant career grade anaesthetist is employed.

d) is supported by an individual specifically trained and experienced inthe necessary skills to assist in monitoring the patient's condition andin any emergency. Contemporary standards of monitoring should beadopted; the current Recommendations for Standards of MonitoringDuring Anaesthesia and Recovery issued by the Association ofAnaesthetists of Great Britain and Ireland are appropriate.



(iv) be satisfied that there is a written protocol, arranged in conjunctionwith, and agreed by the anaesthetist, for the provision for immediatecritical care. In this connection the current guidelines issued by theResuscitation Council (UK) are appropriate. The protocol must includeappropriate arrangements for the supervised transfer of a patient to ahigh dependency unit (HDU) or intensive care unit (ICU), which may beon a separate site. Such arrangements must be agreed between theparties providing the treatment and the HDU and ICU.

RECOVERY AND DISCHARGE

4.23 Patients who are recovering from general anaesthesia must beappropriately protected and monitored continuously in adequaterecovery facilities. Monitoring must be undertaken by the anaesthetistor a dedicated individual who is appropriately trained and directlyresponsible to the anaesthetist. When, in the opinion of theanaesthetist, the patient is sufficiently recovered to leave the premises,the patient must be accompanied by a responsible adult.

All patients must be assessed specifically for fitness for discharge andmust be given post-operative advice specific to the individualregarding after care arrangements. See also 3.8

TRAINING 13

4.24 All those involved in the provision of general anaesthesia or thesupervision of patients during recovery must train together as a team todeal with an emergency. Resuscitation procedures must be practisedfrequently in a simulated emergency as a routine training exercise.

Current guidelines such as those issued by the Resuscitation Council (UK)should be adopted.



5: THE DENTAL TEAM

EMPLOYING STAFF 2

5.1 It is the duty of a dentist to be registered with the Council and to ensurethat any other dentist invited into the practice to provide dentaltreatment is also registered.

A dentist should employ suitably trained and, where appropriate,qualified staff. A dentist may employ a trainee dental nurse, providedhe or she is undergoing training as part of a structured trainingprogramme. All staff must be provided with training appropriate totheir role. A dentist should encourage staff to undertake continuingprofessional development.

A dentist who employs any person to practise dentistry has to besatisfied that the person is permitted by law to practise, by inspectingthe person’s practising certificate or checking registration or enrolmentstatus with the Council. A dentist who knowingly or through neglect ofthis duty enable a person to provide dental treatment which that personis not permitted by law to do is liable to a charge of serious professionalmisconduct. A dentist should, therefore, check, annually, the practisingcertificates of employees.

A dentist should also check that employees providing dental treatmenthave appropriate membership of a defence organisation or areotherwise indemnified against claims for professional negligence.

A dentist who employs professionals complementary to dentistry mustensure that they only carry out work in accordance with the Regulations.

A dentist will generally be held responsible for the actions of employees.

ILLEGAL PRACTICE

5.2 A dentist who knowingly allows, or encourages, others to practisedentistry illegally on the dentist’s premises may be liable to a charge ofserious professional misconduct. Similarly, a dentist should notencourage a patient to seek the services of a dental technician for theillegal practice of dentistry.

DENTAL HYGIENISTS AND DENTAL THERAPISTS

5.3 When referring a patient to a dental hygienist or a dental therapist thedentist must always have first examined the patient and indicated inwriting the treatment to be provided.

A dentist who permits a dental hygienist to work without directpersonal supervision or to administer local infiltration analgesia underthe dentist’s direct personal supervision must be satisfied that the dentalhygienist is competent to do so.


5. THE DENTAL TEAM, NOVEMBER 1997, REVISED MAY 2000

In order to be competent to administer local infiltration analgesia adental hygienist must:

(i) have completed additional training in local infiltration analgesiaand gained a certificate in the administration of local infiltrationanalgesia,

or

(ii) hold the Diploma in Dental Therapy (formerly Certificate ofProficiency as a Dental Therapist) in addition to the Diploma(formerly Certificate of Proficiency) in Dental Hygiene awardedbefore July 1992,

or

(iii) hold the Diploma in Dental Hygiene awarded after July 1992.

DELEGATION OF ORAL HYGIENE INSTRUCTION

5.4 A dentist should only delegate responsibility for instructing patients inthe principles and practice of oral hygiene if:

(i) the person to whom the responsibility is delegated is fullycompetent to discharge it; and

(ii) the dentist accepts personal responsibility for whatever instructionis given.


5. THE DENTAL TEAM, NOVEMBER 1997, REVISED MAY 1999

6: PRACTICE ARRANGEMENTS

PROFESSIONAL RESPONSIBILITY

6.1 A dentist is responsible for his or her personal and professional conduct,whether or not the dentist is in a position to control or influence thepractise, business or institutional arrangements within which he or she ispractising. A dentist who plays a part in the direction or management ofarrangements within which other dentists and professionalscomplementary to dentistry practise has a responsibility to thoseprofessional colleagues to facilitate and promote their adherence toappropriate standards of personal and professional conduct andcontinuing professional development.

PRACTICE AGREEMENTS

6.2 It is essential that a dentist should sign a formal written agreementabout practice arrangements before entering into a partnership or otherassociation in dental practice. The existence of such an agreement, withappropriate prior discussion, will help to reduce the likelihood ofdisputes. A dentist is advised to seek professional advice before signingan agreement.

UNREASONABLE FINANCIAL PRESSURE

6.3 A dentist employed as an assistant or working as an associate in apractice should not be required to achieve a fixed target earning. Sucha requirement places an unreasonable pressure on a dentist and it is notin the interests of patients for a dentist to be practising under such a constraint.

LEAVING A PRACTICE

6.4 A dentist who leaves a practice should ensure that arrangements havebeen made both for the completion of any treatment which has beenstarted and for the continuing care of patients, for whom responsibilityhas been accepted, irrespective of the financial agreement under whichthey are being treated. In the case of treatment under the NHS, the NHSauthorities should be informed of the arrangements which have been made.

DISPOSAL OF CLINICAL AND HAZARDOUS WASTE

6.5 The risk of cross-infection is not limited to the dental surgery itself anda dentist must abide by the legislation which governs the disposal ofclinical and other hazardous waste. Failure to do so may lead to a chargeof serious professional misconduct.


6: PRACTICE ARRANGEMENTS, NOVEMBER 1997, REVISED NOVEMBER 2000

DENTAL RECORDS AND RADIOGRAPHS 5, 16, 17

6.6 Patient records, including radiographs and study models, providevaluable information as to the treatment carried out and, wherepossible, should be retained.

A dentist with computerised patient records must ensure that thecomputer system used includes appropriate features to safeguard thesecurity and integrity of those records.

The Data Protection Act 1998, which covers computer-held records madeat any time, gives the patient the right to see and/or have copies ofcomputer-held records. The Access to Health Records Act 1990 gives thesame rights to patients concerning manual records made after1 November 1991. See also 3.5

DISPOSAL OF PATIENT RECORDS

6.7 In view of the confidentiality of patient records, at the time of disposalthey must be disposed of securely, usually by incineration or shredding.

DEBT COLLECTION

6.8 There is a need for good in-practice systems for fee collection in order tominimise the need to resort to court action or debt collectors. The use ofcourt action or debt collectors as a means of obtaining settlement ofoutstanding accounts should only be considered when all reasonablesteps to obtain payment have first been taken in writing.

BANKRUPTCY 18

6.9 A dentist who is declared bankrupt may continue to practise dentistryprovided that registration is maintained. The general law of insolvencyis complicated and any dentist who is declared bankrupt should seek specific advice as to the extent to which dental work may becontinued and appropriately remunerated without infringing insolvency legislation.

The dentist’s trustee in bankruptcy (in Northern Ireland, the officialassignee) may carry on the business of dentistry for three years from thedate of the declaration of bankruptcy.

CARRYING ON THE BUSINESS OF DENTISTRY – RESTRICTIONS 19

6.10 A person is said to be involved in the business of dentistry when, eitheras an individual or as a member of a partnership, that person receivespayment for services amounting to the practice of dentistry provided bythat person, by a partner, or by an employee of either of them.

Under the Dentists Act there are a number of circumstances in which abody corporate or a person who is not a registered dental or medicalpractitioner may be involved in the business of dentistry. These includepersons and bodies corporate who were involved in the business of



dentistry before 21 July 1955; spouses or children of deceased dentists;trustees in bankruptcy; and companies providing dental treatment fortheir employees where the company does not profit from this.

A dentist who becomes a partner or an employee of someone who iscarrying on the business of dentistry illegally may be liable to a chargeof serious professional misconduct. A dentist who becomes a director oran employee of a body corporate which is carrying on the business ofdentistry illegally would be similarly liable.

BODIES CORPORATE

6.11 A dentist who enters into a partnership or becomes a director of a bodycorporate legally carrying on the business of dentistry acceptsresponsibility for the maintenance of a high standard of professionalconduct in that business.

COMPANIES TO RUN THE ADMINISTRATIVE SIDE OF A DENTAL

PRACTICE/LETTING OF PREMISES

6.12 There is no legal or ethical objection to the setting up of a limitedcompany with the sole object of running the administrative or clericalside of a dental practice.

Such a limited company might acquire and hold the premises, fittingsand equipment of the practice; employ the clerical and othernon-clinical staff to run the administration of the practice; and charge adentist rent in respect of the property and a fee in respect of theadministrative services rendered. A dentist’s responsibility to patientsmust remain unaltered, in that there is a direct liability to individualpatients in respect of any dental treatment provided. The fees for thetreatment would be payable to the dentist and not to the company andas such it is not possible for the company to own the goodwill ofthe practice.

There is no objection to an unregistered person or a company owningpremises which are leased to a registered dentist for the purpose ofcarrying on the business of dentistry. However, it would be contrary tothe Dentists Act 1984 for the rental to be linked to the dentist’s earnings.It would also be contrary to the Act for an unregistered person or acompany to own in full, or in part, a dental practice or to take profitsfrom the proceeds of a dental practice.

USE OF THE WORDS ‘DENTAL’ AND ‘DENTISTRY’ IN COMPANY TITLES 20

6.13 Under the provisions of the Companies Act 1985 the words ‘dental’ and‘dentistry’ are protected. A company, or applicant for a Consumer CreditLicence, which proposes to use either or both of these words in itsregistered title is therefore required by Companies House to obtain aletter of non-objection from the Council.



PRACTICE TITLES

6.14 The approval of the Council is not needed for practice titles. The mainconsideration in relation to the title of a dental practice is that it shouldnot mislead the public.

When choosing a practice title, dentists should have regard for otherpractices in the area.

A practice title may only mention a particular form of dentistry, forexample, Denture Clinic or Orthodontic Practice if the practice inquestion is limited to the provision of that particular type of treatment.

SIGNS AND PROFESSIONAL PLATES

6.15 The name of each dentist who regularly attends patients should beshown at the premises where the dentist practises by means of aprofessional plate. The display of a sign indicating that a dentist is inregular attendance at a practice when this is not the case is misleading.

When a dentist ceases to work at a practice the relevant professionalplate should be removed within a reasonable period. For the informationof patients, the use of words such as ‘late’ or ‘formerly’ to indicate aprevious association of a dentist with the practice is acceptable for areasonable time after the named dentist has left the practice.

APPEARANCE OF NAMES OTHER THAN A DENTIST’S6.16 The names of dental hygienists working in the practice of a registered

dentist may appear on headed paper and in practice information leafletsor brochures.

Dentists may, at their discretion, also permit a dental hygienist’s namewith the designation ‘dental hygienist’ or ‘EDH’, to be displayed outsidethe practice premises.

The names of persons other than dentists and dental hygienists may notbe displayed outside the premises. The names of persons other thandentists in the practice may not appear in advertisements.

SCREENING OF WINDOWS

6.17 A dentist should take care that the windows of the surgery area areadequately screened so as to take account of the sensibilities of patientsand public.

CANVASSING

6.18 There is no objection to a dentist distributing leaflets to promote adental practice providing that the leaflet conforms to the guidelines insection 7, Promoting the Practice. The use of personal contact, such asunsolicited telephone calls or house to house visits, to promote apractice would diminish public confidence in the profession and bringthe profession into disrepute.


6: PRACTICE ARRANGEMENTS, NOVEMBER 1997, REVISED MAY 2001

INCENTIVES

6.19 The Council takes the following view with regard to the use ofincentives:

(i) there is no objection to a token or other gift being given by adentist directly to a patient who attends for treatment;

(ii) it is not acceptable for a financial incentive to be paid to a thirdparty by a dentist in return for encouraging or promoting theuptake of dental care by individual members of the public;

(iii) a dentist’s professional relationship with patients may becompromised if any member of the dental team were to acceptfinancial incentives from third party interests in return forpromoting to patients:

a) enrolment in a particular scheme for the provision of dental care;

b) specific dental products;

c) the uptake of insurance;

(iv) when referrals are made between professional colleagues noinducements should be offered or accepted.

PRODUCT PROMOTION

6.20 Printed matter relating to a dental practice may include advertisementsfor other products and services. A dentist should ensure that theacceptance of commercial sponsorship or payment for advertising doesnot cause a conflict of interest which might be detrimental to theprofessional relationship with patients. In particular, a dentist whoincludes advertisements in printed matter should ensure that noproducts or services are promoted which would be in conflict withdentistry or the principles of health care.



7: PROMOTING THE PRACTICE

LEGAL, DECENT, HONEST, TRUTHFUL

7.1 A dentist may only use publicity or advertising material which is legal,decent, honest and truthful and has regard for professional propriety.Responsibility for all publicity and advertising in relation to a practicerests with the dentist.

NAME OF DENTIST TO BE INCLUDED

7.2 All advertisements and printed material relating to a given practiceshould include the name of at least one dentist normally in attendanceat the practice in question.

Advertisements in a foreign language should include the name of thedentist in the form in which it is listed in the Dentists Register. However,the name may also be written in the language concerned.

UNACCEPTABLE CONTENT

7.3 Publicity or advertising material should not:

(i) be of a character that could reasonably be regarded as likely tobring the profession into disrepute;

(ii) make a claim which is not capable of substantiation;

(iii) contain any reference to the efficiency, skills or knowledge of anyother dentist or practice;

(iv) make a claim which suggests superiority over any other dentist or practice;

(v) recommend a specific product.

CLARITY OF TREATMENT AVAILABLE

7.4 The Council takes a serious view of any advertising or publicity materialwhich is liable to mislead patients about the availability of treatment orthe nature of the services to be provided.

INTERACTIONS WITH THE MEDIA

7.5 Publicity about a dentist or a practice which arises through, or frominterviews with representatives of, the media and which may beregarded as likely to bring the profession into disrepute should beavoided. A dentist who comments to the media has a particularresponsibility to ensure that all statements are factually accurate. Thereis a duty to distinguish between personal opinion or political belief andestablished facts and a dentist should, whenever possible, request accessto the article, statement or interview before publication or broadcast.


7: PROMOTING THE PRACTICE, NOVEMBER 1997

The Council will generally hold a dentist, who gives interviews torepresentatives of the media, responsible for any publicity which mayensue.

Any public statement which is calculated to mislead the public ordamage public confidence in the profession may lead to a charge ofserious professional misconduct. See also 4.6

SPECIALIST CLAIMS

7.6 No publicity or advertising material should indicate that a dentist hasspecialist expertise unless the dentist is the holder of a specialist title andthe dentist’s name is entered in a specialist list. A statement to thateffect may appear in publicity or advertising material. No other claim tospecialist expertise should be made by any dentist. See also 1.5

Advertising material may indicate that a practice is wholly or mainlyrestricted to a particular type or types of treatment. A dentist whochooses to give such an indication has a responsibility to ensure that itdoes not imply or amount to a claim to specialist expertise. As statedabove, only a dentist whose name is entered on a specialist list may claimto be a specialist.

CLARITY OF INFORMATION ON FEES

7.7 If advertising material includes reference to fees for professional adviceor treatment, it should indicate:

(i) if free-of-charge items will be provided under the NHS;

(ii) whether the stated fee relates to treatment provided under the NHSor some other arrangement;

(iii) whether the stated fee is liable to vary;

(iv) that further details may be obtained on request.


7: PROMOTING THE PRACTICE, NOVEMBER 1997, REVISED MAY 1999

8: THE COUNCIL’S JURISDICTION

JURISDICTION

8.1 The Council has a statutory remit to promote high standards ofprofessional conduct among dentists. It also has jurisdiction in caseswhere a dentist’s fitness to practise is seriously impaired by reason ofmental or physical condition.

Such matters are dealt with by the Council’s Professional ConductCommittee and Health Committee. Both Committees have the power tosuspend a dentist’s registration. The Health Committee may imposeconditions on a dentist’s registration and the Professional ConductCommittee may erase a dentist’s name from the Dentists Register.

PROFESSIONAL CONDUCT

A DENTIST’S PROFESSIONAL DUTY AND LIABILITY

8.2 The conduct of a dentist must at all times be compatible with the highstandard which the public and the profession have a right to expect.Responsibility to patients is the first priority.

A dentist’s name is liable to be erased from the Dentists Register or adentist’s registration suspended or refused if at any time that dentist hasbeen convicted of a criminal offence or is found guilty of seriousprofessional misconduct.

SCOPE AND DEFINITION OF SERIOUS PROFESSIONAL MISCONDUCT 21

8.3 It is not possible to be explicit as to what constitutes serious professionalmisconduct. However, it has been broadly defined as “... conductconnected with the profession in which the dentist concerned has fallenshort, by omission or commission, of the standards of conduct expectedamong dentists and that such falling short as is established should be serious.”

Earlier sections of this guidance indicate a variety of matters which couldlead to a charge of serious professional misconduct. The scope of sucha charge is not limited and will vary depending on the circumstances.

EXTENT OF DISCIPLINARY JURISDICTION

8.4 The Council’s disciplinary jurisdiction as regards criminal offences and in cases of serious professional misconduct extends to all registered dentists.


8: THE COUNCIL’S JURISDICTION, NOVEMBER 1997, REVISED NOVEMBER 2000

UNDERGRADUATE BEHAVIOUR

8.5 Behaviour reflecting adversely on the profession, such as dishonesty,indecency or violence; conviction in a court of law; or problems relatedto alcohol or drugs, during the time as an undergraduate dental studentcould lead to the first application for registration being referred to thePresident. It could equally well be taken into consideration later if theCouncil had cause to consider the conduct of a registered dentist.

SOURCES OF INFORMATION 22

8.6 Information to be considered under the Council’s disciplinary jurisdictionmay be received from a number of sources:

(i) the police report criminal convictions to the Council but may alsoprovide information about formal cautions or other matters of concern;

(ii) a patient, a member of the public or another dentist

(iii) a person acting in a public capacity which would include an officerof a Health Authority, Trust or similar body;

(iv) the Council’s solicitors.

CONVICTIONS

8.7 The Council may consider any criminal conviction including those foroffences which are not directly connected with a dentist’s profession orpractice or which occurred while the dentist was not registered.

Dentists should be aware that if a conviction is referred to theProfessional Conduct Committee the Committee must accept thefindings of the court on matters of fact as conclusive proof of thosefacts. This means that a dentist cannot then claim to have been innocentof the original charges.

DISCIPLINARY PROCEDURE

STAGES 23

8.8 Convictions and complaints alleging serious professional misconductmay be considered in up to three stages:

- Preliminary Screening

- Preliminary Proceedings Committee

- Professional Conduct Committee



PRELIMINARY SCREENING

PRELIMINARY SCREENER

8.9 A senior member of the Council acts as Preliminary Screener andconsiders whether the conviction or complaint may suggest evidence ofserious professional misconduct.

ACTION

8.10 When a complaint is received, the dentist involved will be told about it.If it is decided that there is no case to answer the matter proceeds nofurther. Where appropriate the complainant, for example a patient, isinformed of the decision.

If it is considered that there may be a case to answer, the matter isreferred to the Preliminary Proceedings Committee.

PRELIMINARY PROCEEDINGS COMMITTEE

MEETINGS AND MEMBERSHIP 24, 25

8.11 The Preliminary Proceedings Committee normally meets twice each year,in March and September, but may meet at other times if necessary. It sitsin private and considers documentary information only, except wheninterim suspension may be considered. The membership of theCommittee comprises the President and five other Council members, oneof whom is a lay member. See also 8.16

NOTIFYING THE DENTIST

8.12 If a matter is referred to the Preliminary Proceedings Committee, thedentist in question is either notified that the conviction has beenreported to the Council or sent a copy of the information which hasbeen considered by the Preliminary Screener. The dentist is invited tosubmit written comments or observations on the matter forconsideration by the Committee. Such notification is generally issued atleast 28 days prior to the meeting.

CONSIDERING THE INFORMATION

8.13 The Preliminary Proceedings Committee considers the conviction orcomplaint together with any written response received from the dentistor a representative. The Committee may decide there is no case toanswer and the matter should proceed no further. If, however, theCommittee decides that there is evidence to support an allegation ofserious professional misconduct the matter will be referred to theProfessional Conduct Committee for inquiry. The Committee also hasthe option of referring the matter to the Health Committee.



NOTIFYING THE DECISION

8.14 Following the meeting the dentist and, where appropriate the complainant, for example the patient, are notified of theCommittee’s decision.

ADVICE AND WARNINGS

8.15 If a matter is not referred for inquiry the Committee may direct thatsome advice as regards behaviour be given to the dentist. TheCommittee may also direct that the dentist be warned that the mattermay be reconsidered if further information about the dentist is formallybrought to the attention of the Council.

INTERIM SUSPENSION 26

8.16 The Preliminary Proceedings Committee has the power, if it feels thatmembers of the public may be at risk, to order that a dentist’sregistration be suspended immediately, pending the outcome of aninquiry by the Professional Conduct Committee. See also 8.24

In referring a matter of a particularly serious nature to the PreliminaryProceedings Committee the Preliminary Screener can indicate that theCommittee may wish to consider interim suspension. The dentist will beadvised of this and offered the opportunity to make representations tothe Committee, either in person or through a representative, as towhether such an order should be made.

The Preliminary Proceedings Committee first considers whether thematter should be referred to the Professional Conduct Committee andonly if it is, does the Committee then consider whether to imposeinterim suspension. On such occasions a Legal Assessor sits with theCommittee. See also 8.17

PROFESSIONAL CONDUCT COMMITTEE

MEETINGS AND MEMBERSHIP 27, 28, 29

8.17 The Professional Conduct Committee normally meets twice each year, inMay and November, but may meet at other times if necessary. Meetingsare held in public. The membership of the Committee comprises thePresident and ten other members of Council, five of whom must beelected members and two of whom must be lay members. A LegalAssessor, who is a barrister, advocate or solicitor of not less than tenyears standing, sits with the Committee to advise on matters of law and procedure.


8.18 If a matter is referred to the Professional Conduct Committee a formalNotice of Inquiry is sent to the dentist, by the Council’s solicitors, at least28 days before the date of inquiry.



NOTICE OF INQUIRY

8.19 The Notice includes the charge to be faced by the dentist. In convictioncases the charge sets out the basic details of the conviction and thepenalty imposed by the Court. For conduct cases the charge sets out thefacts which, if proved, may constitute serious professional misconduct.

PRESENTATION OF CASE AND RULES OF EVIDENCE

8.20 A barrister or solicitor will present the Council’s case. The dentist isusually similarly represented. The Committee does have the power toproceed in the absence of the respondent dentist.

Evidence is taken on oath and either party to the proceedings maysubpoena witnesses. The procedure is similar to that used in a court oflaw and the standard of proof is the same as in criminal proceedings,namely beyond reasonable doubt.

FINDING OF SERIOUS PROFESSIONAL MISCONDUCT

8.21 In conduct cases the Professional Conduct Committee must firstdetermine whether the facts alleged in the charge have been proved.Only if some or all of the facts are found proved does the Committeethen consider whether the facts found proved amount to seriousprofessional misconduct.

DISPOSAL OF CASE

8.22 Where a dentist has already been convicted in a criminal court or isfound guilty of serious professional misconduct, there are a number ofoptions open to the Committee:

(i) the Committee may conclude the case with an admonition;

(ii) judgement may be postponed until a future meeting when theCommittee will consider the dentist’s conduct during theintervening period. Postponement is generally for one year;

(iii) the Committee may direct that the dentist’s registration besuspended for a specified period not exceeding 12 months;

(iv) the Committee may direct that the dentist’s name be erased fromthe Dentists Register.

The Committee also has the option of directing that the matter bereferred to the Health Committee.

IMMEDIATE SUSPENSION 30

8.23 Following a determination of suspension or erasure the ProfessionalConduct Committee may, if it feels it is necessary for the protection ofthe public or that it would be in the best interests of the dentist, furtherdirect that a dentist’s registration be suspended with immediate effect.See also 8.40


8: THE COUNCIL’S JURISDICTION, NOVEMBER 1997

APPEALS AND IMPOSITION OF DETERMINATION 31, 32

8.24 A determination of immediate suspension, or interim suspension by thePreliminary Proceedings Committee, takes effect immediately but thedentist may apply to the appropriate Court, for example in England theHigh Court, for the suspension to be terminated.

If the Committee’s direction is for suspension or erasure there follows aperiod of 28 days during which the dentist may choose to lodge anappeal with the Judicial Committee of the Privy Council.

If the dentist does not exercise this right of appeal the determinationtakes effect at the end of the appeal period. If an appeal is lodged thedentist may continue to practise at least until the outcome of the appealis known. See also 8.42

RESTORATION AFTER SUSPENSION

8.25 If a dentist’s registration is suspended that dentist’s name isautomatically restored to the Dentists Register at the end of the periodof suspension.

RESTORATION AFTER ERASURE FOR MISCONDUCT 33, 34

8.26 An application for a dentist’s name to be restored to the DentistsRegister may be made not less than ten months after the date oferasure. The application is considered by the Professional ConductCommittee. The Committee will be reminded of the circumstances whichled to the erasure and will take account of the dentist’s behaviourduring the intervening period and any evidence of professionalrehabilitation submitted by the applicant.

If the application is granted the dentist’s name is restored to the DentistsRegister as soon as the appropriate registration fee has been paid.

If the application is refused the dentist must wait at least ten monthsfrom the date of the hearing before submitting another application.

FITNESS TO PRACTISE

INFORMATION ABOUT A DENTIST 35

8.27 A person, who is not a person acting in a public capacity, writing to theCouncil with information concerning a dentist’s fitness to practise maybe asked to submit a statutory declaration or affidavit.

INITIAL CONSIDERATION OF INFORMATION

8.28 The information is submitted to the President who acts as PreliminaryScreener. If the President feels a question does arise as to whether ornot the dentist’s fitness to practise may be seriously impaired the President will direct that the dentist be invited to be medically examined.



If the President feels there is no question to be answered the personwho provided the information is notified accordingly and the mattergoes no further.


8.29 If the President directs that the matter should proceed the dentist is senta copy of the information considered by the President and invited tosubmit to one or more medical examinations. The dentist is asked toreply within 14 days and must reply within 28 days.

MEDICAL EXAMINATIONS

8.30 Medical examiners are chosen from persons nominated by theappropriate professional body. They will be asked to report on thedentist’s fitness to engage in practice either generally or on a limitedbasis. They will also be asked for recommendations as to themanagement of the case. The examinations are generally arranged at avenue local to the dentist.

The dentist may also nominate other medical practitioners to undertakean examination and report to the Council. However, such examinationswould be at the dentist’s expense. The opportunity is also given for thedentist to submit observations on the matter.

CONSIDERATION OF MEDICAL REPORTS

8.31 The President will consider the medical reports and decide whether ornot the matter should be referred for the consideration of the HealthCommittee. If it is not referred, the dentist is notified accordingly andsent a copy of the reports.

If a dentist fails to respond to the invitation to be medically examined orrefuses to be examined the President may still refer the matter to the Committee.

HEALTH COMMITTEE

MEETINGS AND MEMBERSHIP 35, 36, 37

8.32 The Health Committee normally meets twice each year, in January andJuly, but may meet at other times if necessary. The Committee meets inprivate. The membership of the Committee comprises a Chairman whomust be a registered dentist and ten other members of the Council ofwhom five must be elected members and two lay members. ThePresident may choose whether to sit as a member of the HealthCommittee and if so would act as Chairman.

As with the Professional Conduct Committee the Health Committee isassisted by a Legal Assessor. One or more Medical Assessors also sits withthe Committee to advise on the significance of the medical evidence.




8.33 If a dentist’s case is referred to the Health Committee the dentist is sent a formal Notice of Referral at least 28 days before the date of the hearing.

NOTICE OF REFERRAL

8.34 The Notice will be accompanied by a copy of all the information to bepresented to the Committee.

CONDUCT OF HEARING

8.35 While the proceedings of the Health Committee are of a judicial naturethey are rather less formal than those of the Professional ConductCommittee. The Council’s case is presented by a solicitor and the dentistis usually similarly represented. The Committee does have the power toproceed in the absence of the dentist.

INFORMATION CONSIDERED BY THE HEALTH COMMITTEE

8.36 In most cases the principal evidence considered by the Committeeconsists of the reports prepared by the medical examiners. In some caseswitnesses may be called to give evidence and such evidence is given on oath.

FINDING CONCERNING FITNESS TO PRACTISE

8.37 Having considered all the evidence the Health Committee must firstdecide whether or not a dentist’s fitness to practise is seriously impairedby reason of physical or mental condition. If the Committee finds that itis not, the matter is concluded.

If the case has been referred by either the Preliminary ProceedingsCommittee or the Professional Conduct Committee, the HealthCommittee notifies its determination to that Committee which will thencontinue its consideration of the case.

DETERMINATION OF HEALTH COMMITTEE

8.38 If the Committee finds that a dentist’s fitness to practise is seriouslyimpaired it may impose conditions on the dentist’s registration for an initial period not exceeding three years or suspend the dentist’s registration for a period not exceeding 12 months. Such casesare reviewed by the Committee before the end of the period of theoriginal determination.

NOTICE OF RESUMED HEARING

8.39 When a case is due to be reviewed by the Committee the dentist is senta Notice of Resumed Hearing at least 28 days before the date of thehearing. As with the original referral the Notice is accompanied by acopy of all the information to be presented to the Committee.



IMMEDIATE SUSPENSION

8.40 The Health Committee has the same powers as the Professional ConductCommittee in that it may direct that a dentist’s registration besuspended with immediate effect. See also 8.23

CONDITIONS

8.41 Conditions imposed by the Health Committee may relate to dentist’shealth or practice. Any conditions relating to the practice will be printedon the back of the annual practising certificate. Conditions are tailoredto the particular case.

If, having reviewed the case after the initial period of conditionalregistration, the Committee makes a direction for a further period ofconditional registration, that period shall not exceed 12 months.

APPEALS AND IMPOSITION OF DETERMINATION

8.42 The procedure as regards appeals and the imposition of the Committee’sdetermination is the same as for the Professional Conduct Committeeexcept that in the case of the Health Committee the direction will eitherbe for conditional registration or suspension. See also 8.24

JURISDICTION OF THE HEALTH COMMITTEE

8.43 The jurisdiction of the Health Committee extends to all registereddentists. Once the Committee has determined that a dentist’s fitness topractise is seriously impaired the dentist will remain under thejurisdiction of the Health Committee until such time as the Committeedetermines that fitness to practise is no longer seriously impaired. Atthat point any conditions which had previously been imposed on thedentist’s registration will be revoked.



BIBLIOGRAPHY

This list is not exhaustive but is intended as a guide for anyone seeking further information.

1 Dentists Act 1984, section 38.HMSO, ISBN 0 10 542484 6.

2 Dental Auxiliaries Regulations 1986 (SI 887) as amended by the Dental Auxiliaries(Amendment) Regulations 1991 (SI 1706). HMSO, ISBN 0 11 066887 1 (1986) and 0 11 014706 5 (1991).

3 Statement of Policy on Postgraduate Education. General Dental Council, May 1995.

4 Dentists Act 1984, section 26.

5 Data Protection Act 1998. HMSO, ISBN 0 10 542998 8.

6 Complaints, Listening ... Acting ... Improving. Guidance Pack for General Dental Practitioners. Department of Health 1996, 3959 1P 25K Feb 96 (24).

7 Chief Dental Officer, letter to all dentists in England. Cross Infection Control.Department of Health 1993, PL/CDO (93) 3.

8 Guidance for Clinical Health Care Workers: Protection Against Infection with HIV andHepatitis Viruses. Recommendations of the Expert Advisory Group on AIDS.HMSO, January 1990, ISBN 0 11 321249 6. (Currently under revision).

9 AIDS-HIV Infected Health Care Workers. Occupational Guidance for Health CareWorkers, Their Physicians and Employers. Recommendations of the Expert AdvisoryGroup on AIDS. Department of Health, December 1991. Available from BAPS.

10 Protecting Health Care Workers and Patients from Hepatitis B. Recommendations ofthe Advisory Group on Hepatitis.Department of Health, August 1993. Available from BAPS.

11 Guidelines on Post-Exposure Prophylaxis for Health Care Workers OccupationallyExposed to HIV. Department of Health, June 1997. PL/CO(97)1.

12 Exposure prone procedures are defined as:

Those where there is a risk that injury to the worker may result in theexposure of the patient’s open tissues to the blood of the worker. Theseprocedures include those where the worker’s gloved hands may be in contactwith sharp instruments, needle tips or sharp tissues (spicules of bone or teeth)inside a patient’s open body cavity, wound or confined anatomical spacewhere the hands or fingertips may not be completely visible at all times.


BIBLIOGRAPHY, NOVEMBER 1997, REVISED NOVEMBER 2000

Taken from: AIDS/HIV-Infected Health Care Workers: Guidance on the Management of Infected Health Care Workers. Recommendations of the Expert Advisory Group on AIDS.Department of Health, March 1994. Available from BAPS.

13 The 2000 Resuscitation Guidelines for Use in the United Kingdom.Resuscitation Council (UK).

14 The Ionising Radiation (Medical Exposure) Regulations 2000 (SI 1059).HMSO, ISBN 0 11 099131 1.

15 Dental Practitioners’ Formulary 1998-2000.The British Medical Association and the Royal Pharmaceutical Society of Great Britain.ISBN 0 85369 426 5.

16 How to Store Patients’ Dental Records on a Computer. Department of Health/Dental Practice Board, January 1995, 1944 1P 28,900 Dec 94.

17 Access to Health Records Act 1990.HMSO, ISBN 0 10 542390 4.

18 Dentists Act 1984, section 41(6).

19 Dentists Act 1984, sections 40 to 44.

20 Companies Act 1985.HMSO, ISBN 0 10 540685 6.

21 Privy Council Appeal No. 15 of 1987. Doughty v The General Dental Council.

22 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 4.11.

23 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 4.11 and 4.12.

24 Dentists Act 1984, Schedule 1 Part II.

25 General Dental Council Rules and Regulations, November 1998 (as revised), paragraph 3.13 and 4.12.


27 Dentists Act 1984, section 27; Schedule 1 Part II; Schedule 3.

28 The General Dental Council Professional Conduct Committee (Procedure) Rules Orderof Council 1984 (SI 1517).HMSO, ISBN 0 11 047517 8.



31 Dentists Act 1984, sections 29 and 30.



32 The Judicial Committee (Dentists Rules) Order 1985 (SI 172).HMSO, ISBN 0 11 056172 4.



35 The General Dental Council Health Committee (Procedure) Rules Order of Council 1984(SI 2010).HMSO, ISBN 0 11 048010 4.

36 Dentists Act 1984, section 28; Schedule 3.

37 The General Dental Council Health Committee (Constitution) Order 1984 (SI 1816).HMSO, ISBN 0 11 047816 9.

38 Recommendations for Standards of Monitoring during Anaesthesia and Recovery.Revised Edition 1994.The Association of Anaesthetists of Great Britain and Ireland.

39 CMO/CDO (England) Report A Conscious Decision: A review of the use of generalanaesthesia and conscious sedation in primary dental care [ref 21967 PC 1P 3.2k July 00(CWP)] can be obtained from the Department of Health by e-mail request [email protected] and at www.doh.gov.uk/dental/conscious.htm

and associated letters of advice from Chief Dental Officers in England, NorthernIreland, Scotland and Wales.

40 Dental Anaesthesia Committee. Standards & Guidelines for General Anaesthesia forDentistry. Royal College of Anaesthetists, February 1999

41 Implementing and ensuring Safe Sedation Practice for healthcare procedures inadults: Academy of Medical Royal Colleges and their Faculties: Report of anIntercollegiate Working Party chaired by the Royal College of Anaesthetists,November 2001.

42 Standards in Conscious Sedation for Dentistry: the report of an independent workinggroup produced by the Society for the Advancement of Anaesthesia in Dentistry,email [email protected] / www.saaduk.org/sedbooklet.pdf, October 2000

43 NHS MEL (1999) 22. Emergency Dental Drugs (1999): National Dental AdvisoryCommittee. The Scottish Office Department of Health, ISBN 07480 8121 6



USEFUL ADDRESSES

Academy of Medical Royal Colleges, 1 Wimpole Street, London, W1G 0AETel: 020 7290 3913, Fax: 020 7290 3914, Email: [email protected], Website: www.aomrc.org.uk

Association of Anaesthetists of Great Britain and Ireland, 9 Bedford Square, London, WC1B 3RATel: 020 7631 1650, Website: www.aagbi.org

BAPS, Health Publications Unit, DSS Distribution Centre, Heywood Stores, Manchester Road, Heywood, Lancashire, OL10 2PZ.

British Dental Association, 64 Wimpole Street, London, W1M 8AL. Tel: 020 7935 0875.

Dental Practice Board, Compton Place Road, Eastbourne, East Sussex, BN20 8AD. Tel: 01323 417000.

Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NS. Tel: 020 7210 3000

General Dental Council, 37 Wimpole Street, London, W1G 8DQ. Tel: 020 7887 3800, Website: www.gdc-uk.org

HMSO is now The Stationery Office Ltd. The Stationery Office, 123 Kingsway, London, WC2B 6PQ. Tel: 020 7242 6393, Fax: 020 7242 6394, www.thestationeryoffice.com.

Resuscitation Council (UK), 5th Floor, Tavistock House North, Tavistock Square,London, WC1H 9HR. Tel: 020 7388 4678, Website: www.resus.co.uk

The Pharmaceutical Press, PO Box 151, Wallingford, Oxon, OX10 8QU. Tel: 01491 824 486.

Royal College of Anaesthetists, 48-49 Russell Square, London WC1B 4JYTel: 020 7813 1900, Fax: 020 7813 1876, E-mail: [email protected], Website: www.rcoa.ac.uk

Society for the Advancement of Anaesthesia in Dentistry53 Wimpole Street, London, W1G 8YH, E-mail: [email protected], Website: www.saaduk.org



Aabsence, extended 3.12Access to Health Records Act 1990 6.5account, itemised 3.6administration, practice 6.12admonition 8.22Advanced Life Support 4.22advertisements 6.16, 6.18, 6.20, 7.1-7.6advice

definition of 1.1legal, professional 1.2, 2.4, 3.5

agreementspractice 6.2treatment 3.6

alcohol and drugs, misuse of 2.2anaesthesia, sedation

administration of 4.22consent procedure 3.7drugs 4.15equipment 4.15monitoring 4.15, 4.23recovery from 4.16, 4.23risks of 4.17third party’s presence 3.8see also conscious sedation; intravenous sedation

analgesia, local infiltration 5.3anxiety control 4.8appeals 8.24, 8.42associate in practice 6.1, 6.2, 6.3

Bbankruptcy 6.9, 6.10behaviour

advice, warnings 8.15conduct, professional 6.11, 8.2-8.7patient, management of 3.10, 4.9, 4.17personal 2undergraduate 8.5

bibliography Appendix Ibodies corporate 6.10, 6.11British Dental Association, guidance by 3.13, 4.1

Ccanvassing 6.18case, disciplinary 8.20, 8.22certificate, practising 5.1, 8.41Certificate of Proficiency as a Dental Therapist 5.3Certificate of Proficiency in Dental Hygiene 5.3charge, disciplinary 8.19charges see fees, treatmentchildren

difficult, treatment of 3.10clerical administration 6.12clinical and hazardous waste 6.5collapse of patient 4.7colleagues, relationships between 2.4commercial sponsorship 6.20communication, postal 3.5companies, provision of dental treatment by 6.10Companies Act 1985 6.13Companies House 6.13company, administrative 6.12company titles 6.13comparison with other practitioners 7.3claims see complaints; professionalnegligenceclaims, misleading see patients, public(misleading)compensation 1.2complainant 8.14complaints 2.2, 3.13, 3.14, 8.6, 8.8, 8.13computerised records 3.5, 6.6conditions

of practising certificate 8.41of registration 8.38, 8.41, 8.42revocation of 8.43

confidentiality 3.5, 6.6, 6.7see also privacy

conscious sedationdefinition of 4.11drugs 4.11, 4.13, 4.14, 4.15techniques 4.8, 4.11, 4.12, 4.13, 4.14, 4.15


INDEX, NOVEMBER 1997, REVISED NOVEMBER 2000

INDEX

References are to paragraph number; where an entire section refers to the subject, thesection reference is given in bold type.

consentpatient’s 3.7, 4.12, 4.20written 3.7, 4.12, 4.20

consultation, initial 3.6Consumer Credit Licence 6.13Continuing Professional Development (CPD) 1.3convictions see criminal offencecosts

account, itemised, of 3.6estimate of 3.6scheme 3.6

criminal offence 8.2, 8.5, 8.6, 8.7criminal proceedings 2.2cross-infection 4.1, 6.5

DData Protection Act 1984 3.5, 6.6debt collection 6.8decisions on misconduct 8.14, 8.15defence organisation

advice from 3.5membership of 1.2, 5.1

delegation of tasks 4.5‘dental’ 1.4, 6.13dental auxiliaries, duties of 5.1dentalhygienists

competence of 5.3employment of 5.3name, display of 6.16Regulations 1.1

dental nurse 3.8, 4.22‘dental practitioner’ 1.4dental radiography see radiography‘dental surgeon’ 1.4dental team

arrangements for 5assistance by 3.8, 4.22confidentiality 3.5incentives 6.19protection of 4.1, 4.5training 4.7, 4.15, 4.24see also second person; third party,presence of dental technician 5.2

dental therapistsemployment of 5.3Regulations 1.1

dentistabsence, extended, of 3.12claims by 4.6deceased, spouses, children of 6.10description of 1.4in employment see employment; practice

arrangementsfitness to practice 8.1, 8.27-8.31, 8.32-8.43leaving practice 6.4, 6.15medical reports on 8.31, 8.36 name as on Register 1.1, 7.2qualifications as on Register 1.4registration of see registrationresponsibility to patients of 3, 6.12 statutory duties of 4.4

dentistryancillary, unproven forms of 4.6business of 6.10

‘dentistry’ and company title 6.13Dentists Act Foreword, 6.10Dentists Register 1.1, 1.4, 7.2

see also erasure; registration; restorationof name; suspensiondetermination

imposition of 8.24, 8.38, 8.42notification of 8.37

difficult patients 3.10Diploma in Dental Hygiene 5.3Diploma in Dental Therapy 5.3discharge of patient 4.16, 4.23disciplinary case 8.20, 8.22disciplinary charge 8.19disciplinary jurisdiction of GDC 8.4, 8.6disciplinary proceedings, procedure 1.1, 8.8

see also notification; Preliminary Proceedings Committee; President;Professional Conduct Committee

disclosure 3.5disease see cross-infection; transmissiblediseasedishonesty 2.1, 8.5disrepute see profession, confidence in‘doctor’ as courtesy title 1.4domiciliary treatment 3.9drugs

in conscious sedation 4.11, 4.13, 4.14, 4.15misuse of 2.2prescribing 2.2, 4.5for treating complications 4.15

Eemergency, medical 4.7emergency treatment

arrangements for 3.11, 4.24need for 3.11, 4.24

employees, company dental treatment for 6.10



employmentduties of employed dentist 6.2, 6.4duties of employing dentist 5.1illegal 5.2, 6.9practice procedures 6.2, 6.3, 6.4, 6.10

enrolment status 5.1equipment, facilities 4.4, 4.7, 4.15, 4.16,

4.17, 4.23erasure 8.1, 8.22, 8.24, 8.26ethical guidance

aim and format Introductionevidence

in disciplinary case 8.20, 8.22of fitness to practise 8.36, 8.37of misconduct 8.11, 8.13rules of 8.20

expectation see professional expectation of standards;

public expectation of standards

Ffees, registration 8.26fees, treatment

description of 7.7explanation of 3.6fraudulent 2.3payment of 6.8, 6.12

financial pressure 6.3fitness to practise 8.1, 8.27-8.31, 8.32-8.43

see also notificationforeign language, advertisements in 7.2

Ggeneral anaesthesia see anaesthesia,sedation General Dental Council (GDC)

Committees 8.1see also individually, by name

complaints guidance 3.13, 3.14disciplinary procedure 8.8fitness to practise 8.27-8.31, 8.32-8.43jurisdiction 8.1, 8.6preliminary screening 8.8-8.10professional conduct procedures 8.2-8.7promotion by dentist, view of 7.4, 7.5registration see Dentists Register; registrationRegistration Department 1.4specialist lists 1.4, 1.5, 7.6titles, approval of 6.13, 6.14

goodwill of the practice 6.12

guidance, publications, useful addressesAppendix I

Hhazardous waste 6.5Health Authority 8.6Health Committee (of GDC)

jurisdiction 8.43meetings and membership 8.32powers 8.1proceedings 8.33-8.42referral to 2.2, 8.22, 8.31

Health Departments, guidance by 4.1High Court 8.24HIV infection 4.1home visit 3.9hygiene, oral 5.4

Iillegal practice 5.2, 6.10immediate suspension 8.23, 8.40incentives 6.19indecency 2.1, 8.5indemnity cover 1.2, 5.1infection see cross-infection; transmissibledisease information

concerning a dentist 8.6, 8.13, 8.27,8.28, 8.29, 8.34, 8.39on fees 7.7misleading see patients, public (misleading)

insolvency 6.9insurance see indemnity coverinterim suspension 8.11, 8.16, 8.24

Jjudgement postponed 8.22

Lleaflets, brochures 6.16, 6.18, 6.20leaving arrangements 6.4, 6.15Legal Assessor 8.16, 8.17, 8.32local infiltration analgesia 5.3


INDEX, NOVEMBER 1997, REVISED MAY 2001

Mmedia, statements in 4.6, 7.5Medical Assessors 8.32medical examination of a dentist 8.28-8.31,8.36medical history of patient 4.3, 4.10, 4.18Medical Register 1.1medical reports on dentist 8.31, 8.36misconduct

decision on 8.14, 8.15see also professional misconduct, serious

misleading statements see patients, public(misleading)monitoring 4.14, 4.15, 4.16, 4.22, 4.23

Nname plates 6.15, 6.16names on stationery 6.16, 7.2National Health Service (NHS) 3.6, 6.4, 7.7

Executive, guidance by 3.13Trust 8.6

negligence, professional 1.2, 5.1notes, patient’s 4.3, 4.18Notice of Inquiry 8.18, 8.19Notice of Referral 8.33, 8.34Notice of Resumed Hearing 8.39notification

in disciplinary proceedings 8.12, 8.14,8.18, 8.19in fitness to practise proceedings 8.33,8.34, 8.37, 8.39

Ooral hygiene 5.4

Ppartnership 6.2, 6.10, 6.11patient

best interest of 3.1records see recordssee also referral; treatment

patients, publicexpectations of 3misleading:

claims, statements 1.4, 1.5, 2.3, 4.6,7.3, 7.6practice description 7.4, 7.5

protection of 2.4, 4.1, 4.2, 4.4, 4.8, 4.17responsibility to 8.2

payment see fees, registration; fees,treatmentpersonal behaviour 2.1, 3.14physical impairment 2.5practice agreements 6.2practice arrangements 6

see also equipment, facilities; premisespractice ownership 6.12practice promotion

content 7.2, 7.3, 7.6fee information 7.7leaflets, brochures 6.16, 6.18, 6.20media involvement 7.5misleading 7.4, 7.5signs 6.15standard 7.1stationery 6.16, 7.2treatment 7.4

practice titles 6.14practising certificate 5.1, 8.41Preliminary Proceedings Committee (of GDC)

meetings, membership 8.11proceedings 8.12-8.16, 8.24referral by 8.37referral to 8.8, 8.10, 8.16

Preliminary Screener 8.9, 8.28Preliminary Screening 8.8, 8.10premises

rented 6.12windows, screening of 6.17

prescribing see drugsPresident

in disciplinary proceedings 8.12, 8.16,8.17in fitness to practise proceedings 8.28,8.29, 8.31as Preliminary Screener 8.9, 8.28referral of application to 8.5

privacy 6.17see also confidentiality

private treatment, persuasion to 2.3Privy Council, Judicial Committee of 8.24products, services, promotion of 6.20, 7.3profession, confidence in 6.18, 7.3, 7.5professional conduct see behaviourProfessional Conduct Committee (of GDC)

meetings and membership 8.17powers 8.1proceedings 8.18-8.26referral by 8.37referral to 8.7, 8.8, 8.16

professional debate 4.6professional duty and liability 8.2



professional expectation of standards 4, 8.2professional knowledge and skills

anaesthesia 4.22conscious sedation 4.14maintaining and updating 1.3, 4.14,4.22

professional misconduct, seriouscharge of, reasons for 1.2, 1.3, 2.1-2.3,3.1, 3.5, 3.14, 4.1, 4.2, 4.4, 4.8, 4.17, 5.1,5.2, 6.5, 6.10, 7.5, 8.19evidence of 8.11, 8.13finding of 8.2, 8.12scope, definition of 8.3, 8.4stages of 8.8

professional negligence, claims for 1.2, 5.1professional plate 6.15professional propriety 7.1professional rehabilitation 8.26professional relationships

between colleagues 2.4between dentist and patient 3.1, 6.19,6.20between dentists 7.3

professional responsibility 6.1Professionals complementary to dentistry,duties of 5.1Promoting the Practice 6.18promotion see advertisements; practicepromotionpublic see patients, publicpublic expectation of standards 1.3, 2, 8.2publications Appendix Ipublicity see advertisements; practicepromotion

Qqualifications 1.4, 5.3

Rradiation protection 4.4radiographs, dental 4.4, 6.6radiography

Regulations 4.4safe procedure 4.4

recordsaccess to 6.6computerised 3.5, 6.6disposal of 6.7patient, medical history of 4.3, 4.18patient’s notes 4.3, 4.18

retention of 6.6recovery

attendance during 3.8, 4.16, 4.23facilities 4.16, 4.23procedures 4.16, 4.23

referralaccepting 3.4making 1.5, 3.3, 4.18, 5.3, 6.19

refusal to treat 4.1Register see Dentists Register; MedicalRegisterregistration 1.1, 5.1, 6.9, 8.1

conditions of 8.38, 8.41, 8.42 fee 8.26see also erasure; restoration of name;

suspensionRegulations 1.1rented premises 6.12restoration of name

after erasure 8.26after suspension 8.25

resuscitationdrugs 4.15routines and guidelines 4.7, 4.15, 4.22,4.24

Resuscitation Council (UK) 4.7, 4.22, 4.24review proceedings 8.38, 8.39, 8.41rudeness, discourtesy 3.14

Sscreening of windows 6.17screening procedures 8.8-8.10second opinion 3.3second person

administration of anaesthesia by 4.22during conscious sedation 4.14

sedation see anaesthesia; conscioussedationself-prescribing 4.5self-referral 1.5services, promotion of 6.20, 7.3signs, practice 6.15, 6.16solicitors

Council’s 8.6, 8.18use of 8.17, 8.20, 8.35

specialist lists 1.4, 1.5, 7.6sponsorship, commercial 6.20standard of care and treatment 1.3, 3.2standard of professional conduct 6.11standard of professional promotion 7stationery 6.16, 7.2statutory duties of a dentist 4.4students



behaviour of 8.5supervisors of 1.1

surgery see premisessuspension 8.1, 8.16, 8.24, 8.42

immediate 8.23, 8.40interim 8.11, 8.16, 8.24restoration of name after 8.25review of 8.38for specified period 8.22, 8.38termination of 8.24

Tthird party, presence of 3.8, 3.9titles, use of 1.4, 1.5, 6.13, 6.14training

postgraduate 4.14, 4.22see also dental team (training);professional knowledge and skills;qualifications

transmissible disease 4.2treatment

ancillary or unproven forms of 4.6of children 3.10consent to, patient’s 3.7, 4.9costs see fees, treatmentdefinition of 1.1description of 7.4of difficult patients 3.10domiciliary 3.9emergency 3.11, 4.12, 4.18

instructions, pre- and post-, to patient 4.9out of hours 3.11of patient collapse 4.7, 4.22plan 3.6private, persuasion to 2.3refusal of 4.1standard of 1.3, 3.2terms of 3.6

trust 3.1, 3.5Trust, NHS 8.6

Uundergraduate behaviour 8.5unregistered person or company 6.12useful addresses Bibliography

Vviolence 2.1, 8.5

Wwaste disposal 6.5windows, screening of 6.17

XX-ray machine 4.4



General Dental Council37 Wimpole Street

LondonW1G 8DQ

Telephone: 020 7887 3800Fax: 020 7224 3294

GENERAL DENTAL COUNCIL

MAINTAINING STANDARDS

SEPTEMBER 1999

GUIDANCE TO DENTAL HYGIENISTS AND

DENTAL THERAPISTS ON PROFESSIONAL AND PERSONAL CONDUCT

Throughout the guidance where reference is made to communication with apatient, for example with regard to consent, this should be taken to alsorefer to the patient’s representative where appropriate.

A numeric superscript (1) immediately following a paragraph headingindicates that additional information, such as a reference to a legal oradvisory document, is to be found in the bibliography.


SEPTEMBER 1999

AMENDMENTS APPROVED BY COUNCIL IN MAY 2000

Paragraph 2.1 New guidance on placement of temporary dressings.

Paragraph 2.2 Cross-reference amended.

Bibliography Amended to include reference to new DentalAuxiliaries Regulations.

Index Amended to include reference to temporary dressings.


AMENDMENTS, NOVEMBER 1997, REVISED MAY 2000

GUIDANCE TO DENTAL HYGIENISTS AND DENTAL THERAPISTS

CONTENTS

INTRODUCTION 2001


Enrolling with the General Dental Council 1.1Indemnity 1.2Keeping up-to-date 1.3The use of titles 1.4Student behaviour 1.5

2: SCOPE OF WORK

Legally permitted duties 2.1Sedated patients 2.2Local infiltration anaesthesia 2.3Dental radiography and radiation protection 2.4Oral hygiene instruction 2.5


Personal behaviour 3.1Alcohol and drugs 3.2Improper statements 3.3Protecting patients 3.4


Acting in the best interests of patients 4.1Providing a high standard of care 4.2Explaining treatment and obtaining consent 4.3Working with the dentist 4.4Updating the medical history 4.5Contemporaneous records 4.6Maintaining confidentiality 4.7Having a third party present 4.8


CONTENTS, SEPTEMBER 1999, REVISED MAY 2001

September 1999

July 2000

September 1999

September 1999

Domiciliary treatment 4.9Treating difficult patients and children 4.10Handling complaints 4.11Complaints of rudeness and discourtesy 4.12

5: WHAT THE PROFESSIONS EXPECT

Professional Responsibility 5.1Dealing with infection control 5.2Dealing with transmissible diseases 5.3Dealing with medical emergencies 5.4Non-dental treatment 5.5Business of dentistry 5.6Illegal practice of dentistry 5.7Advertising 5.8Signs and professional plates 5.9Incentives 5.10Interactions with the media 5.11

6: PROCEDURE FOR DEALING WITH MISCONDUCT

BIBLIOGRAPHY

INDEX


CONTENTS, SEPTEMBER 1999, REVISED MAY 2001

November 2000

September 1999

INTRODUCTION

The General Dental Council has a statutory duty to promote highstandards of personal and professional conduct within the dentalprofession. As part of that duty the Council has published MaintainingStandards as a set of ethical guidelines for the profession.

Maintaining Standards contains advice to dentists, dental hygienistsand dental therapists on principles of personal and professionalconduct, includes guidance on the expectations of the public and thepatient, and also explains the Council’s jurisdiction.

Maintaining Standards is not a set of rules and regulations coveringevery aspect of behaviour in every possible set of circumstances. Thepractice of dentistry requires the exercise of professional judgementand an acceptance of personal responsibility, informed by the Council’sethical guidelines and the principles on which these are based.

Whilst this document is primarily designed as constructive guidancefor the profession, it may be used to inform the Council’s fitness topractise procedures.

Maintaining Standards is regularly updated in the light of currentexpectations and is intended to be helpful advice to the professionrather than a statutory code of conduct. Members of the dental teamshould at all times behave reasonably and in the public interest.

INTRODUCTION, MAY 2001



SEPTEMBER 1999


ENROLLING WITH THE GENERAL DENTAL COUNCIL 1, 2

1.1 Dental hygienists and dental therapists must enrol with the GeneralDental Council (GDC) before they begin to practise and must renew theirenrolment annually if they wish to continue to practise. To practisewithout being enrolled is illegal, and may lead to disciplinaryproceedings.

Dental hygienists and dental therapists should not practise dentistry in aname other than that which appears in the Rolls of Dental Auxiliaries.

The title 'dental hygienist' or 'dental therapist' may be used only by aperson whose name is included in the relevant Roll.

INDEMNITY

1.2 Dental hygienists and dental therapists must ensure that they areindemnified against claims for professional negligence. Failure to haveappropriate indemnity will be taken seriously by the Council and wouldalmost certainly lead to a charge of misconduct.

KEEPING UP-TO-DATE

1.3 In the interests of patients, dental hygienists and dental therapists havea duty to continue professional education whilst continuing to practisein order to keep up-to-date with current developments in theirrespective disciplines. Dental hygienists and dental therapists who fail tomaintain and update professional knowledge and skills and who, as aresult, provide treatment which falls short of the standards which thepublic and the professions have a right to expect, may be liable to acharge of misconduct.

THE USE OF TITLES

1.4 The titles 'dental hygienist' or 'dental therapist' should be used only in connection with the practice of dentistry i.e. these titles may not be usedin connection with the provision of non-dental treatment (see paragraph 5.4 below).

A dental hygienist or dental therapist may use the letters 'EDH' or 'EDT'after their name.

STUDENT BEHAVIOUR

1.5 If a student dental hygienist or dental therapist is convicted in a court oflaw or otherwise engages in behaviour reflecting adversely on theprofessions, such as dishonesty, indecency, violence or abuse of alcoholor drugs, their first application for enrolment could be referred to the


1: BEFORE BEGINNING TO PRACTISE, SEPTEMBER 1999

President of the Council. It could equally well be taken into consideration later if the Council had cause to consider the conduct ofan enrolled hygienist or therapist.


2: BEFORE BEGINNING TO PRACTISE, SEPTEMBER 1999

2: SCOPE OF WORK

LEGALLY PERMITTED DUTIES 3, 4

2.1 Dental hygienists and dental therapists may practise dentistry onlyunder the direction of a registered dentist and to the extent permittedby the Dental Auxiliaries Regulations 1986.

The Dental Auxiliaries Regulations set out the duties amounting to thepractice of dentistry which dental hygienists and dental therapists arepermitted to undertake and the circumstances in which these duties maybe undertaken. It is an offence under the Dentists Act 1984 for dentalhygienists and dental therapists to practise outside these limits.

Permitted Duties of Dental Hygienists

Dental hygienists are permitted to carry out the following kinds of dental work under the direction of a registered dentist who has examined the patient and has indicated in writing the course of treatment to be provided:

(i) cleaning and polishing teeth;

(ii) scaling teeth (that is to say, the removal of deposits, accretions andstains from those parts of the surfaces of the teeth which areexposed or which are directly beneath the free margins of the gums,including the application of medicaments appropriate thereto);

(iii) the application to the teeth of such prophylactic materials as theCouncil may from time to time determine.

A dental hygienist may scale teeth under local infiltration anaesthesia administered by the dental hygienist or under any local or regional blockanaesthesia administered by a registered dentist. Dental hygienists maywork in any sector of dentistry but are permitted to administer localinfiltration anaesthesia only under the direct personal supervision of aregistered dentist who is present on the premises at which the hygienistis carrying out such work at the time it is being carried out.

Permitted Duties of Dental Therapists

Dental therapists are permitted to carry out the following kinds of workunder the direction of a registered dentist who has examined thepatient and has indicated in writing the course of treatment to be provided:

(i) extracting deciduous teeth;

(ii) undertaking simple dental fillings;


3: SCOPE OF WORK, SEPTEMBER 1999

(iii) cleaning and polishing teeth;

(iv) scaling teeth (that is to say, the removal of deposits, accretionsand stains from those parts of the surfaces of the teeth whichare exposed or which are directly beneath the free margins ofthe gums, including the application of medicaments appropriatethereto);

(v) the application to the teeth of such prophylactic materials as theCouncil may from time to time determine;

(vi) giving advice within the meaning of Section 37(1) of the DentistsAct such as may be necessary for the proper performance of thedental work described.

A dental therapist may extract deciduous teeth, undertake simple dental fillings, scale teeth and apply prophylactic materials under local infiltration anaesthesia administered by the dental therapist orunder any local or regional block anaesthesia administered by aregistered dentist.

Dental therapists may work in the public health services. They are not permitted to work in general dental practice, except in pilots forPersonal Dental Services authorised under the National Health Service(Primary Care) Act 1997.

Dental hygienists and dental therapists are permitted to place atemporary dressing in a tooth, under the direction of a dentist, if afilling falls out during the course of dental treatment carried out by thedental hygienist or dental therapist, provided they:

(i) inform the patient’s dentist as soon as possible after thetreatment, and

(ii) advise the patient to see his or her dentist as soon as possible.

Dental hygienists and dental therapists should not place temporarydressings unless they have received appropriate training.

Dental hygienists and dental therapists must not represent themselves as being prepared to practise dentistry beyond the extentpermitted by the Dentists Act and the Dental Auxiliaries Regulations, asdescribed above.

SEDATED PATIENTS

2.2 Dental hygienists and dental therapists are not permitted to treatpatients under conscious sedation or general anaesthesia. (Please referto paragraph 4.11 of Maintaining Standards - Guidance to Dentists onProfessional and Personal Conduct for a definition of conscioussedation.).


4: SCOPE OF WORK, JULY 2000

LOCAL INFILTRATION ANAESTHESIA

2.3 In order to be competent to administer local infiltration anaesthesia adental hygienist must:

(i) hold the Diploma in Dental Hygiene awarded after July 1992, or

(ii) hold the Diploma in Dental Therapy (formerly Certificate ofProficiency as a Dental Therapist) in addition to the Diploma(formerly Certificate of Proficiency) in Dental Hygiene awardedbefore July 1992, or

(iii) have completed additional training in local infiltrationanaesthesia and gained a certificate in the administration oflocal infiltration anaesthesia.

DENTAL RADIOGRAPHY AND RADIATION PROTECTION 5

2.4 Dental hygienists and dental therapists who take dental radiographsmust have received adequate training in accordance with the relevantregulations. Dental hygienists and dental therapists who operate X-ray machines must comply fully with the regulations so that saferadiological practice is ensured for the protection of the patient, members of the dental team and others. Failure to do so may lead to acharge of misconduct.

ORAL HYGIENE INSTRUCTION

2.5 Dental hygienists and dental therapists who give advice on oral hygieneand related matters, whether to individual patients or on a group basis,should recognise their legal and ethical obligations towards the patientsor people concerned. In giving such advice dental hygienists and dentaltherapists should act within the limits of their knowledge andprofessional competence. (See also paragraph 5.7)


5: SCOPE OF WORK, SEPTEMBER 1999


SEPTEMBER 1999


PERSONAL BEHAVIOUR

3.1 Dental hygienists and dental therapists must adhere to appropriatestandards of personal as well as professional conduct.

Any behaviour or activity which is liable to bring the professions intodisrepute or to undermine public confidence in the professions may leadto a charge of misconduct.

Behaviour which reflects adversely on the professions such as dishonesty, indecency or violence, may lead to a charge of misconducteven when such behaviour is not directly connected with practice as adental hygienist or dental therapist.

ALCOHOL AND DRUGS

3.2 Complaints of drunkenness or the misuse of drugs may lead to a chargeof misconduct, even if the offence has not been the subject of criminalproceedings.

IMPROPER STATEMENTS

3.3 A dental hygienist or dental therapist should not make a statement ordeclaration that is untrue or misleading or unethical, nor induce anyother person to do so. Any act or omission by a dental hygienist ordental therapist in connection with the practice of dentistry which isliable to mislead the public may lead to a charge of misconduct.

PROTECTING PATIENTS

3.4 A dental hygienist or dental therapist must act to protect patients whenthere is reason to believe that the patient is threatened by the conduct,performance or health of another member of the dental team. Thesafety of patients must come first at all times and should over-ridepersonal and professional loyalties. As soon as a dental hygienist ordental therapist becomes aware of any situation which puts patients atrisk, the matter should be discussed with a senior colleague orappropriate professional body.


7: WHAT THE PUBLIC EXPECTS, SEPTEMBER 1999


SEPTEMBER 1999


ACTING IN THE BEST INTERESTS OF PATIENTS

4.1 As members of caring professions, dental hygienists and dental therapists have a responsibility to put the interests of patients first.Their relationship with the patient relies on trust and the assumptionthat they will act in the best interests of the patient. Abuses of thisrelationship may lead to a charge of misconduct.

PROVIDING A HIGH STANDARD OF CARE

4.2 A patient is entitled to expect that a dental hygienist or dental therapist will provide a high standard of care. The Council takes aserious view of any neglect by a dental hygienist or dental therapist oftheir responsibilities for the care and treatment of the patient.

EXPLAINING TREATMENT AND OBTAINING CONSENT

4.3 A dental hygienist or dental therapist must inform the patient of thetreatment proposed and ensure that appropriate consent has beenobtained. This is especially important when dealing with children underthe age of consent or adults who are not mentally competent and forwhom the consent of an appropriate person is required.

WORKING WITH THE DENTIST

4.4 Dental hygienists and dental therapists are obliged to carry out thelawful and reasonable directions of the dentist under whose directionthey are working, regarding the care and treatment of the patient.They must not carry out directions which are unlawful or unreasonable.If in doubt they should seek advice from an appropriate professionalorganisation.

The format and content of prescriptions are properly a matter for the prescribing dentist. However, it is the responsibility of the dentalhygienist or dental therapist to ensure that they understand fully thetreatment that the dentist has prescribed. The use of abbreviations orcode in a written prescription is permissible, provided the abbreviationor code used is fully understood by both the dentist and the dentalhygienist or dental therapist. The prescription should be dated andsigned or otherwise authenticated by the prescribing dentist.

The Council has determined that dental hygienists and dental therapists should be permitted to carry out interim treatments betweenexaminations of the patient, as specified by the dentist, provided thatthe dentist has examined the patient within the last twelve months.


9: WHAT THE PATIENT EXPECTS, SEPTEMBER 1999

UPDATING THE MEDICAL HISTORY

4.5 Dental hygienists and dental therapists are responsible for ensuring thatthe patient's medical history is updated prior to carrying out theprescribed treatment. Any relevant changes should be brought to theattention of the prescribing dentist before commencing treatment.

CONTEMPORANEOUS RECORDS

4.6 Full contemporaneous records should be kept of all dental treatment.

MAINTAINING CONFIDENTIALITY 6

4.7 The relationship between the patient and the dental hygienist or dental therapist is founded on trust. Dental hygienists and dental therapists should not disclose information about a patient acquired in aprofessional capacity, except to the dentist directing the treatment ofthat patient, and then only in relation to their work. They should notdisclose information of a personal or confidential nature relating to thepractice in which they are employed.

There may, however, be circumstances in which the public interestoutweighs the duty of confidentiality and in which disclosure would bejustified. In such a situation the dental hygienist or dental therapistshould consult their defence or professional organisation.

Where information is held on computer, dental hygienists and dentaltherapists should have regard to the provisions of the Data ProtectionAct. The Act gives the patient the right to see and/or have copies ofcomputer-held records.

Communications with patients should not compromise patient confidentiality. In the interests of security and confidentiality, for example, it is advisable that all postal communications to patients aresent in sealed envelopes.

HAVING A THIRD PARTY PRESENT

4.8 A third person should be present on the premises at all times whendental hygienists and dental therapists undertake the treatment ofpatients.

DOMICILIARY TREATMENT

4.9 Dental treatment provided on a domiciliary basis should be appropriate within that setting, taking into account the nature of theproblem, the facilities available and the welfare of the patient. Havinga third party present is particularly relevant in this environment.

TREATING DIFFICULT PATIENTS AND CHILDREN

4.10 There can be no justification for intimidation or, other than in the most



exceptional circumstances, for the use of physical restraint in dealingwith a difficult patient.

When faced with a child who is uncontrollable for whatever reason, thedental hygienist or dental therapist should decide whether it would bebetter to cease treatment rather than continue. If treatment is stopped,the dental hygienist or dental therapist should provide a clearexplanation of the reasons to the parent or representative and refer thechild back to the dentist for future treatment to be arranged.

HANDLING COMPLAINTS

4.11 The Council advises dentists that if a patient has cause to complainabout the service provided, every effort should be made to resolve thematter at practice level. Dental hygienists and dental therapists shouldbe aware of the procedures for handling complaints that apply in theirplace of work and ensure that any patient who wishes to complain isable to obtain advice on the correct procedures.

COMPLAINTS OF RUDENESS AND DISCOURTESY

4.12 It would be a matter of concern to the Council if it were to receivecomplaints about rudeness and discourtesy on the part of a dentalhygienist or a dental therapist, even though such behaviour may not, ofitself, amount to misconduct. In such circumstances, the Council may,with the patient's consent, seek the observations of the prescribingdentist and the dental hygienist or dental therapist.




SEPTEMBER 1999

5: WHAT THE PROFESSIONS EXPECT

PROFESSIONAL RESPONSIBILITY

5.1 A dental hygienist or dental therapist is responsible for his or herpersonal and professional conduct, whether or not the hygienist ortherapist is in a position to control or influence the practice, business orinstitutional arrangements within which he or she is practising. A dentalhygienist or dental therapist who plays a part in the direction ormanagement of arrangements within which other dental professionalspractise has a reponsibility to those professional colleagues to facilitateand promote their adherence to appropriate standards of personal andprofessional conduct and continuing professional development.

DEALING WITH INFECTION CONTROL 7, 8, 9, 10

5.2 The risk of cross-infection in dental treatment has always existed andappropriate precautions, which form part of a clear practice policy oninfection control procedures, must be taken to protect patients and all members of the dental team from that risk. The publicity surrounding the spread of HIV infection has served to highlight theprecautions which should be in place whenever dental treatment isundertaken. Detailed guidance on infection control has been issued bythe Health Departments and the British Dental Association, and isendorsed by the Council.

It is unethical for a dental hygienist or dental therapist to refuse to treata patient solely on the grounds that the person has a blood-borne virusor any other transmissible disease or infection.

Failure to implement adequate methods of infection control wouldalmost certainly render a dental hygienist or dental therapist liable to acharge of misconduct.

DEALING WITH TRANSMISSIBLE DISEASES 11

5.3 A dental hygienist or dental therapist behaves unethically if they take noaction when they know that they are infected with a blood-borne virusor any other transmissible disease or infection which might jeopardisethe well being of patients. The Council would take the same view if adental hygienist or dental therapist took no action when they hadreason to believe that they might be infected.

In either situation, it is the responsibility of the dental hygienist or dental therapist to obtain medical advice which may result in appropriate testing and, if the dental hygienist or dental therapist is foundto be infected, regular medical supervision. The medical advice may includethe necessity to cease the practice of dentistry altogether, to excludeexposure-prone procedures or to modify practice in some other way.


13: WHAT THE PROFESSION EXPECTS, SEPTEMBER 1999, REVISED NOVEMBER 2000

Failure to obtain such advice or to act upon it would almost certainlylead to a charge of misconduct.

DEALING WITH MEDICAL EMERGENCIES 12

5.4 A medical emergency could occur in a dental practice at any time. It is,therefore, imperative that dental hygienists and dental therapists areproperly trained and prepared to deal with an emergency, including acollapsed patient. Training should include frequent practice ofresuscitation routines in a simulated emergency.

All dental practices are expected to have suction apparatus to clear theoropharynx, oral airways to maintain the natural airway, equipment with appropriate attachments to provide intermittentpositive pressure to the lungs, and a portable source of oxygen.

Current guidelines such as those issued by the Resuscitation Council (UK)should be adopted.

NON-DENTAL TREATMENT

5.5 Non-dental treatment should not be provided in such a way as to mislead the public that it is part of the practice of dentistry.

BUSINESS OF DENTISTRY 13

5.6 It is illegal for an individual who is not a registered dentist or a registered medical practitioner to carry on the business of dentistry. Thismeans that dental hygienists cannot be paid directly by the patient forthe dental treatment they provide. A dental hygienist should notemploy a dentist to examine patients or prescribe treatment.

ILLEGAL PRACTICE OF DENTISTRY

5.7 A dental hygienist or dental therapist who condones or encourages othersto practise dentistry illegally may be liable to a charge of misconduct.

ADVERTISING

5.8 It is permissible for dental hygienists and dental therapists to advertise for employment, for example, by a notice in a newspaper or journal stating their name, title, private address or box number, telephone number and a statement of the post required. It is also permissible to make a direct approach to potential employers.

Dental hygienists should not advertise or canvass for the purpose ofobtaining patients for any dental practice, whether or not they areemployed in it.

The title 'dental hygienist' or 'dental therapist' should not be used toadvertise or promote the sale of a commercial product. Advice on theuse of any dental product should be based on its clinical efficacy.



If dental hygienists or dental therapists engage in dental health education work for a commercial company they should use a title suchas 'dental health educator'. Use of the title 'dental hygienist' or 'dentaltherapist' is not permissible in this context.

SIGNS AND PROFESSIONAL PLATES

5.9 The names of dental hygienists working in the practice of a registereddentist may appear on headed paper and in practice information leafletsor brochures. The name of a dental hygienist, with the designation'dental hygienist' or 'EDH', may be displayed outside the practicepremises with the permission of the dentist.

INCENTIVES

5.10 The Council take the following view on the use of incentives:

(i) there is no objection to a token or other gift being given by adental hygienist directly to a patient who attends for treatment,provided they have obtained the agreement of the dentist;

(ii) it is not acceptable for a financial incentive to be paid to a thirdparty by a dental hygienist in return for encouraging or promotingthe uptake of dental care by individual members of the public;

(iii) a dental hygienist's professional relationship with patients maybe compromised if they were to accept financial incentives fromthird parties in return for promoting to patients:

a) enrolment in a particular scheme for the provision ofdental care; or

b) specific dental products; or

c) the uptake of insurance.

INTERACTIONS WITH THE MEDIA

5.11 Publicity about a dental hygienist or dental therapist which arisesthrough, or from interviews with representatives of, the media andwhich may be regarded as likely to bring the professions into disrepute should be avoided. A dental hygienist or dental therapist whocomments to the media has a particular responsibility to ensure that allstatements are factually accurate. There is a duty to distinguish betweenpersonal opinion or political belief and established facts, and a dentalhygienist or dental therapist should, whenever possible, request accessto the article, statement or interview before publication or broadcast.

The Council will generally hold a dental hygienist or dental therapist,who gives interviews to representatives of the media, responsible forany publicity which may ensue. Any public statement which is calculatedto mislead the public or damage public confidence in the professionsmay lead to a charge of misconduct.



6: PROCEDURE FOR DEALING WITH MISCONDUCT 14

6.1 The Dental Auxiliaries Committee of the General Dental Council (or itsduly appointed Disciplinary Sub-committee) may, after holding aninquiry, direct the Registrar of the Council to erase from the Rolls ofDental Auxiliaries the name of any dental hygienist or dental therapistwho has:

(a) been convicted of a criminal offence, or

(b) been judged by the Committee to be guilty of conductunbefitting a dental hygienist or dental therapist.

The name of the dental hygienist or dental therapist may be erased evenif the conviction or misconduct occurred before enrolment.

The Dental Auxiliaries Committee, in considering a conviction reported to the Council, has to decide whether the gravity of theoffence committed by the dental hygienist or dental therapist, or thecumulative gravity of offences committed on more than one occasion,makes it necessary in the public interest to erase their name from theRoll. Convictions for trivial offences are not normally referred to theCommittee for inquiry. The circumstances of the offence need not bedirectly concerned with the occupation or practice of a dental hygienist or dental therapist to render them liable to have their nameserased from the Roll, but the Committee is particularly concerned withoffences which affect a dental hygienist's or dental therapist's fitness topractise.

In considering convictions, the Dental Auxiliaries Committee accepts thefindings of the court on matters of fact as evidence of the facts proved.It is, therefore, unwise for a dental hygienist or dental therapist to pleadguilty in a court of law to a charge which they believe has a defencesince such a plea will be regarded by the court, and subsequently by theDental Auxiliaries Committee, as an admission that the charge againstthem is well-founded.


17: PROCEDURE FOR DEALING WITH MISCONDUCT, SEPTEMBER 1999

BIBLIOGRAPHY

This list is not exhaustive but is intended as a guide for anyone seeking further information.

1 Dentists Act 1984, Sections 45 and 47.HMSO, ISBN 0 10 542484 6.

2 Dental Auxiliaries Regulations 1986 (SI 887) Regulations 2 to 6HMSO, ISBN 0 11 066887 9

3 Dentists Act 1984, Section 46

4 Dental Auxiliaries Regulations 1986, as amended by the Dental Auxiliaries(Amendment) Regulations 1999 (SI 3460), Regulations 23 and 27.HMSO, ISBN 0 11 085723 2

5 The Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 (SI 778). These are due to be replaced by the Ionising Radiation (Medical Exposure) Regulations 1999HMSO, ISBN 011 086778 5 (1988)

6 Data Protection Act 1984HMSO, ISBN 0 10 543584 8

7 Guidance for Clinical Health Care Workers: Protection Against Infection with HIV and Hepatitis Viruses. Recommendations of the Expert Advisory Group on AIDS. (Currently under revision) HMSO, January 1990, ISBN 0 11 321249 6

8 AIDS-HIV Infected Health Care Workers. Occupational Guidance for Health Care Workers, Their Physicians and Employers. Recommendations of the Expert Advisory Group on AIDS. Department of Health, December 1991. Available from BAPS.

9 Protecting Health Care Workers and Patients from Hepatitis B. Recommendations of the Advisory Group on Hepatitis. Department of Health, August 1993. Available from BAPS.

10 Guidelines on Post Exposure Prophylaxis for Health Care Workers Occupationally Exposed to HIV.Department of Health, June 1997. PL/CO (97) 1.

11 Exposure prone procedures are defined as:

Those where there is a risk that injury to the worker may result in theexposure of the patient's open tissues to the blood of the worker. Theseprocedures include those where the worker's gloved hands may be incontact with sharp instruments, needle tips or sharp tissues (spicules ofbone or teeth) inside a patient's open body cavity, wound or confinedanatomical space where the hands or fingertips may not be completelyvisible at all times.


BIBLIOGRAPHY, JULY 2000

Taken from: AIDS/HIV-Infected Health Care Workers: Guidance on theManagement of Infected Health Care Workers. Recommendations of theExpert Advisory Group on Aids.Department of Health, March 1994. Available from BAPS.

12 The 1998 Resuscitation Guidelines for Use in the United Kingdom. Resuscitation Council (UK)

13 Dentists Act 1984, Sections 40 to 44

14 Dental Auxiliaries Regulations 1986 Regulations 9 to 17

USEFUL ADDRESSES

BAPS, Health Publications Unit, DSS Distribution Centre, Heywood Stores,Manchester Road, Heywood, Lancashire, OL10 2PZ

British Association of Dental Therapists, Dental Auxiliary School, University DentalHospital, Heath Park, Cardiff, CF4 4XYTel: 01222 744251

British Dental Association, 64 Wimpole Street, London, WIM 8ALTel: 020 7935 0875

British Dental Hygienists Association, 13 The Ridge, Yatton, Bristol, BS19 4DQTel: 01934 876 389

Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NSTel: 020 7210 3000

General Dental Council, 37 Wimpole Street, London, W1M 8DQTel: 020 7887 3800


BIBLIOGRAPHY, SEPTEMBER 1999

Aadvertising 5.8

advice, professional 1.2, 3.4, 4.4, 4.7

alcohol and drugs, misuse of 3.2

anaesthesia, general 2.2

anaesthesia, local infiltration 2.1, 2.3

Bbehaviour,

student 1.5

personal 3.1

business of dentistry 5.6

Ccanvassing 5.8

children, treatment of 4.10

colleagues, relationship with dentist 4.4

complaints 4.11, 4.12

computerised records 4.7

confidentiality 4.7

conscious sedation 2.2

criminal convictions 1.5, 6.1

cross-infection 5.2, 5.3

DData Protection Act 1984 4.7

Dental Auxiliaries Committee 6.1

dental hygienists,

enrolment of 1.1

name, display of 5.9

permitted duties 2.1

title, use of 1.4

dental radiography 2.4

dental therapists,

enrolment of 1.1

permitted duties 2.1

title, use of 1.4

dentist, working with 4.4

Dentists Act 1984 2.1

difficult patients 4.10

diploma in dental hygiene 2.3

diseases, transmissible 5.3

dishonesty 1.5, 3.1

domiciliary treatment 4.9

drugs, misuse of 3.2

Eemergencies, medical 5.4

employment, dental therapists 2.1

enrolment 1.1

equipment,

X-ray 2.4

emergencies 5.4

erasure 6.1

Ggeneral anaesthesia 2.1

General Dental Council enrolment 1.1

Hhazardous waste, see infection controlHIV infection 5.2

hygiene, instruction 2.5

INDEX

References are to paragraph numbers.


INDEX, SEPTEMBER 1999, REVISED NOVEMBER 2000

Iillegal practice 1.1, 5.7

incentives 5.10

indemnity 1.2

infection control 5.2, 5.3

insurance, see indemnity

Lleaflets, brochures 5.8, 5.9

legally permitted duties 2.1

local infiltration anaesthesia 2.1, 2.3

Mmedia statements 5.11

medical history, updating 4.5

misconduct,

procedure for dealing with 6.1

charge of 1.2, 1.3, 2.4, 3.1,3.2, 3.3, 4.1, 5.2,5.3, 5.7, 5.11

Nname plates 5.9

negligence, professional 1.2

non-dental treatment 5.5

Ooral hygiene instruction 2.5

Ppatients, protection of 2.4, 3.4, 5.2, 5.3

patient records 4.6

personal behaviour 3.1

personal dental services 2.1

premises 5.9

privacy, see confidentiality

products, promotion of 5.8

professional knowledge and skills 1.3

professional negligence, claims of 1.2

professional plate 5.9

professional responsibility 5.1

promoting the practice 5.8, 5.10

publications, see bibliography

publicity, see advertising and

promoting the practice

Rradiation protection 2.4

radiographs, dental 2.4

radiography regulations 2.4

records 4.5, 4.6, 4.7

refusal to treat 4.10

resuscitation 5.4

rudeness 4.12

Ssedated patients 2.2

sponsorship, commercial 5.8

standards of care 1.3, 4.2, 4.4

stationery, display of name 5.9

students, behaviour of 1.5

Ttemporary dressings 2.1

third party, presence of 4.8, 4.9

titles, use of 1.1, 1.4

training 1.3



transmissible diseases 5.3

treatment,

consent 4.3

definition of 2.1

domiciliary 4.9

emergency 5.4

non-dental 5.5

of children 4.10

of difficult patients 4.10

of patient collapse 5.4

Vviolence 1.5, 3.1

XX-ray machine 2.4




General Dental Council37 Wimpole Street

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Telephone: 020 7887 3800Fax: 020 7224 3294

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