Case Study: Domiciliary dental care

BACKGROUND

A dentist – Dr U – has been approached with a request to provide domiciliary dental treatment in a local care home. Her practice dental nurse works restricted hours and would be unable to accompany Dr U on visits – although the care home staff will be available to assist. She contacts MDDUS to ask if it would be appropriate to provide this service unaccompanied by a registered dental nurse.

ANALYSIS/OUTCOME

An MDDUS dental adviser replies by letter with advice in the matter. He cites GDC guidance Focus on Standards (6.2.5): "If you are providing treatment in a care or domiciliary setting you should be supported by a GDC registrant or an appropriately trained care professional".

Dr U has confirmed that she will not be accompanied by a GDC registrant and that raises the question as to whether a care home assistant could be categorised as an "appropriately trained care professional".

The adviser acknowledges that this is a somewhat subjective area but is of the opinion that certain dental procedures would not necessarily require the presence of a dental nurse other than for BLS (basic life support). For example, a dental inspection and most denture stages would not require assistance by a dental nurse. However, if during a procedure the resident fell over or became unwell, the intervention of an appropriately trained care assistant would be helpful.

Other treatments, such as extractions, would require the presence of a dental nurse who is familiar with procedures and the likely complications. A care assistant would not be appropriately trained for such invasive treatments.

As such, Dr U is advised that it would be far simpler to ensure the assistance of a dental nurse on all domiciliary visits – but failing this she would need to risk assess each case in terms of the planned procedure. Simple treatments not requiring much assistance from a dental perspective could be provided alongside a care worker who could also act (at all times) as a chaperone. Dr U would also need reassurance that BLS provisions were in place.

Dr U is also advised to create protocols which would inform decision-making processes so that if challenged in the future, she could demonstrate (having read the relevant GDC standard) a system for the delivery of dental care that did not put care home residents at risk. These protocols would need to be tailored to reflect care provision in the individual’s home.

KEY POINTS

• Dentists providing treatment in a care or domiciliary setting should be supported by a GDC registrant or an appropriately trained care professional.
• Practitioners would be expected to be able to demonstrate that they considered the particular patient, procedure and their own skills and experience before making the decision to work without trained chair-side assistance.
• A chaperone can be helpful to a clinician when faced with accusations of misconduct.