Manual of Clinical Procedures in Dentistry

Nairn Wilson, Stephen Dunne, Nairn Wilson, Stephen Dunne

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119389576
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

A definitive manual covering everything you need to know about the core procedures in dentistry

The Manual of Clinical Procedures in Dentistry comprehensively explains the core procedures in dentistry, how to do them, and the rationale that underpins them. Full of useful and easy-to-access information, it acts as a compendium of practical procedures in primary dental care, supporting students and dental practitioners in their daily professional and academic lives.

This manual is a complete, practical guide to the delivery of effective, state of the art oral healthcare—the 'what, when, and how' of clinical practice. It compiles chapters written by expert clinicians on topics such as dental imaging, the management of dental pain, conscious sedation, operative dentistry, implant dentistry, oral medicine and surgery, paediatric dentistry, periodontics, prosthodontics, special care dentistry, dental trauma, aesthetic dentistry, and much more.

• Provides step-by-step guidance on procedures in primary dental care
• Comprehensive coverage of all dental disciplines, from endodontics to orthodontics
• Compiled by two highly experienced editors with contributions from expert authors
• Covers essential non-clinical areas, such as communicating with patients, obtaining valid consent, audit procedures, and handling of complaints

The Manual of Clinical Procedures in Dentistry is an invaluable text for dental students and new graduates, as well as a definitive guide for the whole dental team.

1
The Changing Nature of the Practice of Dentistry

Nairn Wilson

This introductory chapter gives an overview of the changing nature of the practice of dentistry, highlighting current and anticipated future issues and challenges.

Big Picture

Dentistry is a fast developing biomedical healthcare science which should be viewed as an integral element of mainstream healthcare – oral health having been recognised to be important to general health and wellbeing. Moving on from the long‐established, experienced‐based, mechanistic approach to treating different forms of oral and dental pain, discomfort and disease, dentistry is evolving into a patient‐centred, evidence‐based, preventatively orientated, minimum intervention system of care to establish and maintain oral health – a health‐ rather than a disease‐management service. This, however, only holds true for dentistry in forward‐looking, typically well‐developed countries of the world. In other countries, where there are provisions for oral healthcare, dentistry may be found to be caught, to different degrees, in a twentieth century time warp, with treatment focusing on pain relief, often by means of traditional, interventive restorative procedures and the extraction of teeth, with or without prosthetic replacement. Elsewhere in our diverse, unequal world, billions of people have no, or at best very limited access to any form of dental care.

This chapter, in common with the rest of the manual, considers arrangements, procedures and techniques for patient‐centred, evidence‐based, preventatively orientated approaches to oral healthcare provision – best practice.

Oral and Dental Disease

The social determinants of oral and dental disease are largely universal: exposure to an unhealthy diet, tobacco use, excessive consumption of alcohol, and poor oral hygiene all contribute to poor oral health. In addition, many adults do not help themselves limit their exposure to oral and dental disease, by, for example, indulging in the frequent consumption of sugar, forgetting to brush their teeth, not bothering with interdental cleaning, and only seeking dental care when in pain or experiencing a problem.

In most developed countries overall levels of dental disease, in particular amongst children, have shown improvements in recent years, but behind such encouraging statistics there tend to be widening health inequalities, with levels of oral and dental disease increasing amongst the children of the poorest members of society. At the other end of the age spectrum, there is increasing longevity, with many more teeth being retained into old age; however, oral health among older people is generally poor, with levels of xerostomia and advanced periodontal disease being a particular cause for concern. In adolescents and young adults pathological tooth wear is now relatively common, and oral mucosal disease, notably the incidence of oral cancer, is increasing. So, while much has been achieved through the application of advances in the prevention of oral and dental disease, much remains to be done, and new forms of disease such as peri‐implantitis, albeit limited to those who have been fortunate enough to access implant dentistry, are generally considered to be a ‘ticking time bomb’. Overall, it may be concluded that there continues to be widespread exposure to the determinants of oral and dental disease, the most prevalent forms of which – caries and periodontal disease – are opportunistic and given the chance will affect patients of all ages. Furthermore, as discussed in detail in Chapter 2, it may be concluded that oral and dental diseases continue to be a major public health problem, in large part because of the failure of individuals to practise the most basic of preventative measures.

In helping to address oral and dental disease issues, dental teams should seek to find ways, in the community in which they operate, to help reduce oral health inequalities and increase public awareness of the importance of oral health and how it may be achieved and maintained. Such a service to society, if undertaken by all dental teams, would make an enormous difference to oral health in general.

The Dental Team

Modern oral healthcare is best provided by a dental team. The day of the single‐handed general dental practitioner, attempting to meet most, if not all of the many different dental needs of a diverse population of patients of all ages, is widely considered to be a thing of the past. For maximum efficiency and effectiveness, the dental team, led by one or more dentists and supported by a network of specialists in different, distinct branches of dentistry, should comprise:

• Oral health therapists, which may comprise (dental) therapists with skills and expertise in oral hygiene, or therapists together with dental hygienists.
• Dental nurses, trained together with other members of the dental team, with roles and responsibilities, over and above chairside participation in the provision of treatment, ranging from the recording of simple intraoral radiographic images to the application of preventive measures (e.g. fluoride varnishes) and oral health education. Dental nurses in modern practice environments must have well‐developed skills in running, or at least overseeing, state of the art decontamination and sterilisation procedures.
• Dental technologists, including clinical dental technologists, to work with the chairside team in the provision of indirect restorations, removable prostheses and other appliances. Increasingly, dental technologists are critical to developments in digital dentistry, including, for example, the production of restorations from digital images and CAD CAM (computer assisted design–computer assisted milling). It is anticipated that dental technologists of the future may have as many information technology (IT) skills as traditional manual skills.
• Practice managers with wide‐ranging roles and responsibilities to ensure the safe, efficient running of the practice or dental health centre. Practice managers’ skills and expertise may usefully include, by way of example, business development and marketing, practice accounting, consumables logistics and the management of human resources within the practice or centre.
• Dental receptionists as the patient’s first and most common point of contact with the dental team. In this role, receptionists require excellent human relationship and communication skills, together with skills in diary management, aimed at the best use of the time and skills of the various members of the dental team. Dental receptionists, in addition to requiring good telephone and face to face communication skills, are extending their roles to include multimedia communications with patients. Receptionists may also pay crucial roles in patient satisfaction surveys and the initial response to concerns and complaints.

As leaders of dental teams, dentists, amongst the many other challenges they face, must develop the necessary leadership skills during their formative years in clinical practice. Leadership courses are anticipated to become an important element of postgraduate dental education.

The Practice Environment

With the further demise of ‘old‐style’, single‐handed dental practices, in favour of multisurgery practices, if not dental health centres, the practice environment will continue to change. General dental practitioners of the future, more often than not with advanced skills and knowledge in some aspect of dentistry, may increasingly find themselves working in the same environment as specialists, as part of a ‘full service’ dental team. The facilities to support dental teams of different sizes and composition will grow in sophistication to take advantage of anticipated advances in dental technologies, some of which may be transformational, and possible changes in the scope of dentistry to facilitate the shared care of patients with other healthcare professionals. Innovations in IT, ergonomically enhanced ways of working, new devices and different forms of instrumentation, novel presentations of materials and growing patient expectations are some of the many factors which will individually and collectively shape and fashion the practice environment of the future. Above all else, the practice environment, apart from being welcoming and comfortable for patients and a good work environment for the dental team, must become an increasingly safe place for both patients and all those involved in their care.

Regulation

It is hoped that the clinical practice of dentistry will come to be regulated by modern, ‘right touch’ regulation, based on the following qualities:

• Proportionate: Regulatory intervention only when necessary, with measured, cost‐effective remedies appropriate to the risk posed.
• Consistent: Interrelated rules and standards implemented fairly.
• Targeted: Focused arrangements fit for purpose.
• Transparent: Open, simple, user‐friendly regulation.
• Accountable: Subject to, and satisfying public scrutiny.
• Agility: Forward‐looking and evolving to meet changing needs.

Good regulation should first and foremost protect the public, but with measures which support and encourage the profession to comply with the relevant code of conduct.

The main elements (pillars) of codes of conduct relevant to the practice of dentistry are anticipated to remain:

• Patient respect and autonomy.
• Do no harm (non‐maleficence).
• Act in the best interest of the patient – ‘do good’ (beneficence).
• Honesty and truthfulness (veracity).

In essence, treat others the way you would wish to be treated.

Developments in regulation will sooner or later include revalidation (recertification) including requirements for lifelong learning (continuing professional development, CPD) and possibly some form of self‐assessment and peer review or appraisal. Transformational innovations in dental technologies may bring about the need for top‐up training, or new arrangements for dental specialties, possibly including the demise or merger of existing specialties and the introduction of new specialties. To remain fit for purpose, the regulation of dentistry must change with changes in, amongst other factors, clinical practice, the regulation of other healthcare professionals, the dental workforce, relevant technologies and the needs and expectations of patients and the public.

The day of self‐regulation, once considered to be a defining characteristic of a profession, may have passed, in favour of ‘lay dominated’ regulation, but this should not disadvantage or cause con...