The scene

A DDU member contacted the dento-legal advice line with the following dilemma:

'I have recently seen a new patient who reported discomfort beneath an anterior fixed bridge, after having had implants and the bridge fitted outside the UK.

'My clinical and radiographic assessment showed that the bridge was supported by dental implants, which appear to be failing. I undertake implant placement and restoration myself, but I am not familiar with the type of implants that appear to have been used.

'I'm unsure about the extent of the advice and treatment I should provide for this patient. What should I do?'

Background

Dentists will routinely see new patients who have received dental advice and treatment in a number of previous practices and/or settings, both in and outside the UK.

For patients who have undergone dental care outside the UK, the type and extent of treatment will vary according to that patient's individual circumstances.

Such patients may include:

• those who have needed to seek urgent treatment only and/or further planned treatment whilst living, working or holidaying abroad
• those who have moved to the UK from another country where they have undergone previous treatment
• those who have travelled outside the UK as a 'dental tourist', to undergo specific dental treatment.

Our advice

Regardless of whether previous care has been provided in or outside the UK, we advise that:

• After assessing any new patient, you should explain your findings, using language and terms the patient can understand.
• If you think the patient is unable to understand you fully because of a language barrier, you would be expected to consider ways of overcoming this, such as by arranging for an appropriate interpreter.

• With a patient's consent, you may wish to contact their previous dentist or DCP if you need more details or clarification about care provided. Details of any verbal communication should be accurately noted in the patient's records. If necessary, consider requesting copies of the records from the previous dental professional.
• Requesting or obtaining dental records and information about treatment provided outside the UK may be problematic. There could be issues around communicating with the practice/colleague to request the records, and the records themselves may be in an unfamiliar language and/or format.
• As well as this, and as the example above indicates, the treatment that has been provided may be unfamiliar too, particularly in relation to materials and/or techniques used.
• The benefit of seeking previous records and information requires careful assessment on an individual patient basis, especially if you consider the patient is in need of urgent or emergency dental care.
• Your advice to a patient, including options for treatment, should of course be based on what you consider to be in their best interests.
• Options may include referring to an appropriate colleague in primary or secondary care, if you consider this would be in the patient's best interests, or if you consider any aspect of the patient's care to be outside your scope of practice or competence (as indicated by GDC Standard 6.3.3).
• If the patient raises concerns about previous care, advise them that these should be appropriately directed to the colleague who provided that care.
• While questions or queries from the patient regarding your findings should be answered honestly, avoid making any subjective and inflammatory comments about care provided previously by other dental professionals.