General dentistry stuff Flashcards
4x GDC domains
Clinical
Communication
Leadership and management
Professionalism
GDC roles
Based on The Dentists Act 1984
Protect, promote and maintain the safety, health and wellbeing of the public:
- Register new dental care professionals and keep a register of everyone
- Education standards for students
- Complaint handling
- Professionalism standards for the dental team
- Ensure continued professional development
CPD
100 hours per 5 years for dentists - mandatory and w/o will get struck off the register.
Started in 2018
At least 10h every 2 years (can have 1 year of 0h)
Needs to be verifiable:
- Aims and objectives
- Quality assured
- Outcome/domain achieved
Reflection and plan in the PDP. You need to cover all 4 domains of the GDC and include things like medical emergencies, radiation, oral cancer, infection control, safeguarding
PDP
Professional development plan - holds a record of all your CPD, domains and reflections.
Plan -> do -> reflect -> record
CQC
Care quality commission
They register practices, monitor, inspect, and enforce certain standards of care quality.
- Is it safe, effective, caring, maintained and enforced?
9x standards/principles of professionalism
- Put patient’s best interests first
- Valid/informed consent
- Maintain patient confidentiality
- Communication
- Clear complaints procedure
- Raise concerns
- Maintain, develop and work within your skillset
- Work with team to provide the best care for patients
- Personal behaviour should be professional
Who is special care dentistry for
Anyone with social, physical, mental, intellectual sensory impairment or disability
Case mix tool for special care dentistry - 6 domains
Communication Co-operation Medical status Oral risk factors Access Legal and ethical barriers
Case mix tool for special care dentistry - communication
O = No problems A = Can communicate without 3rd party e.g. English as a second language, lip reading B = Can mostly communicate with support e.g. sign language, interpreter, writing, C = Can't communicate - e.g. severe learning difficulty, dementia, brain damage
May have fluctuating capacity/communication problems so wait until they can communicate best and then get consent for the treatment plan and future treatment. Do least restrictive treatment if they can’t communicate, follow Mental Capacity Act and coordinate with MDT and carers/IMCA/next of kin etc.
Use communication aids e.g. pictures
Case mix tool for special care dentistry - Co-operation
O =
A = Can cooperate but needs extra time to acclimatise
B = Can mostly cooperate but needs extra appointments, violent risk, may need to do some clinical holding, limited treatment e.g. maybe just an exam
C = need GA or sedation for treatment
Clinical holding - don’t do it if they have severe medical conditions, bone diseases, etc.
Overcoming cooperation issues - tell, show, do, CBT, hypnosis, acupuncture, sedation, relaxation techniques
Case mix tool for special care dentistry - medical status
O =
A = Minor considerations needed e.g. antibiotic or steroid cover, stable epilepsy
B = Special considerations needed - need to check interactions, special tests, liaise with GP e.g. bisphosphonates, radiotherapy, unstable angina, asthma diabetes, epilepsy
C = multidisciplinary meeting needed - bedbound, hospital, extra precautions, bleeding risk
Check drugs and interactions, liaise with healthcare professionals, modify the treatment plan to reduce risks, refer to hospital
Case mix tool for special care dentistry - oral risk factors
O =
A = (moderate) can follow most of the DBOH toolkit e.g. some physical limitations,
B = (severe) need lots of support to follow some of the DBOH toolkit. Someone else looks after their oral health. E.g. v poor diet and OH, paraplegia, dementia, learning difficulties, xerostomia, limited opening, stroke
C = (extreme) Can’t follow the DBOH toolkit. V severe xerostomia, PEG fed, severe learning difficulties, immunocompromised, MRONJ, ORN, methadone/IV opioids.
High fluoride toothpaste, modified OHE, diet, regular reviews and fluoride varnish, educate carers, artificial saliva
Case mix tool for special care dentistry - access
O =
A = Can access the practice and treatment with some help e.g. carer, paraplegic, elderly, learning disability
B = Needs specialist equipment to access the practice e.g. chair lift, wheelchair transfer, bariatric chair, hoist. Homeless people or disability
C = Can’t access the practice - domiciliary visits needed e.g. living in a care home, hospitalised, in prison, immobilised.
Make sure practice is as accessible as possible, do outreach and dom visits
Case mix tool for special care dentistry - legal and ethical barriers
O =
A = Some difficulties
B = Liaise with next of kin/carer/GP, etc. May have fluctuating capacity
C = Needs a multidisciplinary team meeting e.g. safeguarding issue, no capacity, IMCA or next of kin make decisions.
Mental Capacity Act
MCA 2005
- Everyone has assumed capacity until proven otherwise
- Use every tool/offer all help before deciding that they don’t have capacity
- Act in the patient’s best interest
- Follow the least restrictive treatment plan if the patient doesn’t have the capacity and liaise with MDT/IMCA/social services/carers/next of kin
Independent Mental Capacity Advocate IMCA
Independent mental capacity advocate - legal safeguard for people who lack capacity, with no next of kin or independent person to advocate for them
Ottawa charter
Part of health promotion - allows people to take control over the environmental/socio-economic contributors to health and improve their health.
WHO Ottawa charter
- Create supportive environments
- Health public policies
- Strengthen community action
- Develop personal skills
- Re-orientate health services
Fluoride’s effect on teeth
Fluorapatite is more acid resistant and stronger than hydroxylapatite
- Interferes w bacteria metabolism
- Re-mineralises
Health promotion rationale [6]
- Environmental and behavioural changes have more of an impact than health services
- Major health problems are expensive to treat and rarely cured
- Health services are getting more expensive to keep going
- Public education isn’t enough - environment affects lifestyle
- Major health problems can be prevented by behavioral and environmental changes
- Widening gap between the wealth or the rich and poor
Assuring the quality of health services e.g. NHS
Health services need to be safe, effective, caring, monitored and enforced
- setting clinical policy
- evidence based guidelines
- Baselines/benchmark
- event analysis
- risk management
- strategies and targets - monitoring clinical policy
- benchmarking
- auditing
- peer review and self-assessment
- CPD
- complaints
What investigations and treatments can dental therapists do
- Diagnose but not treatment plan
- Order Xrays
- Take Xrays
- Direct restorations
- Photos
- OHI/diet/smoking
- oral cancer screening
- Take DH,MH, chart
- Paeds - XLA, pulpotomy, pulpectomy, cons, FS, PMC
- Give LA
+ with extra training - can do tooth whitening, IHS and remove sutures but needs to be prescribed and checked by a dentist first.
Pros and Cons of peer reviewed papers
Peer review = scrutinized
Usually accessible to health care professionals
Methods and data need to be accurate and honest
Have enough details to be understood and useful
But quality of peer review varies bw journals
Can contain lots of opinion
Can be hidden behind a paywall
May contain extensive jargon
To be safe, a material must… [4]
Not create inflammation, irritation, allergic reaction or cancer
Materials can be toxic (cytotoxic, genotoxic, carcinogenicity, teratogenecity, metabolic toxicity) or cause allergic reactions (1-4)
How has the risk from dental materials been reduced
Pre-market testing
CE mark - risk assessment
Post market surveillance
Packing and use instructions to stop them being used wrong/coming in contact with clinicians
