Dental training may have qualified dentists as fit to practise, but UK-wide dental defence organisation MDDUS is reminding dentists that maintaining these standards is paramount to ensuring patient care is not compromised.
‘Cutting corners and taking shortcuts is something we are all probably a bit guilty of at some point in our lives,’ writes MDDUS dental adviser Claire Renton in SoundBite, MDDUS magazine for trainee dentists.
‘It is common to make judgements on what risks we are prepared to take by weighing up the likely benefits against any potential harm.
‘But what happens if we start to cut corners in dentistry? What are the risks of deviating from our training when carrying out assessments or providing treatment for our patients?
‘There is no doubt that, over time, as our experience and ability increase this will inevitably lead to changes in our clinical practice. Occasionally, however, these changes might not be made for the right reasons – i.e. to speed up treatments or increase profit – and this could lead to problems.
‘Patients may be adversely affected, prompting complaints, and you could find yourself in professional difficulties with the GDC if your clinical practice is not in line with their guidance.
‘At the root of many dento-legal cases dealt with by MDDUS are a handful of basic errors and omissions – or sloppy habits – that, if avoided, could have prevented a lot of trouble for our members.”
Top of the list when it comes to sloppy habits has to be not using rubber dam for root canal treatment.
‘A dentist might be tempted to access a canal with a file without rubber dam,’ added Claire.
‘Some dentists don’t bother using it because they find it difficult to place and believe they can work just as effectively without it. Root canal treatment is actually much simpler with rubber dam.
‘It keeps tongues at bay and, by popping in a saliva ejector underneath, your nurse can concentrate on assisting you rather than aspirating every two seconds. Once you’ve cleaned and irrigated the canals they don’t fill straight up with contaminated saliva, making the treatment more like to be a success.
‘Of course, one of the most important functions of rubber dam is airway protection. There is simply no defence for an inhaled or swallowed file during root canal treatment performed with no rubber dam in place.
‘MDDUS has dealt with cases where endodontic instruments have been ingested because of a lack of rubber dam and it’s always a stressful situation for all concerned.
‘The patient clearly has a serious medical problem if they have swallowed or inhaled an endodontic file and the dentist is in the awful position of explaining that the patient now has to make an urgent visit to hospital for assessment and possible surgery to retrieve the file. Not surprisingly, patients are not happy about this and often complain or raise a claim through solicitors.’
Another treatment that can fall victim to complacency is omitting to carry out a BPE (basic periodontal examination), which can be a costly mistake. “Failure to perform a BPE for new patients and as part of regular check-up appointments could lead to an emerging periodontal problem being missed,” says Claire.
‘The BPE is a simple and quick way of checking the state of the patient’s periodontal health and is an essential component of patient management. Claims for cases relating to undiagnosed periodontal problems usually run into thousands of pounds.
‘Other slightly sloppy habits we can get into include failing to use retraction cord, or an equivalent, if needed during crown preparations with inevitable resultant poor margins and poor fit of restorations. This might not prove problematic for a year or two but patients are likely to remember how much they paid for their crowns and expect them to last.
‘You should always ask yourself if you are changing your practice for the benefit of the patient or for your own financial or other benefit.’
Click on the link to see the latest edition of MDDUS magazine SoundBite. http://bit.ly/MTcdfX