10 • Best practice
Dental training may have qualifi ed you as fi t to practise but have sloppy habits already crept in? MDDUS dental adviser Claire Renton looks at some to avoid
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UTTING corners and taking shortcuts is something we are all probably a bit guilty of at some point in our lives, but on most occasions no harm is done. Anyone who has ever taken driving lessons, for example, will remember being taught to “feed the wheel”, but how many
drivers can honestly say we still do so once our test has faded from memory? It is common to make judgements on what risks we are
prepared to take by weighing up the likely benefi ts 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 profi t – and this could lead to problems. Patients may be adversely aff ected, prompting complaints, and you could fi nd yourself in professional diffi culties with the General Dental Council 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.
Rubber dam Top of the list when it comes to sloppy habits has to be not using rubber dam for root canal treatment. Can anyone remember doing an RCT at dental school without it? No, me neither! But what about now? Are all your root canal treatments still done under rubber dam? Have you ever been tempted to access a canal with a fi le without rubber dam? Some dentists don’t bother using it because they
fi nd it diffi cult to place and believe they can work just as eff ectively without it. I am a great fan of rubber dam and fi nd that once you get
used to applying it (it’s easier if you get your nurse to help) lots of types of dental treatment are so much easier. Root canal treatment is actually much simpler with rubber dam. It keeps slobbery wet 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 fi ll straight up with contaminated saliva and you’ve got half a chance of your treatment being successful. Of course one of the most important functions of rubber dam is airway protection. There is simply no defence for an inhaled or swallowed fi le during root canal treatment performed with no rubber dam in place. Here at MDDUS we see a steady trickle of 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 fi le 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 fi le. Not surprisingly, patients are not happy about this and often complain or raise a claim through solicitors.
Periodontal pitfalls Another treatment that can fall victim to complacency is omitting to carry out a BPE (basic periodontal examination) for new patients and as part of regular check-up appointments which could lead to a failure to spot an emerging periodontal problem (see page 12). 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.
STAND
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