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12 • Professionalism, Law and Ethics
327
has any criminal record that might make them unsuitable
to have contact with vulnerable persons. People working in
health care require an enhanced DBS check. These are
applied for through a registered body or by a recruiting
organisation who needs the applicant to be checked. This
applies for England, Wales, the Channel Islands and the
Isle of Man. This process was previously called Criminal
Records Bureau Enhanced Disclosure (CRBED).
In Scotland, there is a separate but similar scheme called
the Protecting Vulnerable Groups (PVGs) Scheme. This is
managed and delivered by Disclosure Scotland.
Never Events
The NHS has a National Reporting and Learning System
(NRLS) to report never events and advise on minimising
their re-occurrence. A never events list is published annually by NHS Improvement, included in this list is the extraction of the wrong tooth. It is expected that this event should
be reported to NRLS or the local health authority, unless it
is a deciduous tooth removed under general anaesthesia.
Currently, the only other never event listed that might possibly occur in a dental environment is the mis-selection of
high strength midazolam for use in intravenous sedation.
Safeguarding
It is important to have safeguarding training for all staff,
and, to this end, Public Health England has issued a booklet
‘Safeguarding in General Dental Practice – A Toolkit for Dental
Teams’. This recommends that:
n
each dental practice have a named safeguarding practice
lead
n
all members of staff (clinical and non-clinical) undertake the appropriate level of safeguarding training
n
there is a safeguarding reporting system in place and
staff are familiar with this
n
all members of staff know how to access the NHS
Safeguarding app for local safeguarding contact details.
Similarly, the GDC in principle 8 of Standards for the
Dental Team require that:
8.1. Always put patients’ safety first.
8.2. Act promptly if patients or colleagues are at risk, and
take measures to protect them.
8.3. Make sure if 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.
8.4. 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 it is followed at all times.
8.5. Take appropriate action if you have concerns about
the possible abuse of children or vulnerable adults.
Cases of neglect or abuse may be obvious to the practice
staff and care is needed to confirm this. There will be a local
Social Services Team who deal with these cases, and any
concerns should be reported to that Team rather than pursuing the investigation in the practice.
Whistleblowing
The Public Interest Disclosure Act [1998] (PIDA) specifically protects whistleblowers, giving protection to employees who raise genuine concerns about potentially illegal or
dangerous practices. It applies to everyone working in the
NHS. A disclosure must be made in good faith which the
reporter believes is true and is not making the disclosure for
personal gain. This act applies to all dental professionals
within the NHS whether employees or self-employed. Action is required if any of the following are seen:
n
Attitudes or skills below expected levels.
n
Poor clinical skills or lack of competence.
n
Behavioural problems.
n
Poor managerial or organisational skills in health care
delivery.
n
A high number of patient complaints.
n
Inadequate induction or training of staff.
n
A bullying culture.
n
Financial irregularities.
Raising concerns is also endorsed by the GDC in its guid-
ance within Standards for the Dental Team (Section 8.11).
If advice is needed before raising concern in the NHS,
NHS Improvement has advice in its website and a whistleblowing helpline; also the charity Protect (formerly called
Public Concern at Work) will offer advice.
There is a duty to raise any concern that you might
have, it is a matter of highlighting a potential problem
rather that proving the case. After that, it is up to the head
or designated person in your organisation to investigate
the measure.
Friends and Family Tests
There are two contexts in which this can be used:
Firstly, in gaining patient feedback, a questionnaire can
ask, ‘How likely are you to recommend us [our practice/our
hospital/our clinic/etc.] to your friends and family?’:
n
Extremely likely
n
Likely
n
Neither likely or unlikely
n
Extremely unlikely
n
Don’t know
Secondly, when deciding on a particular treatment for a
patient, ask yourself, ‘Would you do the same treatment for
a friend or family member?’.
General Liability
Owners of property and/or land have a general liability
concerning safety to the general public, and prudent owners take out insurance to cover this liability.
Discrimination
There have been several pieces of antidiscrimination legislation passed over the years. These have been brought together by the formation of the Commission for Equality and
Human Rights (see previously mentioned details).
Legislation Involved in Dental Treatment
national health service acts and regulations. Naturally
these only cover patients receiving NHS treatment. Copies
of the appropriate rules and regulations should be issued to
all independent practitioners undertaking treatment under
Health Service regulations by the appropriate health authority. In the case of employees, the appropriate health
authority or NHS trust has this responsibility.
data protection. See GDPR (already discussed).
328
Master Dentistry
The Consumer Protection Act 1987
The provision of dental treatment may be considered as the
provision of goods or services under this Act. However, the
vast majority of actions in dental and medical matters are
dealt with via the negligence route.
Social Security Acts
Certain patients on low income are able to have the patient’s contribution to NHS dental treatment paid for by the
State. Employees applying for Statutory Sick Pay, Statutory
Maternity Pay or various other allowances come within the
umbrella of Social Security.
Agreements and Contracts of Employment
It would be expected, or considered essential, that there is
a legal framework governing the interaction between an
individual professional and an employing (contracting)
organisation. In many cases, terms within the contract
are likely to be structured around nationally negotiated
terms and conditions of service. This is likely to be variable both within the United Kingdom (England, Scotland,
Wales, Northern Ireland) and internationally. It is recommended that the individual reviews carefully all documentation and, if necessary, seeks advice and guidance
by a relevant organisation. For example, in the United
Kingdom, this may be the BDA as the trade union for
dental practitioners.
Awareness of the Law
Individuals are subject to the law of the land whether international, national or regional. In addition, dental professionals must also appreciate how the law may interface
with delivery of health care for patients and how changes
in law may impact on their clinical practice, for example,
the Mental Capacity Act in relation to patient choice. The
impact of the law can have a profound effect on the delivery
of health care, both for the individual and the professional;
it is therefore essential to keep up-to-date and have a contemporary understanding.
The law is such a diverse field, which is ever changing.
As such, it is beyond the scope of this book to explore, other
than raising awareness. It is also important to be aware
that there are also differences in the legal systems dependent on the jurisdiction involved. An example of this is that
there are several differences between the Scottish legal
system and the legal system applying to England and Wales
as well as Northern Ireland: for instance, the category of
cases seen in the various levels of courts and the naming
of those levels. Whichever jurisdiction is involved, it is essential to obtain legal advice from someone trained in that
jurisdiction.
Acronyms
There are many bodies and organisations that affect the
practice of dentistry; these are often known by their initials. Also, there are several acronyms in general use
within the healing professions, many of which are listed
here for reference. Whilst every effort has been made to
ensure these are contemporary, reorganisation of bodies,
changes in structures and procedural updates mean that
some of these will become less relevant as they are replaced over time.
ABDFT Advisory Board for Dental
Foundation Training
ABSTD Advisory Board for Specialty
Training in Dentistry
ACF Academic Clinical Fellow
AccessNI Equivalent to DBS in England
ADEE Association for Dental Education in
Europe
AGP Aerosol Generating Procedure
ALARA/
ALARP
As Low As Reasonably Achievable/
Practicable (Radiation dose
minimalisation)
ALB Arm’s Length Body
ARCP Annual Review of Competence
Progression
ARF Annual Retention Fee (to stay on GDC
Register)
ASA Advertising Standards Agency
AT Area Team (previously PCT)
BAOMS British Association of Oral &
Maxillofacial Surgeons
BASCD British Association for the Study of
Community Dentistry
BDA British Dental Association
BDS (BChD) Bachelor of Dental Surgery
BNF British National Formulary [of
medicines]
BOS British Orthodontic Society
BSDH British Society for Disability & Oral
Health
BSDMFR British Society of Dental & Maxillofa-
cial Radiology
BSPD British Society of Paediatric Dentistry
CBD Case-Based Discussion
CCG Clinical Commissioning Group
CCST Certificate of Completion of Specialist
Training (see also FTTA)
CDEC Continuing Dental Education
Committee (Wales)
CDO Chief Dental Officer (of England, or
Northern Ireland, or Scotland or
Wales)
CDS Community Dental Service
CDT Clinical Dental Technician
CEX Clinical Evaluation Exercises
CGDent College of General Dentistry
COPDEND Committee of Postgraduate Dental
Deans & Directors
COPMeD Conference of Postgraduate Medical
Deans (UK)
CPD Continuing Professional Development
CQC Care Quality Commission
CQUIN Commissioning for Quality &
Innovation (Scheme)
CRB Criminal Records Bureau (now DBS –
Disclosure & Barring Service)
CRG Clinical Reference Groups
12 • Professionalism, Law and Ethics
329
CT Computed Tomography
DBS Disclosure & Barring Service
(previously CRB)
DCS Dental Complaints Service (of GDC for
private patients)
DCT Dental Core Trainee
DDRB Doctors & Dentists Review Body (Advises
Government on NHS pay rates)
DFT Dental Foundation Training/Trainee
DFY1 Dental Foundation Year One
DFY2 Dental Foundation Year Two (previ-
ously SHO (Senior House Officer))
DGA Dental (extractions under) General
Anaesthetic
DHSC Department of Health and Social Care
DOPS Direct Observation of Procedural
Skills
DSC Dental Schools Council
DWSI Dentist with Special Interest (in
carrying out certain treatments)
EBP Evidence-Based Practice
ES Educational Supervisor
EWTD European Working Time Directive
FOIA Freedom of Information Act
FD Foundation Dentist
FDI (Federation Dentaire International)
World Dental Federation
FDS [RCS] Faculty of Dental Surgery (of a Royal
Surgical College)
Fellowship in Dental Surgery (of a
Royal Surgical College)
FFGDP Fellowship of the Faculty of General
Dental Practice
FFT Friends & Family Test
FGDP [UK] Faculty of General Dental Practice
FSG Freedom to Speak up Guardian
FtP Fitness to Practise Investigation
(by GDC)
FT Foundation Trust (NHS organisation)
FTTA (Orthodontic) Fixed Term Training
Appointment (now Post CCST
Trainee)
GDC General Dental Council
GDS General Dental Services (NHS dental
practice services)
GDPC General Dental Practice Committee
(of the BDA)
GDPR General Data Protection Regulations
GMC General Medical Council
GPT General Professional Training (now
Foundation Training)
HCAIs Health Care Associated Infections
HCP Health Care Provider
HCW Health Care Worker
HEE Health Education England
HEFCE Higher Education Funding Council for
England
HEIW Health Education and Improvement
Wales
HIW Health Care Inspectorate – Wales
HMRC Her Majesty’s Revenue & Customs
HSC Department of Health and Social Care
in Northern Ireland
HSCIC Health & Social Care Information
Centre
HTM 01-05 Health Technical Memorandum on
Decontamination
IACSD Intercollegiate Advisory Committee
for Sedation in Dentistry
IADR International Association for Dental
Research
IAT Integrated Academic Training
(pathway)
IC Investigating Committee (of the GDC)
ICO Information Commissioners Office
(Data Protection)
IDA Irish Dental Association
IELTS International English Language
Testing System
IOC Interim Orders Committee (of the
GDC)
IQE International Qualifying Examination
(now replaced by ORE)
IR(ME)R Ionising Radiation (Medical Exposures)
Regulations
IRR Ionising Radiations Regulations
IS Inhalation Sedation
ISCP Intercollegiate Surgical Curriculum
Programme
ISFE Intercollegiate Specialist Fellowship
Examination
IOSN Index (Indicator) of Sedation Need
ITF International Training Fellow
JCPTD Joint Committee for Postgraduate
Training in Dentistry
JSCT Joint Committee for Surgical Training
KPI Key Performance Indicators (in NHS
dental contracts and other clinical
services)
LAT Local Area (Health) Team
LDC Local Dental Committee
LDN Local Dental Network
LDS Licence in Dental Surgery
LETB Local Education & Training Board
LocSSIPs Local Safety Standards for Invasive
Procedures
LPN Local Patient Network
MCN Managed Clinical Network
MDT Multi-Disciplinary Team
MFDS Member of the Faculty of Dental
Surgery (of a Royal Surgical College)
MFGDP Member of the Faculty of General
Dental Practice (of a Royal Surgical
College)
330
Master Dentistry
MHRA Medicines and Health Care Products
Regulatory Agency
Mini-PAT Mini Peer Assessment Tool
MJDF Member of the Joint Dental Faculties
(of the Royal College of Surgeons of
England)
MMI Multiple Mini Interviews
MRC Medical Research Council
MSF Multi-Source Feedback
NACPDE National Advice Centre for
Postgraduate Dental Education
NAO National Audit Office
NatSSIPs National Safety Standards for
Invasive Procedures
NDPB Non-Departmental Public Body
NES NHS Education for Scotland
NHS National Health Service
NHS FFT NHS Friends & Family Test
NHS QIS National Health Service Quality
Improvement Scotland
NHSBSA National Health Service Business
Service Authority
NICE National Institute for Health and
Clinical Excellence
NIDPC Northern Ireland Dental Practice
Committee
NIHR National Institute for Health Research
NIMDTA Northern Ireland Medical & Dental
Training Agency
NSF National Service Framework
NTN National Training Number
NTNa Academic National Training Number
OMFS Oral & Maxillofacial Surgery
ORE Overseas Registration Examination
(of GDC)
OSCE Objective/Observed Structured
Clinical Examination
PBA Procedure-/Problem-Based Assessment
PCC Professional Conduct Committee
(of the GDC)
PCN Primary Care Network
PCO Primary Care Organisation
PCSE Primary Care Support, England
PCT Primary Care Trust (now disbanded)
PDS Personal Dental Services
PECR Private & Electronic Communication
Regulation (GDPR)
PGMDE Postgraduate Medical and Dental
Education
PHE Public Health England
PIDA Public Interest Disclosure Act
(protection for whistleblowers)
PIDO Public Interest Disclosure Order
(Northern Ireland) – as mentioned
previously
PLAB Professional & Linguistic Assessment
Board
PLG Patient Liaison Group
PPC Professional Performance Committee
(of the GDC)
PPE Personal Protective Equipment
PPI Patient & Public Involvement
(in decision making)
PREMs Patient-Reported Experience
Measures
PROMs Patient-Reported Outcome Measures
PSA Professional Standards Authority for
Health & Social Care
Pt Patient
PVG Protecting Vulnerable Groups Scheme
(in Scotland)
QUANGO Quasi-Autonomous Non-
Governmental Organisation
QOF Quality & Outcomes Framework
QoL Quality of Life
RAG Red–Amber–Green (to advise patients
of their oral health risk)
RCPS[Glas] Royal College of Physicians and
Surgeons (of Glasgow)
RCS[Edin] Royal College of Surgeons
(of Edinburgh)
RCS[Eng] Royal College of Surgeons
(of England)
RCSI Royal College of Surgeons in Ireland
REF Research & Excellence Framework
RIDDOR Reporting of Injuries, Diseases &
Dangerous Occurrences Regulations
(1995)
RITA Record of In-Training Assessment
RQIA Regulation & Quality Improvement
Authority (Northern Ireland)
RTF Research Training Fellowship
SAAD Society for the Advancement of
Anaesthesia in Dentistry
SAC Specialist Advisory Committee
SAS Staff & Associate Specialist (a non-
consultant hospital career grade
for Doctors & Dentists)
SCD Special Care Dentistry
SDCEP Scottish Dental Clinical Effectiveness
Programme
SDPB Scottish Dental Practice Board (NHS)
SEDENTEXCT EU Guidelines on the use of CBCT in
dental & maxillofacial radiology
SHA Strategic Health Authority (now
replaced)
SIGN Scottish Intercollegiate Guidelines
Network
SJT Situation Judgement Test (used in
interviews & examinations)
SMART[Goal-
setting]
Specific, Measurable, Attainable,
Relevant & Timebound (multiple
variations)
SMC Scottish Medicines Consortium
12 • Professionalism, Law and Ethics
331
SPDCSs Salaried Primary Dental Care
Services
SpR Specialist Registrar (changed to StR in
2009)
StR Specialty Registrar
STC Specialty Training Committee
TPD Training Programme Director
UCAT University Clinical Aptitude Test
UDA Unit of Dental Activity (in NHS
dental treatment)
UK NARIC National Recognition Information
Centre for the UK
Self-Assessment: Questions
MULTIPLE CHOICE QUESTIONS (TRUE/FALSE)
1. The following are eligible for full registration with the
GDC:
a. Dentists who qualified in the United States
b. Dentists who qualified in India
c. Dentists who qualified from a UK University
d. Dentists who have not completed dental foundation
training
e. Dentists who only have a Licentiate of Dental Sur-
gery from a Royal College, not a Bachelor of Dental
Surgery from a UK university
2. The Overseas Registration Examination:
a. Is in three parts
b. Each part can only be attempted once
c. Includes an English language test
d. Has to be passed by UK qualified dentists for full
registration
e. Has to be passed by Israeli dentists for full registration
3. The following specialties are recognised by the GDC for
specialist registration:
a. Dental public health
b. Maxillofacial surgery
c. Endodontics
d. Oral surgery
e. Crown and bridge
4. Consent to treatment:
a. Can be verbal
b. Can be written
c. Can be implied
d. Is not required for patients under 16 years of age
e. Can be withdrawn by the patient
5. A dentist referring a patient for general anaesthesia must:
a. Fully justify why a general anaesthetic is required
b. Take a full medical history
c. Explain to the patient the risks involved
d. Obtain consent from the patient or their guardian
e. Offer alternative methods of pain control in order to
complete treatment for the patient
6. When treating a patient under general anaesthesia, the
dentist must:
a. Repeat the history taking
b. Repeat the explanations concerning risk, alternative
treatments and pain control
UOA Unit of Orthodontic Activity (in NHS
treatment)
VT Vocational Training
VTE Vocational Training Equivalence
(a scheme for overseas dentists to
allow them to undertake NHS prac-
tice in the United Kingdom)
WBA Work-Based Assessment
WHO World Health Organisation (part of
United Nations)
WPBA Workplace-Based Assessment
c. Obtain verbal consent
d. Keep careful records of the treatment
e. Give written pre- and postoperative instructions
7. Before undertaking treatment under sedation, the
dentist must:
a. Assess the patient
b. Take a full medical history
c. Obtain written informed consent
d. Ensure that equipment and facilities are adequate
e. Advise on alternative methods of completing treatment
8. When treating a patient under sedation:
a. A chaperone must be present
b. The patient should be monitored only during the
sedation
c. Drugs must be available for resuscitation
d. The patient’s recovery must be supervised
e. The patient must be accompanied by a responsible
adult
9. Complaints from patients:
a. Every dental practice should have a complaints
procedure
b. Only dentists and doctors can deal with complaints
from patients
c. Should be managed by an outside body or organisa-
tion
d. Only complaints in writing can be accepted
10. The following would not be considered negligent:
a. Something going wrong when treating a friend out-
of-hours
b. Not treating a patient to the standard that would be
expected of a specialist
c. If the patient did not suffer harm or damage from a
dentist’s error
d. If the dentist had a duty of care at the time
e. If the dentist did not exercise reasonable skill and
care
11. A claim for compensation for negligence against a
dentist is unlikely to succeed:
a. If the patient pleads ‘res ipsa loquitur’
b. If the dentist carried out reasonable treatment
c. If the patient persuaded the dentist to undertake
treatment that the dentist was doubtful would be
successful
332
Master Dentistry
d. If the damage occurred as a result of the patient
grabbing the dentist’s working arm
e. If the negligent act or omission was carried out by
an employee
12. The following laws affect the practice of dentistry:
a. COSHH Regulations
b. The Dentists Act
c. Health and Safety at Work Acts
d. General Data Protection Regulation
e. Financial Services Act
13. It is illegal to discriminate against people because of their:
a. Race
b. Dietary habits
c. Pregnancy
d. Sex
e. Age
SINGLE BEST ANSWER QUESTIONS
1. The UK General Dental Council is:
A. A department of the government
B. A higher education provider
C. A health care regulator
D. An indemnity organisation
E. A trade union organisation
2. Which of the following registration types are included in
the General Dental Council’s Dental Care Professional
register:
A. Clinical Dental Technician
B. Dental Practice Manager
C. Dental Receptionist
D. Maxillofacial Prosthetist and Technologist
E. Oral Health Educator
3. A requirement when renewing registration with the
General Dental Council includes declaration of:
A. Income protection
B. Membership of a trade union organisation
C. Membership of one of the Royal Colleges
D. NHS performer number
E. Professional indemnity
4. According to the GDC in the United Kingdom, continuing professional development should be planned:
A. As opportunities arise as long as all necessary topics
are covered
B. Based on local opportunities, availability and delivery
C. In conjunction with scope of practice and a personal
development plan
D. On a 3-year rolling cycle
E. To focus on topics a dental professional has interest
in and is proficient at
5. The following is recognised on the General Dental Council
Specialist list:
A. Aesthetic dentistry
B. Cosmetic dentistry
C. Maxillofacial surgery
D. Oral surgery
E. Surgical dentistry
6. The following would not be within the Scope of Practice
of a Dental Hygienist in the United Kingdom:
A. Application of fissure sealant
B. Periodontal examination and charting
C. Restoration of a primary tooth
D. Root surface debridement
E. Smoking cessation advice
7. Which of the following options would be the most appropriate registrant for a dentist to refer a patient to for
caries removal and restoration of a permanent tooth in
a 12-year-old child?
A. Dental Hygienist
B. Dental Nurse
C. Dental Technician
D. Dental Therapist
E. Orthodontic Therapist
ESSAY QUESTIONS
1. Whilst working as a Dentist in an Oral Surgery department, you see a patient and carry out multiple tooth
extractions under local anaesthetic. When you complete
the extractions you notice you have been working from
an old dental pantomogram (DPT) taken several years
ago, rather than the one taken at the patient’s recent
assessment visit. After re-checking your notes you realise you have extracted a tooth that was not included in
the treatment plan. Describe how you would manage
this situation.
2. How would you deal with a complaint from a patient
whom you treated a few months earlier?
Self-Assessment: Answers
MULTIPLE CHOICE ANSWERS
1. a. False.
b. False.
c. True.
d. True.
e. True.
2. a. False.
b. False.
c. False.
d. False.
e. True.
3. a. True.
b. False. It is a medical specialty.
c. True.
d. True.
e. False.
4. a. True.
b. True.
c. True.
d. False. Required for all patients, in loco parentis if
necessary.
e. True.
5. a. True.
b. True.
c. True.
d. True.
e. True.
12 • Professionalism, Law and Ethics
333
6. a. True.
b. True.
c. False. Written informed consent is essential.
d. True.
e. True.
7. a. True.
b. True.
c. True.
d. True.
e. True.
8. a. True.
b. False. The patient must also be monitored during
recovery.
c. True.
d. True.
e. True.
9. a. True.
b. False. Every practice or health organisation should
have someone nominated to deal with complaints,
but they do not have to be a doctor or dentist.
c. False. Complaints should be dealt with internally in
the first instance.
d. False. Complaints can be verbal or written.
10. a. False. Liability is present whenever treating any patient.
b. False. Unless you are a specialist in the same or a
related field.
c. True.
d. False.
e. False.
11. a. False.
b. True.
c. False. A dentist should refuse to treat in this case.
d. True.
e. False. A dentist is liable for acts and omissions of
employees.
12. a. True.
b. True.
c. True.
d. True.
e. False.
13. a. True.
b. False.
c. True.
d. True.
e. True.
SINGLE BEST ANSWER QUESTION ANSWERS
1. C
2. A
3. E
4. C
5. D
6. C
7. D
ESSAY QUESTIONS
1. Points to consider when structuring your answer:
n
Immediate management and patient care
n
Communication and informing the patient (Duty of
candour)
n
Incident reporting (considered to be a ‘never event’)
discussing whom you would inform and the process
that would take place following this
n
Long-term care arrangements or follow-up
n
Reflection and avoiding similar incidences in the
future (how: audit, clinical governance)
n
For completeness, sign-posting any complaints procedure a patient may wish to follow
2. Points to consider when structuring your answer:
n
All health care organisations must have a system for
dealing with complaints. In the United Kingdom, in
addition to this, the General Dental Council’s ‘Stan-
dards for the Dental Team’ Principle 5 outlines the need
to have a clear and effective complaints procedure
n
Respecting the patient’s right to complain
n
Communication: Acknowledgement of complaint,
listening to their complaint, keeping the patient informed of progress, prompt and constructive response
n
Flexibility of approach and responding appropriately to
the complaint – how this may be achieved if the complaint was received by telephone, in person or in writing
n
Appropriate recording
n
Information gathering and investigating
n
Options for resolution
n
Involvement of Indemnity organisation
n
Local resolution if possible, options for escalation if
complaint cannot be resolved
n
Future learning: personal or practice development
and risk management (personal development planning for continuing professional development)
Index
Page numbers ending in ‘b’, ‘f ’ and ‘t’ refer to Boxes, Figures and Tables respectively. The letter ‘Q’ following a page number indicates a related question.
A
Abfraction, 95
Abrasion, 94 – 95
tooth surface loss, 184
Abscess
acute periradicular, 50
chronic periradicular, 50
exudate, 3
facial swelling, 5
periodontal, 19Q, 40
Abutments
implants, 144, 147 – 148
overdentures, 131
Access
canal preparation, 61 – 62
cavity preparation, 79
coronal, 57
endodontic openings, 57 – 58
pre-enlargement and straight-line radicular,
canal preparation, 61 – 62, 79Q
prior considerations, 58b
radicular, 57, 61 – 62
root canal system, 58, 58b
technique, 58, 59b
Accessory cusps, evaginated teeth, 261
Accessory root canals, 20
Acid
caries, 86 – 87
enamel bonding, 91
etching, 91
Acrylic resin, 122
Actinomyces, 64
Active enamel lesions, 88 – 89
Acute periradicular abscess, 50
Acyanotic defects with shunts, 209
Adams’ clasp, 290
Adhesive bridgework, 109 – 110
Adhesive retention, 97 – 98
Adhesive vs. mechanical onlay preparations,
102f
Adolescence, 173
Adrenal insufficiency, 212
Adult orthodontics, 271 – 272
Advanced glycation end-products (AGEs), 18
Aesthetics
Index of Orthodontic Treatment Need,
227 – 228
pontic design, 109
African countries, necrotising ulcerative
gingivitis, 10
Age factors
apical anatomy, 57
consent, 322
gingiva, 2
see also Children
AGEs see Advanced glycation end-products
(AGEs)
Aggregatibacter actinomycetemcomitans, 13, 16
Aggressive periodontitis
associated syndromes and medical
conditions, 28 – 30
Down syndrome, 29
334
Aggressive periodontitis (Continued)
Ehlers–Danlos syndrome, 29 – 30
hypophosphatasia, 30
Langerhans cell histiocytosis, 30
leukocyte adhesion-deficiency syndrome, 30
Papillon–Lefevre syndrome, 29
AI see Amelogenesis imperfecta (AI)
Akerly classification of traumatic incisor
relationship, 28, 29f
Alginate
copy box technique, copy/duplicate
dentures, 127 – 129
master impressions, complete dentures, 122
Aligners, removable appliances, 291
Allergies
benzodiazepines, 154
latex, 231
medical history, 198
nickel, 231
Altered cast technique, 135b, 137Q
Alveolar bone
destruction, 39Q
loss of, 299
radiographic features, 2
supporting, injuries to, 204
upper median diastema, 257 – 258
Alveolar crest, 2, 10
Amalgam, 93 – 94
caries treatment, children, 178 – 179
overhangs, 18
Amelo-dentinal junction (ADJ), 89 – 90
Amelogenesis imperfecta (AI), 191t, 207
Amnesia, 197
Anaemia, 211
Anaesthesia
endodontic examination, 52
general, 323 – 324
local, 76
nitrous oxide, 156
selective, 52
see also Sedation
Analgesia
nitrous oxide, 156
reservoir bag, relative analgesia machine, 165
see also Pain
ANB angle, 237 – 238, 246Q
Anchorage
control, 294
defined, 290
demands, 290
extractions, 243
extraoral reinforcement, 290
fixed appliances, 294
headgear safety, 290
high/very high, 290
intraoral reinforcement, 290
loss, 301Q
low, 290
moderate, 290
orthodontic treatment, 242
reinforcement, 290
removable appliances, 290, 301Q
temporary devices, 243, 294
Angle’s classification, malocclusion, 226, 226f
Ankylosis, 256
Anomalies, dental (children), 216Q
amelogenesis imperfecta, 207
chronological disturbances, 207
dens evaginatus, 206
dens invaginatus, 206
dentine defects, 207 – 208
dentine dysplasia, 208
dentinogenesis imperfecta type II, 207 – 208
developmental, 255 – 256
double teeth, 206, 260 – 261
enamel defects, 207
eruption and exfoliation disorders,
208 – 209
fluorosis, 207
form, 260 – 261
hypodontia, 205 – 206, 254 – 255, 276Q
macrodontia, 206
megadontia, 259
microdontia, 206
number and morphology, 205 – 207
osteogenesis imperfecta, 208
size, 259 – 260
supernumerary teeth, 206, 255
talon cusp, 207
taurodontism, 207
Anterior bite plane, 291, 301Q
Anterior crossbite, 270
Anterior open bite, 268 – 269, 277
Anterior teeth, 180
dental caries, 180
discoloured, 180
management, 191
Anteroposterior plane, orthodontic
assessment, 231
Anteroposterior skeletal pattern
cephalometric analysis, 231, 237 – 238
classification, 231
Antibiotic prophylaxis, 4 – 5
Anticoagulant, 5, 210
Antifungal agents, 212
Antimicrobials, 40Q
Antimuscarinics, 88
Antipsychotics, 153 – 154
Anxiety, in children, 174
Anxious and uncooperative children, 174
Apexogenesis, 189f
Aphthous-type ulcers, 214
Apical anatomy, age changes, 57
Apical and middle third root fractures, 202
Apical lock, 204
Apically positioned flap, 34, 34b
with bone removal, 35
no bone removal, 35, 35f
technique, 34b
Apical patency, root canal preparation, 62
Apical periodontitis, 49
Apical preparation
conventional instruments, 62
NiTi instruments, 62 – 63
rotary nickel–titanium instrumentation
technique, 63 – 64
Index
335
Apical third, access to in root canal
retreatment, 73
A-pogonion line, 238
Approximal caries
diagnosis, 175
permanent teeth, 180
Arachidonic acid metabolites, 16
Arches see Dental arches
Archwires, 293
Armamentarium, 62, 181b
Arthritis, orthodontic assessment, 231
Assessment of patient, 50 – 53
case selection and treatment, 52 – 53
complete dentures, 119 – 125, 137Q
consciousness, 164
diagnosis, 52
extraoral examination, 51
implants, 145
intraoral examination, 51
occlusal analysis, 51
patient history, 50 – 51
pulp testing, 51 – 52
sedation, 155, 167Q
special tests, 51 – 52
tooth mobility, 51
traumatic injuries in children, 197 – 199
Asthma, 212, 230
Asymptomatic periradicular periodontitis, 50
Asynchronous multiple burst theory, 17
Attached gingiva, 2
Attrition, 95
Autism, 216
Avulsion, 216Q
permanent teeth, 203 – 204
primary teeth, 200
Axial reduction, 101
B
Backfilling of canal, vertical condensation of
gutta-percha, 66, 67b, 67f
Bacteria
pathology, pulpal and periradicular, 48
plaque, 16
Balanced forces, root canal preparation, 60
Bands, fixed appliances, 292
Base plate, removable appliances, 290 – 291
Basic Periodontal Examination (BPE), 39Q, 175
Bass toothbrushing technique, 31
B cell defects, 211
Beading, master impressions, 122
Behavioural/learning difficulties, orthodontic
assessment, 231
Benzocaine gel, 212
Benzodiazepines
allergy to, 154
amnesic actions, 156
antagonist drugs, 157
available for sedation, 157
flumazenil, 157
intravenous, 156 – 157
mechanisms of action, 156
midazolam, 157
overdose, 167Q
pharmacodynamic properties, 167Q
remimiazolam, 157
side-effects, 156 – 157
Benzydamine hydrochloride, 212
Beta-titanium, 293
Bilateral buccal crossbite, 270
Biliary atresia, 214
Bimaxillary procedures, 274
Bimaxillary proclination, 262, 277Q
Bionator functional appliance, 295
Bis-glycidyl methacrylate (GMA)-based
resins, 92
Bismuth oxide, 54
Bispectral Index (BIS), 165
Bisphosphonate-related osteonecrosis of the
jaw (BRONJ), 5
Bisphosphonates, 231
Bitewing radiographs, 175, 192Q, 235
Blast cells, leukaemia, 211 – 212
Bleaching
external, 182
home bleaching technique, 181
inside–outside non-vital, 182
internal, 182
nightguard vital, 182, 183b
non-vital technique, 181 – 183
vital technique, 182
Bleeding
following probing, 2, 23
gingival see Gingival bleeding
periodontitis, 10
Bleeding disorders
classification, 210t
coagulation disorders, inherited, 210
diatheses, orthodontic assessment, 231
haemophilias, 210
medical history, 198
prevalence of inherited, 211t
thrombocytopenia, 210
von Willebrand’s disease, 210
Blood disorders see Red and white blood cell
disorders
Blood pressure, non-invasive recording,
164 – 165
Blood tests, 175
Bodily movement, effect, 298f
Body osteotomy, 274
Bolam principle test, 326
Bonded molar tubes, fixed appliances, 292
Bonding
bis-glycidyl methacrylate (GMA)-based
resins, 92
chemical, 109
dentine, 91 – 92, 91f
enamel, 91
resin, 91 – 92
smear layer, 91
total-etch technique, 91 – 92
Bone
alveolar see Alveolar bone
loss of, 39Q, 299
regeneration, furcation lesions, 21
removal, 77
Bone marrow
biopsy, 211 – 212
transplantation, 214
Bone resorption, alveolar bone, chronic
periodontitis, 11
Bottle brushes, 32
Bow, long labial, 290
BPE see Basic Periodontal Examination (BPE)
Brackets
fixed appliances, 292
splints, 203
Breastfeeding, sedation contraindication, 154
Bridge pontics, plaque accumulation, 18
Bridges/bridgework, 107 – 110
adhesive bridgework, 109 – 110
cantilever design, 107, 107f, 108
clinical assessment, 107 – 108
fixed bridge, 107
implants, 146
periodontal health, 107
previous restoration, 108 – 110
fixed–fixed bridge, 108, 108f
material choices, 109
pontic design, 108 – 109, 109f
tooth positions, 107 – 108
Bristles, 31
British Dental Association (BDA), 319
British Dental Journal, 320
British Standards Institute (BSI), malocclusion
classification, 226, 226f
Bronchitis, in COPD, 153
Brushite, 13
Bruxism, 4
Buccal displacement, 277Q
Buccal segment
distal movement, 245
extractions in, 244
final relationship, planning, 242
Bucco-lingual discrepancy, 234 – 235, 234f
Bullet-nosed pontics, 109
C
Calcification, 173t
pulp, 49
Calcium-channel blockers, 25
Calcium silicate bioceramic cements, 78
Calcium silicate cements (CSCs), 54, 68
Calculus, 13
dental, 38Q
subgingival, 13
supragingival, 13
Calvarium, craniofacial skeleton, 222
Canal see Root canal; Root canal preparation;
Root canal retreatment
Cancer, children, 211
Canines
angulation of, orthodontic assessment, 234
ectopic maxillary, 259
endodontic openings, 57
extractions, 244
lower, 242, 244
maxillary, displacement, 260t
orthodontic assessment, 234
orthodontic treatment, 242
primary, early loss, 257
upper, 244
Cannulation, intravenous, 161
Capnography, 165
Carbamide peroxide gel, 181
Cardiac defects, orthodontic assessment, 230
Care Quality Commission (CQC), 330
Caries
anterior teeth, 180
cavity finalisation, 90 – 91
in children
development, 176
diagnosis, 175
epidemiology, 176
prevention, 177 – 178
primary teeth see Primary teeth
risk assessment, 176 – 177
treatment, 178 – 180
clinical assessment, 88 – 89
deep lesions, 90
development and progression, 86 – 87, 87f
diet, 177
epidemiology, 176
initial management, 89
lesion assessment, 183
management principles, 87 – 88
non-operative management, 89
operative management, 89 – 90
orthodontic treatment, 239 – 240
permanent teeth, 179 – 180
preventive regime, 177 – 178
primary teeth, 179
restorative materials
amalgam, 178 – 179
glass ionomer cements (GIC), 179
polyacid-modified composite resin, 179
336
Index
preformed crowns, 179
resin-based composite, 179
risk assessment, 88Q, 89b, 110 – 111
root, 89
treatment, 178 – 180
Carrier-based techniques, 67 – 68, 68f
Case selection, and treatment, 52 – 53
Cast, removal, 72 – 73
Cationic agents, 32
Cavity
design optimisation, 103
endodontic examination, 52
Cementation, restorations, 106
Cementoenamel junction (CEJ), 2, 2f
Cement-retained implant-supported crown, 146f
Cements
glass ionomer see Glass ionomer cements (GIC)
root filling materials, 65
Centrelines, orthodontic assessment, 234
Centric relation (CR), 100
Cephalometric analysis, 235 – 238
aim and objective, 236
ANB angle, 237 – 238
anteroposterior skeletal pattern, 237 – 238
Ballard conversion, 238
class III malocclusion, 277
as diagnostic aid, 236
facial proportion, 238
incisor position, 238
interpretation, 236 – 238
lateral, uses, 236
MMPA and facial proportion, 238
standard points, 237f, 237t
technique, 237b
treatment
and growth changes assessing, 236
progress, means of checking, 236
vertical skeletal pattern, 238
Wits analysis, 238
Ceramic restorations, 96
Cerebral palsy, children, 215
Cervical-enamel projections (CEPs), 20, 20f
Cervical vertebral maturation (CVM),
263 – 264
Chamfer preparation, 101f
Chaperones, 323, 324
Charters’ techniques, 31
Chemotactic disorders, 211
Chemotherapy, microdontia resulting from,
206
Chewing, 240
Chief Dental Officers, 310
Child protection, 205
Children
adrenal insufficiency, 212
anaemia, 211
anomalies, dental see Anomalies, dental
(children)
anxious and uncooperative, 174
asthma, 212
autism, 216
bleeding disorders, 210
bone marrow transplantation, 214
caries
development, 176
diagnosis, 175
epidemiology, 176
prevention, 177 – 178
risk assessment, 176 – 177
treatment, 178 – 180
cerebral palsy, 215
cognitive development, 173
congenital cardiac disease, 209 – 210
cystic fibrosis, 212
deafness, 215
Children (Continued)Caries (Continued)
dental anomalies see Anomalies, dental
(children)
dentist-patient relationship, 173 – 174
detection of bony or dental pathology, 175
developmental disability, 215 – 216
developmental problems see Developmental
problems
diabetes mellitus, 212
endodontics, 186 – 190
examination, 174 – 175
febrile convulsions, 215
gingiva in, 2
graft-versus-host disease, 214
hepatic disease, 214 – 215
HIV, oral disease associated with, 214
language development, 173
management of, 172 – 174
metabolic and endocrine disorders, 212 – 213
molar-incisor hypomineralisation (MIH),
190 – 192
motor development, 173
neoplastic disease, 213
neurological disease, 215
organ transplantation, 213 – 214
parental influence and dental treatment, 173
perceptual development, 173
periodontal tissues in, 2
permanent teeth see Permanent teeth
physical abuse, 205, 216Q
psychological aspects, 173 – 174
pulp treatment
primary teeth, 186 – 188
pulpectomy, 188
pulpotomy, 187
radiographic examination, 175
red and white blood cell disorders, 211 – 212
renal disease, 214
respiratory disease, 212
social development, 173
teeth
congenital absence of some (hypodontia),
205 – 206, 254 – 255
dentine defects, 207 – 208
development, 172
discolouration see Discolouration of teeth
double, 206, 260 – 261
with dry storage time of greater than one
hour, 204
enamel defects, 207
eruption, 172
eruption disorders, 208 – 209
evaginated, 261
exfoliation disorders, 208 – 209
fragments, lost, 197
lost, 197
macrodontia, 206
microdontia, 206
permanent teeth, 188 – 190
primary teeth see Primary teeth
supernumerary, 255
supernumerary teeth, 206
surface loss, 184 – 186
treatment plan, 175 – 176
visual impairment, 215
Children Act of 1989, 216Q
Child safeguarding, 204 – 205
Child wellbeing, 205
Chisels, 33
Chlorhexidine digluconate, 32
Chlorhexidine mouthwash, 39Q, 203
Chloroform, 73
Chronic gingivitis, 13
Chronic obstructive pulmonary disease
(COPD), sedation contraindication, 153
Chronic periradicular abscess, 50
Ciclosporin, 5, 25
Cinnamon, 9
Civil Justice System for England and Wales,
Woolf reforms (1996), 327
Clear aligner therapy, 291
Cleft lip and palate
aetiology, 274
alveolar bone grafting, 277Q
body tissues, anomalies, 275
care management, 275 – 276
classification, 274, 275f
clinical features, 275
dental and occlusal features, 275
dental anomalies, 277Q
growth, 275
hearing, 275
Millard technique, 275 – 276
mixed/permanent teeth, 276
neonatal period, 275 – 276
prevalence, 274 – 275
primary dentition, 276
retention, 276
skeletal features, 275
speech, 275
Cleft Lip and Palate Association (CLAPA), 275
Clinical dental technicians, 315
Clinical examination, 174. see also
Examination
Clinical risks, caries assessment, 88
Closed inside–outside bleaching technique
(IOC), 182
Coagulation disorders, inherited, 210
Cobalt–chromium alloy, 293
Cobalt-chromium removable partial dentures
(CCRPDs), 18, 137
Code of Ethics for Dentists, 318
Cognitive development, 173
Cold, pulp sensitivity test, 51
Collagenases, 15
Colonisation, plaque, 13
Community Periodontal Index of Treatment
Needs (CPITN), 5
Complaints procedure, 324 – 328
adaptation and flexibility, 324
fitness to practise investigations, 317 – 318
GDC complaints advice service, 325
Health Service Commissioner
(Ombudsman), 325
local resolution, 325
mediation, 324
and mixing, 325
Complement system, 16
Completion of specialist training (CCST),
319 – 320
Complications
implants, 149 – 150
intravenous sedation, 161 – 163
Compomer (polyacid-modified composite resin)
caries management, in children, 179
Composite resin
caries management, in children, 179
polyacid-modified, 179
splints, 202
veneers, 183 – 184, 184b
Composite restoration
direct, 173
localised resin, 183b
Compression dome effect, 103
Compromised anterior teeth restoration, 104
Computed tomography (CT) scans,
implants, 145
Computer-aided design–computer-aided
manufacture (CAD–CAM) technology,
ceramic restorations, 96
Computer-assisted probes, 7
Concrete operations, 173