Planning Permission

February 20, 2014

Dental consultationA patient comes in for a check-up.  They may be in pain and upset.  You may be rushed and hassled.  The priority is getting them out of trouble.  However, ‘planning’ the next stage may get pushed lower down the list of things to do!

More than the obvious!

More and more practitioners are facing problems (such as litigation!) by not planning appropriate treatment and by not explaining all the options and risk to patients.  It can be argued that the examination is the most important treatment we ever provide, but this involves treatment planning too.  So, after listening to the patient’s story and any physical examination, all the possibilities need to be discussed.  Treatment planning is about finding a pathway for patients to achieve that level of oral health they are capable of supporting, by listing appropriate, safe, evidence based treatment that reflects their needs, preferences and diversity.  Options need to include information about the most appropriate ways to keep their mouth, teeth and gums healthy.

There are some basic planning guidelines too –

  • Think of how you might build a house.  Look to starting with sound foundations and complete periodontal treatment before any sophisticated restorations.
  • Find out how important aesthetics are to the patient and plan whitening before anterior fillings, so that shades match.
  • Find out if there are any alternative belief systems that might affect the type of treatment which the patient will find acceptable.

It is always the case that the more information you give a patient about treatment, the better choices they can make. Remember that ‘Informed Consent’ is not valid unless all the alternatives have been explained with the advantages, risks and costs of all the options.  Valid options include ‘do nothing’ or ‘keep the status quo’.   When someone refuses treatment, we must respect the choice and record the decision.  Every patient should be provided with a written, personalized Treatment Plan.  These actions insure compliance with CQC Essential Standards, Outcome 2 – Consent to care and Treatment.

NHS contract Compliance

As well as our CQC obligations, we need to ensure that we do not breach NHS regulations.   If you provide Band 2 or Band 3 treatment, use the stock NHS treatment plan document.  Never suggest to an NHS patient that they can only be accepted if they have any private treatment first. In addition, make sure private options are listed on the plan alongside the NHS treatments.

Holistic or Holistic?

The GDC Standards talk about an ‘holistic’ approach to planning care.  Unfortunately, this has two meanings!  The holistic concept in conventional practice, means that all aspects of people’s needs including psychological, physical and social should be taken into account and seen as a whole.   This involves taking a thorough history from the patient and involving their wishes and needs in any plan.

The other meaning is concerned with ‘alternative medicine’ and care.  Holistic dentistry is a practice that features the use of non-toxic methods of caring for oral health.  It covers the same areas as traditional dentistry but works with the entire body in order to ensure optimal health.  If this is the path you follow, it is essential to informed consent that you talk to the patient about all options and gain their agreement to alternative treatments.

Homeopathic Dentistry

Homoeopathy is an important part of holistic dentistry.  It is believed that homoeopathic remedies can help to minimise and reduce inflammation and speed healing times.  As well, they can reduce anxiety and pain, as well as help with the treatment of many different dental diseases.   There are qualifications available for the practice of homeopathy and it should not be practiced without completion of a recognised course.  If a patient requests this style of dentistry, the same principles apply as those relating to referral for treatment outwith your skills.

Treatment Planning is not simple!  The basic principles are enshrined in the QCSUK Treatment Planning Policy and Procedures document.  Refer to this if you are unsure.

John Shapter
John Shapter

Dental Specialist


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