Law, Ethics and Professionalism Flashcards
What is the aim of restraint? But, what must we consider?
- Removing the patients free will
- Permitting the operator to impose their will upon the patient
- Inhibit the patient from applying their own inhibitions
We must consider the medico-legal implication
What are the medico-legal issues concerning consent that we must consider?
- Duty of care
- Standard of practice
- Law
- Risk avoidance
- Management of critical incidents
What are the 9 standards for a dentist?
- Patient’s interest first
- Communicate effectively
- Consent
- Protect and maintain patient info
- Clear and effective complaints procedure
- Work the colleagues in a way in the patients best interests
- Maintain, develop and work within your professional knowledge and skills
- Raise concern if patients at risk
- Personal behaviour maintains patient’s confidence
What is the definition of the dentist’s duty of care?
To provide safe, effective dental care of a standard a patient has a right to expect from a reasonable dental; practitioner; that is an individual holding themselves out to be someone professing to have the skills that a reasonably competent dental practitioner would have
Procedures that are considered restraint? And, what is necessary before administration?
- GA and sedation
- Written consent is 100% needed
Can restraint be used in the dental practice?
- Use of restraint may be lawful; provided that it was reasonable restraint
- Reasonableness requires reference to accepted practice
Forms of planned restraint?
- Physical (for LA)
- Oral sedation
- IV sedation
- GA
- Surreptitious use of sedation
Process necessary to document, inform and perform restraint?
- How much and what restraint
- Comprehensive records
- Establish the need
- Have and follow the protocol
- Justify use
- Act in the patient’s best interest
Premises necessary to perform safe restraint?
- Access
- Surgery accomodation
- Recovery rooms
- Admin facilities
- Health and safety legislation
Staff qualifications and training for the safety to perform restraint?
Staff: - qualified
- registered
- trained
- in date
- under indemnity
Training: - pre GA/sedation procedure
- the procedure
- recovery
- emergencyEquipment necessary to perform safe restraint?
- Appropriate
- Availability
- Maintenance
- Documentation
The needs of a suitable protocol for a treatment?
- Difference between guidelines, procedures and protocols
- Available in surgery
- Understood
- Appropriate
- Fully understood
- Audited updated and developed
What must a clinical practice demonstrate to be acceptable in the eyes of the GDC?
- Duty of care
- Appropriate
- Diagnosis
- Treatment planning
- Risks
- Alternatives
- Justifications
- Consent
- Review
- CPD
- Resus training
- Staff training
- Records
What are the necessary assessment questions for use of all restraints?
- Separate appointment
- Can be performed by different person
- Assessor trained and competent
- Discuss fully with patient
- Discuss with colleague if in doubt
- Document everything
- Assess for treatment plan and treatment required
- Discuss risks and alternatives
- Write and duplicate referral letter
Contents of a referral letter?
- Name, address and contact details of referrer and patient
- Medical and dental history
- Reasons for sedation
- Risks and alternative described
- Written pre and post OP instructions given
What should records include and demonstrate?
- History
- Clinical exam
- Treatment plans
- Treatment carried out
- Problems
- Future treatments
What is included in the GDC’s definition of scope of practice for a dentist?
A set of skills and abilities each registrant should have
Additional skills that may develop after registration to increase your scope of practice
Understand your limits and don’t exceed them
Trained for medical emergencies
What is expected legally from us as dentists?
Ethics Professionalism Professional governance Law Confidentiality Consent Negligence Record Keeping Risk management Clinical governance Referral of patients Dealing with complaints Working well as a team Professional development Self appraisal
What can dental nurses do?
Maintain equipment Carry out infection prevention Record dental charting Mix dental biomaterials Chairside support Keep accurate patient records Prepare dental radiography Process radiographs Patient aid/advice Aid in medical emergency Make appropriate referrals
What can orthodontic therapists do?
Prepare teeth for orthodontic treatment Maintain equipment Insert passive removable orthodontics Insert removable appliances Remove fixed appliances Place auxiliaries Study models Make orthodontic appliance Fit headgear Fit facebow Take occlusal records Clinical photographs Place brackets and bands Place archwires Advice on appliance car Fit tooth separators Fit bonded retainers Carry out IOTN Make appropriate referrals Keep full records Give patient advice
What can dental therapists do?
• obtain a detailed dental history from
patients and evaluate their medical
history
• carry out a clinical examination within
their competence
• complete periodontal examination and
charting and use indices to screen and
monitor periodontal disease
• diagnose and treatment plan within their
competence
• prescribe radiographs
• take, process and interpret various film
views used in general dental practice
• plan the delivery of care for patients
• give appropriate patient advice
• provide preventive oral care to patients
and liaise with dentists over the treatment
of caries, periodontal disease and tooth
wear
• undertake supragingival and subgingival
scaling and root surface debridement
using manual and powered instruments
• use appropriate anti-microbial therapy to
manage plaque related diseases
• adjust restored surfaces in relation to
periodontal treatment
• apply topical treatments and fissure
sealants
• give patients advice on how to stop
smoking
• take intra and extra-oral photographs
• give infiltration and inferior dental block
analgesia
• place temporary dressings and re-cement
crowns with temporary cement
• place rubber dam
• take impressions
• care of implants and treatment of
peri-implant tissues
• carry out direct restorations on primary
and secondary teeth
• carry out pulpotomies on primary teeth
• extract primary teeth
• place pre-formed crowns on primary teeth
• identify anatomical features, recognise
abnormalities and interpret common
pathology
• carry out oral cancer screening
• if necessary, refer patients to other
healthcare professionals
• keep full, accurate and contemporaneous
patient records
• if working on prescription, vary the detail
but not the direction of the prescription
according to patient needs. For example
the number of surfaces to be restored or
the material to be used.
What can dental technicians do?
• review cases coming into the laboratory to decide how they should be progressed • work with the dentist or clinical dental technician on treatment planning and outline design • give appropriate patient advice • design, plan and make a range of custom-made dental devices according to a prescription • modify dental devices including dentures, orthodontic appliances, crowns and bridges according to a prescription • carry out shade taking • carry out infection prevention and control procedures to prevent physical, chemical and microbiological contamination in the laboratory • keep full and accurate laboratory records • verify and take responsibility for the quality and safety of devices leaving a laboratory • make appropriate referrals to other healthcare professionals
What can dental hygienist do?
• provide dental hygiene care to a wide
range of patients
• obtain a detailed dental history from
patients and evaluate their medical history
• carry out a clinical examination within their
competence
• complete periodontal examination and
charting and use indices to screen and
monitor periodontal disease
• diagnose and treatment plan within their
competence
• prescribe radiographs
• take, process and interpret various film
views used in general dental practice
• plan the delivery of care for patients
• give appropriate patient advice
• provide preventive oral care to patients
and liaise with dentists over the treatment
of caries, periodontal disease and tooth
wear
• undertake supragingival and subgingival
scaling and root surface debridement
using manual and powered instruments
• use appropriate anti-microbial therapy to
manage plaque related diseases
• adjust restored surfaces in relation to
periodontal treatment
• apply topical treatments and fissure
sealants
give patients advice on how to stop
smoking
• take intra and extra-oral photographs
• give infiltration and inferior dental block
analgesia
• place temporary dressings and re-cement
crowns with temporary cement
• place rubber dam
• take impressions
• care of implants and treatment of
peri-implant tissues
• identify anatomical features, recognise
abnormalities and interpret common
pathology
• carry out oral cancer screening
• if necessary, refer patients to other
healthcare professionals
• keep full, accurate and contemporaneous
patient records
• if working on prescription, vary the detail
but not the direction of the prescription
according to patient needs
What can clinical dental technicians?
• prescribe and provide complete dentures
direct to patients
• provide and fit other dental devices on
prescription from a dentist
• take detailed dental history and relevant
medical history
• perform technical and clinical procedures
related to providing removable dental
appliances
• carry out clinical examinations within their
scope of practice
• take and process radiographs and other
images related to providing removable
dental appliances
• distinguish between normal and abnormal
consequences of ageing
give appropriate patient advice
• recognise abnormal oral mucosa and
related underlying structures and refer
patients to other healthcare professionals
if necessary
• fit removable appliances
• provide sports mouth guards
• keep full, accurate and contemporaneous
patient records
• vary the detail but not the direction of a
prescription according to patient needs
What can a dentist do?
diagnose disease • prepare comprehensive treatment plans • prescribe and provide endodontic treatment on adult teeth • prescribe and provide fixed orthodontic treatment • prescribe and provide fixed and removable prostheses • carry out oral surgery • carry out periodontal surgery • extract permanent teeth • prescribe and provide crowns and bridges • provide conscious sedation • carry out treatment on patients who are under general anaesthesia • prescribe medicines as part of dental treatment • prescribe and interpret radiographs
What are the training pathway outcomes for dentists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental therapists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental hygienists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for clinical dental technicians?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental technicians?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for orthodontic therapists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental nurses?
Clinical
Communication
Professionalism
Management and Leadership
What are the CPD requirements for a dental therapist, hygienist, orthodontic therapist and clinical dental technician?
75 hours
What are the CPD requirements for a dentist?
100 hours over 5 year cycle and at least 10 hours for a 2 year period
What responsibilities does a dentist have when a complaint is made against his team?
Dentist’s responsibility to talk to the patient and to the staff member
At the end of the day, it all falls on the Dentist
What responsibilities does a dentist have when a complaint is made against his team?
Dentist’s responsibility to talk to the patient and to the staff member
At the end of the day, it all falls on the Dentist
What are the guidelines for tooth whitening?
Anything over 6% H202 is prohibited for tooth whitening or bleaching products, unless of treatment or prevention of disease
At what age does teeth whitening become legal?
Above 18 years old
What checks must be done before the treatment for teeth whitening?
Appropriate clinical exam to ensure no risk factor or oral pathology exists
Exposure to the h202 is limited and are only used for the intended use with frequency and duration considered
Products should not be available to the consumer only via a dental care professional
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST
the following cycles can be administered by a dental care professional
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST
the following cycles can be administered by a dental care professional
What are the botox and fillers governed by?
Medical Acts
What is the definition of a legal restoration?
That it gives the tooth a therapeutic advantage at becoming healthier, than it was in its original state in the practice
What is a risk assessment?
Weighing up the risks vs the benefits for a specific procedure
What questions should we ask to the patient when gauging patient expectations?
What they want?
What they care about?
Intermediate restorations can appease the patient’s expectations
Our own expectations need to be of sufficient standard
How to manage expectations?
Explain to the patient what modern medicine and your skills are capable of
Don’t over sell yourself
Be realistic
When a new patient arrives for a check up, and you check their teeth, what questions should you ask them?
What are the patient’s dental needs?
What are the risks?
What is the treatment?
Ask patient what their thoughts are about their dentition?
WIll the patient be happy with your treatment plan?
What problems can occur during treatment?
Don't panic Take advice Limit any damage Don't be afraid to say 'sorry' (if treatment failed/under expectations) Make the patient presentable (aesthetically) Deal with the pain first Don't be afraid to refer Prevent recurrence in the future
What actions can you implement to reduce the likeliness of patient complaints?
Careful treatment planning
Realistic expectations of treatment that patients understand
Providing questionnaires to assess what that patient thinks about the practice
Reacting promptly to patients comments giving reasons if you are not accepting them
Having a sound clinical governance programme in place
Carrying out critical incident analysis
Peer review
Making patient feel that you have their best interests uppermost in your mnd
treat patients with respect
Respect equality and diversity (equality act)
Advise patients if procedures do not go well and what you’ll do to rectify and prevent recurrence (duty of candour)
All practice staff maintain a professional demeanour
What is the definition of clinical governance?
A mechanism for monitoring and reviewing the healthcare provided for patients to give assurance that all patient receive consistent health care of an appropriate quality irrespective of where it is provided or from whom it is provided by.
To analyse the data to see if it can be used to improve the general health and healthcare of the population
How does clinical governance help the dentist?
Patient’s need to know benefits outweigh risks
Better job satisfaction
Save money from complaints or rectifying procedures
Why do we need clinical governance?
To ensure patient recieve safe treatment, effective treatment, consistent quality of treatment
What does clinical governance include?
Clinical risk management Information governance Clinical effectiveness Fitness to practice Other risks in the practice
What is included in information governance?
Data protection (GDPR 2018)
Freedom of information act
Information security
Records management
What is included in a clinical governance folder?
Contains all the protocols for each specific treatment and/or consent
To protect yourself
Consider risks and advising patient about risks
What is included when considering clinical effectiveness?
Dental materials used Effectiveness of materials Safety of dental materials Longevity of treatments Person centered care Efficiency Same treatment to each patient Timing
What is included when considering Fitness to practice?
Registered with the GDC
Have indemnity
Ensure healthy
Continue CPD
What is a proforma?
A list of steps that occur during a specific treatment
How to make a good and consistent referral letter?
Typed Copy Patient details with contact info Medical histories Dental histories History of condition Radiographs Photograph Urgency (routine, soon or urgent) Protocol if patient fails to turn up
What to include to reduce risk when thinking about treatment planning and clinical notes?
Evidence of throught and appropriate examination
Evidence of perio conditions
Radiographs as required
Study models as required
Tests as required
Explanation of risks and benefits
Necessity of the treatment for the patient
A key abbreviation to start every clinical note?
C.O.
Complaining of
if none put none
if something put something
What are the guidelines to follow for radiographs?
IR(ME)R
Unless it is an emergency what is the dentist’s ethical and legal requirement to undertake?
Must carry out a full examination and determine all the treatment necessary to secure and maintain oral health
How to increases the likeliness of a patient to attend follow up appointments?
Each appointment to be planned
What is proposed to be done at each appointment
Length of time for each appointment
Explain step-by-step to the patient what is going on
What are essential to write in the notes?
Communication with the reception staff? Does patient understand the nature of contract which they are being treated? Why patient came to the surgery? Pain? Other problems? Use templates
What other risks are there in the dental surgery?
Health and safety risk assessment Slips and trips Fire risk Electrical risk Security risk Critical incident analysis Clinical risk assessment
What to include for a critical incident analysis?
Complaints
Disasters
Things that go well
Things that do not go well
What is the definition of audit?
Identify a significant risk, do something to eliminate it, review to see if it worked
What is the definition of peer review?
Reviewing with peers processes and procedures that you follow to see what they do and see if what you are doing can be improved
What is the definition of duty of candour?
Must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress
Seek advice if unsure about the consequence and subsequently tell the patient something has gone wrong
Apologise to the patient and offer an appropriate remedy or support to put matter right and explain the short and long term effects of what has happened and document what has happened
Raise concerns where appropriate if you believe a patient’s best interests have been compromised
Name the 5 substandards for child protection and vulnerable adults?
Always put the patient first
Act promptly if patients or colleagues are at risk and take measure to protect them
Measure sure if you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns and openly and without fear of reprisal
Measure sure if you employ, manage or lead a team that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that is is followed at all times
Take appropriate action if you have concerns about the possible abuse f children or vulnerable adults
What is included in the Wood report 2016?
4% of child deaths relate to safeguarding or require an SCR to be carried out
Should be moved to the Department of Health
Promote innovation and deliver efficiency in the design of local arrangements to safeguard children and young people
If a tragic events happens learn from it and stop it from happening in the future
What is the definition of Child Abuse?
Physical and emotional abuse + neglect
Is early intervention good and why?
Have a greater chance they have to break the cycle and health
Is child abuse only violent?
No, it can also be neglect and emotional abuse, they are more subtle and can have long-lasting effects
Is child abuse only carried out by ‘bad people’?
No, not all abusers are intentionally harming their children, many have been victims of abuse themselves, and don’t know how to parent
Other struggle with mental health or a substance abuse problem
Where does Scotland lie in the substance abuse league table?
1 in Europe
Does child abuse happen in ‘good families’?
It can happen in all families
Behind closed doors it’s a different story
Who are the people who child abuse?
Usually family members, but stranger abuse does happen
Do abused children grow up to be abusers?
Some will as they know no different, and so have a more likely chance, but if you can break the cycle as early as possible then the likeliness will become lower
Survivors of child abuse have a strong motivation to become better parents
What are the effects of child abuse and neglect?
Leave lasting scars
Can be physical or emotional
Damaging child’s sense of self, ability to make healthy relationships
Reduced ability to function at home, work or at school
What are the long lasting effects of child abuse and neglect?
Lack of trust and relationship difficulties
Feelings of being ‘worthless’ or ‘damaged’
Trouble regulating emotions
What are the long lasting effects of lack of trust and relationship difficulties?
Very difficult to learn to trust people or know who is trustworthy
Difficulty in maintaining relationships due to fear of being controlled or abused, and can also lead to unhealthy relationships as they think it is normal
What are the long lasting effects of feeling of being ‘worthless’ or ‘damaged’?
Adults may not strive for more education, or settle for a job that may not pay enough because they don’t believe they can do it ro worth more
Sexual abuse survivors, with the stigma and shame surrounding the abuse, often especially struggle with a feeling of being damaged
What are the long lasting effects of trouble regulating emotions?
Can’t express emotions safely
Emotions are stuffed down and come out in unexpected ways
Struggle with unexplained anxiety, depression or anger
Can turn to alcohol or drugs to numb painful feelings
What do children need to have a good upbringing?
Predictability
Structure
Clear boundaries
Knowledge that their parents are looking out for their safety
Name the 3 types of child abuse?
Emotional
Physical
Neglect
Sexual abuse
Give examples on how a child can be emotionally abused and its long term effects?
Shaming and humiliating child Calling names and making negative comparisons to others Telling child they're no good Frequent yelling or threatening Silent treatment Limited physical contact Exposing the child to violence Damage child's mental health or social development
What is the definition of child neglect?
Pattern of failing to provide for a child’s basic needs, whether it be adequate food, clothing hygiene or supervision
What is the definition of physical child abuse?
Involves physical harm or injury to the child
How do abusers explain their actions?
Insist that their actions are imply a form of discipline
What are the differences between physical abuse and discipline?
Unpredictability
Lashing out in anger
Using fear to control behaviour
What is the definition of child sexual abuse?
Layers of guilt and shame
Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved
What are the long lasting effects of shame and guilt in child sexual abuse?
Tormented by shame and guilt
Feel some sort of responsibility
Self loathing and sexual problems as they grow older
Hard for them to come forward
If they have the courage to tell you, take them seriously
What are the signs for physical child abuse?
Frequent injuries or unexplained bruises, welts or cuts
Child very alert
Injuries appear as patterns from hand or belt
Shies away from touch
Flinches at sudden movements
Afraid to go home
Wears inappropriate clothing to cover up injuries
What are the signs for emotional child abuse?
Excessively withdrawn, fearful or anxious
Show extreme behaviours (complaint, demanding or aggressive)
Detached from parent or caregiver
Act inappropriately adult-like or infantile (rocking, thumb-sucking)
What are the signs for child neglect?
Clothing are ill-fitting, filthy or inappropriate for weather clotting
Hygiene constantly bad
Untreated illnesses or physical injury
Child is frequently unsupervised or left alone in unsafe areas
Child late or missing from school
What are the risk factors for child abuse and neglect?
Domestic violence Alcohol and drug abuse Untreated mental illness Lack of parenting skills Stress and lack of support
How can domestic violence of a parent affect a child?
Witnessing violence
Situation extremely damaging
How can alcohol and drug abuse from the parents affect a child?
Difficult to live with Lead to abuse and/or neglect Poor parenting decisions Dangerous impulses Leads to physical abuse
How can untreated mental illnesses of a parent affect a child?
Trouble taking care of themselves and so much less of their child
Distant or withdrawn from child
Quick to anger
How can lack of parenting skills affect a child?
Unrealistic expectations
May not know what to do in certain situations
Abuse survivors continue the cycle to their children
How can stress and lack of support of a parent affect a child?
No support from family + stress from job can lead to less caring for the child
Disability needs extra care
What to do if you have suspicions of child abuse?
Write in patient’s notes
Think about the child
Child isn’t necessarily taken away
Reporting is the first step to helping the child
Garner information from their GP, and advice from other colleagues
When reporting child abuse what should you remember?
Be as specific as you can be
It is not our job to prove it, just report on the suspicion
If future incidents occur report them too
Name 2 legislations that protect children?
Children Act 1995 - section 19/20/21
Local Government in Scotland Act 2003 - Part 2/3
What does the Children Act 1995 - Section 19, 20 and 21 cover?
19@
- local authority to prepare, publish and keep under review plans in relation to services for children and lists who should be consulted in prep of such plans
20:
- covers the publication of information about services for children
21:
- deals with coop between authorities
What does the Local Government in Scotland Act 2003 - part 2 and 3 cover?
2:
- Community planning
- places a duty of local authority to initiate and maintain a process of community planning and also a duty of agencies, to cooperate
3:
- deal with the power to advance well being
- allows local authority to do anything to promote or improve well-being within an area
What are the typical oral signs for child abuse?
Bashed central incisors
Damage to the frenum
Facial/head bruising (fatal)
Cigarette burns
What is the % of children suffering serious abuse or neglect?
7% abuse
6% neglect
What other problems can affect a child’s oral wellbeing?
Eating disorders
What are the typical oral signs for eating disorders?
Eroded teeth due to acid
Cuts on knuckles
Tender palate
Explain the process for reporting child abuse?
Important to keep good and full records
Discuss concerns with colleagues
Discuss concerns with their GP
Take advice from defence organisation
Report the case to social services if the doctor does not
Follow up actions by colleagues, doctors and social services
Whom might be considered vulnerable?
Domestic violence survivors Elderly Poor Disabled Children Mental illness Depressed adults Sexual abuse survivors
Whom is responsible for child protection?
Everyone
Shared
Everyone in the dental team
No such thing as justifiable chastisement
What is the legislation for female genital mutilation?
Call 101
Report ASAP, if sufficient evidence and/or suspicion
Who is best to discuss potential abuse claims with?
The families or person’s GP
What is the most common form of abuse in England?
Neglect with 42%
Emotional with 19%
What is the definition of physical abuse?
Hitting, shaking, throwing, poisoning, burning, scalding, drowning, suffocating or otherwise causing physical harm to a child
Fabricated and induced illnesses
How to recognise physical abuse?
Bruising, abrasions, lacerations, burns, bites, eye injuries, bone fractures, intraoral injuries
Site, size and patterns
Delay in presentation
Does not fit explanation
Name 8 types of Accidental injuries?
Head - parietal occipital or forehead Nose Chin Palm of hand Elbows Knee Shins
Bony prominences
Match history
Keeping with development of child
Name 12 types of abusive injuries?
Black eye Soft tissues of cheeks Intraoral injuries Forearms when raised to protect self Chest and abdomen Any groin or genital Inner aspect of thigh Soles of feet Back and sides Inner aspect of arm Ears Triangle of safety
What is the triangle of safety?
Ears, side of face, neck and top of shoulders
All areas for accidental injury to be unusual
What is the definition of sexual abuse?
Forcing or enticing a child or young person to take part in sexual activity, including prostitution, whether or not the child is aware of what is happening
What trends can be seen with abusive injury?
Injuries on both sides of the body Injuries to soft tissue With particular patterns Doesn't fit explanation Delayed presentation untreated injury
How to recognise sexual abuse?
Direct allegations STIs Pregnancy Trauma Emotional and behavioural signs: - delayed development - anxiety - depression - self-harm - drug
What is the definition of emotional abuse?
Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on a child’s emotional development
How to recognise emotional abuse?
Poor growth Developmental delay Education failure Social immaturity Lack of social responsiveness Aggression Challenging behaviour Attention difficulties
What is the definition of neglect?
The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development
Failure to access appropriate medical care
How to recognise neglect?
Failure to thrive Short stature Inappropriate clothing Frequent injury Ingrained dirt Delayed development Withdrawn or attention seeking behaviour
What is the role of the dental team when it comes to abuse or neglect?
We are not responsible for making the diagnosis of neglect or abuse, but sharing our concerns with someone whom can help the situation
GPs are best to contact
Describe principle 8 of the GDC guidelines (Raise concerns if patients are a risk)
Always put patient’s safety first
Act promptly if patients or colleague are at risk and take measures to protect them
Maure sure you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns openly and without fear of reprisal
Make sure if you employ, manage or lead a team that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that is is followed at all times
Take appropriate action if you have concerns about the possible abuse of children or vulnerable adult
What to do when you have NO concerns about the welfare of the child?
Provide necessary dental care
Full clinical records
Provide info about local support
Arrange dental follow-ups
How to manage dental neglect of a child?
Raise concern Explain what changes are required Offer support Keep accurate records Continue to liaise with parents Monitor the progress If concerned involve other agencies
How to manage dental neglect of a child?
Raise concern Explain what changes are required Offer support Keep accurate records Continue to liaise with parents Monitor the progress If concerned involve other agencies
What is the gold standard for safeguarding children protocol?
Identify staff member to take the lead on child protection
Adopt a child protection policy
Create a step by step guide of what to do if we have concerns
Follow best practice in record keeping
Undertake regular team training
Practice safe staff recruitment
Name the 7 steps for reporting child abuse?
Keep good and full records
Discuss concerns with colleagues
Discuss with GP
Take advice from defence organisation
Report to social services if doctor does not
Follow up with everyone
Safeguarded under the Public Information Disclosure Act if wrong
Name 2 publications about Child abuse in Scotland?
National action plan on Child sexual exploitation
Safeguarding Scotland’s vulnerable children from child abuse
Name the 3 main groups that are considered vulneable?
Vulnerable adults especially elderly
Mentally compromised
Children
What is the definition of vulnerable?
Abuse occurs when a person is mistreated, neglected or harmed by another person who holds a position of trust
What is the definition of adult abuse?
A single or repeated act or lack of appropriate actions, occurring within any relationship where there is an expectation of trust, which causes harm or distress to a vulnerable person
What is the definition of a vulnerable adult?
Deparmtnet of health defines as a person aged 18 YO or older who is or may be in need of community care services by reason of mental or other disability, age or illness, and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation
What is the definition of safegaurding?
Protection of people
What are the risk factors for being the sufferer of abuse?
Lack mental capacity Increased age Being physically dependent on others Low self-esteem Previous abuse history Negative experiences of disclosing abuse Social isolation Lack of access to health and social services or high quality information
What are examples of financial or material abuse?
Theft Fraud Will Property Inheritance Benefits
What is the definition of domestic abuse?
Psychological, physical, sexual, financial, emotional, so called honour based violence
What is the definition of organisational abuse?
Neglect and poor care practice within an institution
What is the definition of self-negelct?
Personal hygiene
Health
Hoarding
What is the primary aim of safeguarding?
Keep an individual safe and prevent further abuse from occurring
Name the 6 principles of good safeguarding practice?
Empowerment Protection Prevention Proportionality Partnership Accountability
Name the 2 acts for safeguarding vulnervake adults?
Care Act 2014 (RoUK)
Adult Support and Protection Act 2007 (Scotland)
What are the limitations to safeguarding?
Limitless
Aim to make life easier
Possible mobility aid or something to maintain their independence
How does the Adult support and Protection Act (Scotland) 2007 defines ‘adults at risk’?
Unable to safeguard their own wellbeing, property, right or other interests
At risk of harm and
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
How does the Adult support and Protection Act (Scotland) 2007 defines ‘risk of harm?
Another person’s conduct is causing or likely to cause the adult to be harmed or
Adult is engaging or likely to engage in conduct which causes or is likely to cause self-harm
How does the Adult support and Protection Act (Scotland) 2007 defines ‘Harm’?
Causes:
- physical harm
- psychological harm
- unlawful conducts which affects property rights or interests
- self harm
How can the Mental Capacity Act (2005) make things difficult?
No legal authority to make best interest decisions on their behalf, however, balancing a respect for the choices of adults who retain capacity, against the desire to promote welfare can present genuine dilemmas
Name 5 factors to consider when inquiring about abuse?
Vulnerability of individual Nature and extent of abuse Length of time occurred for Impact on individual Risk of repeated or increasingly serious acts
How to manage the conversation with an individual when abuse is suspected?
Abuser not present
Be accompanied by a more trusted person
Appropriate support to express themselves
Be clear with what will happen to the information
Establish facts of the allegation and acknowledge the impact
Make them feel safe
What to consider when thinking about reporting abuse?
Where to report and how
What relevance does legislation have to working with the elderly as a dentist?
Working lawfully and legally Duty of care to patient Working with proper skill and attention RIsk versus benefit analysis working in a patient's best interests Working within one's own capabilities Achieving expected outcomes
What are the factors leading to ageing?
Decreasing ability to survive physiological stress
Rate of organ function decline caries with the wear and tear of the cells
Cytokines
What is the definition of a cytokine?
Interact with cells of the immune system in order to regulate the body’s response to disease and infection
Also mediate normal cellular processes
How is the skin affected in an old patient?
Pale and thin
Altered wound healing
How is the skeletal muscle affected in an old patient?
30-40% reduction in muscle mass, strength, functionaluty and endurance
How are the eyes affected in an old patient?
Presbyopia
Impaired adaptation to the dark
Decreased lacrimation
How is the CVS affected in an old patient?
HR decreases
BVs stiffer
How is the immune system affected in an old patient?
Decreases with age
Increases infections
Autoimmune disorders
Neoplasms
How is the NS affected in an old patient?
SMall decreases in brain mass, synaptic and NuT changes
Decreased sensitivity in feet and to hot and cold
How is the skeleton affected in an old patient?
Loss of bone possibly resulting in osteoporosis
Risk of fracture
Worse in women
How is the GI affected in an old patient?
Reduced body fat Liver mass Metabolic rate Increased gastric acid leading to peptic ulcers Increased Vit D Cholesterol increases
How are the kidneys affect in an old patient?
Low renal mass and reduced ability to respond to stress
Reduced renal BF and hormones decreases
How is the endocrine system affected in an old patient?
Increases
Increased adenomas in pituitary and adrenal glands + thyroid
What are the findings of the Meeting the challenges in Oral Health a strategic Review 2005?
2025 1 in 5 people aged 65+ will be edentulous
2025 40-45% of older people will have 21 or more teeth
Increased maintenance
What will change if the elderly have more teeth at older ages?
Shift in resto treatment from middle age to older
Increases exposed roots
Increased risk factors for decay (dry mouth and medications)
Pain via denture wearing
Poor oral hygiene from frailty
Reliance of carers for oral hygiene
Poor diet (high sugar)
How may treatment change for the elderly in the future?
Specialist care Free/closer parking Infection fear for COVID-19 Home visits? Online visits? aerosol producing procedures more risky for elderly Access to surgery and dental chairs Suction Payment Domiciliary care
What is domiciliary care?
Home visits
Name the 8 ethical obligation of a dentist?
Good not harm Relieve pain Act in patient's best interest Fulfill your duty of care Gather information from many sources to fulfil obligations Use information to fulfil ethical obligations Honesty Safety against the virus
What are the oral side effects for:
- aspirin, methotrexate, NSAIDs, antibacs, antivirals and anticonvulsants (sulfonamides)?
- ACE inhibitors, antidiabetics and diuretics?
- antibac?
Burns
Cytotoxicity
Oral ulceration
Erythema multiform or Stevens-Johnson syndrome
Lichenoid eruptions
Candida
What are the oral side effects of:
- chlorhexidine
- tetracycline
- Fl
- bisphosphonates
Cl: - brown staining Tetra: - intrinsic staining Fl: - Fluorosis and mottling Bisphosphonates: - MRONJ - Osteoporosis - Paget's disease
