At the risk of stating the obvious, any investigation or treatment of a patient should only be prescribed by an appropriate GDC registered dental professional, working within their scope of practice, who has examined the patient and determined the need for the investigation or treatment.
It also requires informed patient consent, which involves giving the patient enough information to let them to make an informed decision on whether to go ahead.
But obvious or not, issues can still arise, so it's helpful to know what you can do to minimise the risks.
Background - GDC Scope of Practice and illegal practice
The GDC's Scope of Practice sets out the roles for each registrant group. Apart from dentists, only clinical dental technicians, dental hygienists and dental therapists can examine patients and plan treatments, within their training and competence.
The GDC can and does bring disciplinary actions against registrants who exceed their Scope of Practice, or knowingly allow others to do so. These can end up in a public fitness to practise hearing, with the dental professional's registration at risk.
The GDC also brings prosecutions for the illegal practice of dentistry, which is defined in the Dentists Act and is restricted by law to registered dental professionals working within their scope of practice.
The emergence of new special tests
In recent years dentistry has enjoyed an explosion in sophisticated technology, with new methods of investigation and treatment available that have transformed the way dentistry is delivered.
However, any special test should be an aid to diagnosis, and never an end in itself. It should follow a clinical examination of the patient, be prescribed by the examining dental professional, and only be provided if it is appropriate, necessary, in the patient's best interest, and with the patient's informed and expressed consent.
Special tests, such as radiographs and intraoral scans, should never be carried out routinely on all patients or groups of patients, and never simply because the expensive equipment involved is available in the practice. It is important that you can justify every test and investigation in terms of patient need - which might be different from what the patient wants.
Only dental professionals can prescribe special tests and formulate dental treatment plans, based on their clinical findings and investigations. The patient then has the right to either accept or reject the proposed investigation or treatment, having been given sufficient information about it.
Only dental professionals can prescribe special tests and formulate dental treatment plans, based on their clinical findings and investigations.
The GDC's Standards for the Dental Team states that dental professionals must have valid consent before starting any investigation or treatment, and that discussions that take place during the consent process are documented, usually in the clinical notes.
Consent to an investigation or treatment can only be obtained by an appropriate dental professional, working within their scope of practice, who has clinically examined the patient and has the necessary knowledge to give the patient with full explanations and any warnings.
This means that patients shouldn't undergo special tests, such as radiographs or intraoral scans, as a matter of routine before seeing a dental professional for examination.
The principles set out above apply more widely than might be expected. For example, a clinical photograph is wholly non-invasive, but its purpose should still be justified to a patient, and their consent obtained to taking it and to how it will be used in future.
Any such image becomes part of the clinical record and should be securely stored, in accordance with the practice's information governance policies and in line with GDPR/the Data Protection Act 2018.
Photo credit: Alamy
In focus: intra-oral scanners
The rapid growth of digital dental technologies, in combination with the increasing numbers of patients seeking aesthetic and cosmetic dentistry, is transforming many aspects of clinical practice.
As a concept, the technology is not new - the first digitally designed and milled restoration was produced and fitted in 1985. But in recent years, the improved quality and accessibility of 3D imaging, CAD/CAM milling and 3D printing is allowing a much wider acceptance of the technology.
At the forefront of the patient digital interface is the intra-oral scanner, which allows clinicians to accurately capture images of the patient to use in a variety of diagnoses and treatments. Scanners are reliable, portable and increasingly affordable, and the latest ones use high-definition photographic imaging to produce 'real life' scans of the dentition and soft tissues.
3D photographic scans can be used by a clinician to assist in diagnosis, smile design, general treatment planning and monitoring, while digital impressions can be used by clinicians and dental technicians in fixed and removable prosthodontics, in implant planning and restoration, and to create orthodontic devices.
Advantages of intraoral scanners
Scanning is faster than traditional impression and bite registration techniques, and doesn't rely on dental materials and plaster casts. For patients, there are no uncomfortable impressions, and the images can be used to enhance patient communication.
Digital impression files can be sent directly to the laboratory and stored securely without degradation.
The start-up costs can still be substantial. The operator needs to be familiar with technology, computing and be able to integrate scanning into their clinical practice.
Scanners are unable to image in the presence of fluids (such as blood and saliva). They have difficulty detecting restorations with deep margins and are generally not suitable for subgingival restorations.
Senior dento-legal adviser
Senior dento-legal adviser
Rupert Hoppenbrouwers (BDS LDSRCS) was head of the DDU until his retirement at the end of 2015. He is a former general dental practitioner and was director of the School of Dental Hygiene at University College Hospital, London, from 1980 to 1986. He has lectured and written widely on risk management and dento-legal matters, has previously chaired the UK Dental Law and Ethics Forum, and has a particular interest in complex ethical and legal issues affecting dental members.
See more by Rupert Hoppenbrouwers
Dental telephone adviser
Dental telephone adviser
Since qualifying from Bristol in 1996, James has worked as a general dental practitioner in Hampshire. He has been a dental foundation trainer since 2004 and is a training program director for Health Education England. He currently works part-time as an associate, having been a practice principal.
James has enjoyed supporting local practitioners through the Hampshire GDP appraisal scheme and working with the Hampshire Local Dental Committee. He is the third generation of GDPs in his family and the first to follow a more varied career. He works part-time as a dental telephone adviser for the DDU.
See more by James Kingham