Manual of Dentistry

By Irena Baumruková

The presented work is a manual of medical English in dentistry. The material can be used by dentists, dental nurses, and dental hygienists who encounter English-speaking clients in their surgeries. Professionals and students who are going to work or study in English-speaking countries as well as teachers at high schools and universities will find this book a useful aid for everyday practice.

The topics covered are activities at the dentists, prevention and community dentistry, anatomy and physiology, pathology and microbiology, sterilization and infection control, dental radiology, case taking and examination, psychological aspects of dental care, emergency situations, periodontology, medicine relevant to dentistry, oral medicine, restorative dentistry, oral and maxillofacial surgery, orthodontics, prosthetics, administering medicines, and dental materials.

• Language: English
• Publisher: Xlibris UK
• Release date: Dec 5, 2016
• ISBN: 9781524594916

Irena Baumruková

The author has been teaching medical English for more than fifteen years. She would like to draw the readers’ attention to other materials published to help physicians, dentists, dental hygienists, medical students, paramedics, and nurses to learn professional English in an interesting and pleasant way.

Book preview

Unit 1

At the dentist’s; health and safety; running late; marketing; practice leaflets; communication; duties and non-surgical role of a nurse; record keeping; reception; clerical duties; working with patients and dentists; chair-side assisting; communication and teamwork; dental ethics; handling complaints; confidentiality; consent

Text 1

Health and safety

Employers are required to assess all substances (e.g. vapours, micro organisms) in the workplace which are potentially hazardous and take steps to prevent any risks to the employees. The following procedure is recommended:

• identify hazardous substances

• record frequency and quantity of use

• assess the risk

• monitor the medical conditions of staff where necessary

• prevent or control risk

• provide staff training

• record the assessment

Running late

If running late is becoming a habit, it is imperative to stop and re-assess your working practise. The first step is to re-evaluate the times booked for each common procedure. Go through the appointment book and block out some buffer zones in each session for emergencies, catching up with paperwork or, a breather.

Some additional hints to lessen the everyday stress:

• Have an appointment book divided into 5 min blocks to provide flexibility.

• A working day comprising a longer morning and a shorter afternoon is more productive.

• Designate some specific sessions for longer procedures.

• Schedule more complex work for the morning and less stressful work (e.g. check-ups) for the end of sessions.

• For last-minute cancellations, have a list of patients who are willing to come in at short notice.

• Define the working day and try not to extend beyond this.

• Coffee breaks and lunchtime should not be used to catch up on other work.

• Emergencies are the patients who are willing to attend any time. If buffer zones are built in your timetable, fitting in the true emergencies should not be a problem.

Marketing

The success of a practice is going to depend on its ability to attract and keep patients.

Advertising is a means of letting the public know about the existence of a practice and the services that are available:

• Leaflets

• Open days

• Practise website

• Adverts in local publications

• The best advert is a satisfied patient who will recommend you by word of mouth.

• First appearance counts.

• Most patients will make their initial enquiry by phone. So the phone should always be answered promptly, in person, with a friendly and welcoming greeting.

• When the patient arrives at the surgery the external and internal decor will play a role in determining a patient’s impression. The reception and waiting areas should appear cosy and inviting. Choose light, warm colours, and comfortable seating to give a relaxing ambience. Plants also help.

• A range of interesting magazines and practice leaflets on different aspects of dental care/health should be available.

The receptionist must be friendly and helpful and have good knowledge of dental techniques available so that patient’s queries can be answered correctly. The presentation and attitude of all the staff is of vital importance. It is also helpful if the receptionist can ask new patients how they heard about the practice so as to better target future marketing strategies. It is vital to know your patient base:

• Is there a significant group which may need special attention (e.g. elderly or young families)?

• What special services would your patients like to see?

• What do they feel about your opening times?

Practice leaflets

What information to include?

Compulsory information:

• Practice name, address and telephone number

• For all dentists at the practice: name, sex, qualification

• Hours and appointment system

• Whether suitable for patients who cannot climb the stairs and has wheelchair access

• Any foreign languages spoken

Optional information

• Practice philosophy

• Map showing location of practice

• Web site and e-mail addresses

• Emergency arrangements and contact phone number

• Illustrations of the practice, and photos of staff and facilities

• Details of charges

• Methods of payment accepted

Exercise 1

Answer the following questions. Prepare short talks and/or dialogues on these topics.

1. Speak about Health and safety measures.

2. How to organize the working day?

3. The ways of attracting and keeping the patients.

4. What are the main tasks and duties of a good receptionist?

5. What information should practice leaflets include?

Translation 1

Translate and/or explain in English.

Health and safety at the working place; prevent any risks; hazardous substances; medical conditions of staff; provide staff training; running late; assessing the working practice; the time booked for each common procedure; go through the appointment book; buffer zone; catch up with paperwork; a breather; coffee breaks and lunchtime; to lessen the everyday stress; provide flexibility; more complex work; check-ups; last-minute cancellations; emergencies; patients willing to attend any time; ability to attract and keep patients; advertising; leaflets about the services that are available; a satisfied patient; first appearance counts; answer the phone promptly; in person, with a friendly greeting; cosy waiting room, light, warm colours; comfortable seating, plants, interesting magazines; leaflets with the names of dentists and their contact phone numbers; surgery hours and appointment system; wheelchair access; foreign languages spoken; details of charges and methods of payment accepted.

Text 2

Basic communication

At the reception

• How can I help you?

• Do you have health insurance?

• I just need to take some details from you.

• Your surname? First name?

• Your address? Who is your next of kin?

• Please take a seat in the waiting room. The nurses will call you through.

Nurse - patient communication

• Have you got your insurance card?

• Have you ever had surgery?

• Are you allergic to anything?

• Have you been vaccinated against tetanus?

• I will take your temperature and blood pressure.

• Please have a seat, you will be called by name

• The medicine is available by/on prescription only.

• The doctor will write you a prescription

• For external use only.

• Is the medicine fully covered or is there a surcharge?

Dentist – patient communication

• What is the matter?

• I have a toothache. I have a headache.

• I have a sore throat. I cannot sleep.

• Can you give me something for the pain?

• What sort of pain is it? Is it sharp, dull?

• Where is the pain? How long does it last?

• Are you taking any medications?

• Now I am going to examine you.

• Does it hurt now? Where does it hurt?

• I must drill and fill this tooth.

• Or shall I take it out?

• No, I do not want it extracted.

• I want you to have an X ray.

• You must be taken to hospital.

• Are you alright?

• Here is a prescription for some pills.

• Take them three times a day after each meal.

• I would like you to come back in 3 days.

Dentist – nurse communication

• Have you good knowledge of dental techniques? Can you answer questions correctly?

• Have you any map showing the location of our practice?

• Where can a patient get details of charges and methods of payment accepted?

• What do you feel about our opening hours?

• What special services would you like to see?

• You should catch up with paperwork, too.

• I have to go through the appointment book.

• I have blocked out some time for emergencies.

• Please, call to ask which patients are willing to attend any time.

• Schedule more complex work for the morning.

• I usually schedule check-ups for the end of sessions.

Text 3

Medical histories

Reception and non-clinical duties are very important in the smooth running of any dental surgery. Medical histories should be completed for all patients, with no exceptions. Most standard forms have room for six-monthly signatures to indicate that the medical history has not changed since the patient’s last signing.

If details require updating, a new form should be completed. The form should also record the patient’s medical practitioner in case details need verifying or advice sought. All completed forms should remain with the patient’s record card. The existence of any serious conditions should be highlighted in some way, such as a red star on the record card.

Serious conditions that may affect the provision of dental treatment are:

• all heart disorders

• all respiratory disorders

• all liver or kidney disorders

• diabetes

• epilepsy

Details of current and recent medication should also be recorded, especially long-term steroids, antidepressants and anticoagulants.

Recent medical treatment should also be recorded. Any history of adverse reactions to anaesthesia, either local or general, should also be indicated. All these medical details will allow the dentist to decide whether treatment is appropriate at the surgery, or whether the patient needs a hospital referral, for example, for those with blood-clotting disorders.

Those details may determine which local anaesthetic is safe to use, for example, those with heart conditions should not be given a local anaesthetic with adrenaline as a vasoconstrictor. They also determine whether treatment should be provided under antibiotic cover, for example, for those patients with a history of rheumatic fever.

The medical history is of vital importance to the safety of the patient whilst undergoing dental treatment and this history should be taken as a matter of routine before they enter the clinical area.

Clinical record keeping

Clinical records can be recorded on forms or any suitable card. They should record the patient’s personal details, and practice reference details for accurate filing purposes. They should be able to hold all medical history forms, radiographs, referral letters and replies, and all signed consent forms for dental treatment.

The oral status at first attendance should be charted in the usual manner, together with an easy-to-follow charting of all dental treatment received at the surgery since first recorded.

The clinical notes can then be recorded in date order on the record card. The record card constitutes a legal document; this can be used in litigation claims as proof of treatment provided.

All discussions between the dentist and the patient should be recorded, especially items of treatment provided against the dentist’s advice. All the patient’s comments should also be recorded in relation to dental treatment.

Accurate charting records are often used in forensic medicine to identify bodies, especially those involved in fires where all other means of identification are lost.

A full accounting record of costs and payments for dental treatment should be included throughout the clinical records, including refunds made. Many legal disputes between patients and their dentist are settled against the dentist because inaccurate or incomplete records have meant that the case has been indefensible. Staff should also remember that the patient has a right to access to their clinical notes, so derogatory comments should always be avoided.

Exercise 2

Answer the following questions. Prepare short talks and/or dialogues on these topics

1. Medical histories

2. The importance of clinical record keeping

Translation 2

Translate and/or explain in English.

Smooth running of a dental surgery; complete medical histories; the patient´s signing; complete a new form; record the name of the medical practitioner; verifying of the details; seek advice; highlight serious conditions; affect the provision of treatment; indicate adverse reactions; appropriate treatment; a hospital referral; determine safe anaesthetics; under antibiotic cover; be of vital importance; undergoing treatment; matter of routine; clinical record keeping; record personal details; accurate filing; referral letters and replies; signed consent forms; the oral status at first attendance; charted in the usual manner; record in date order; litigation claims; proof of treatment provided; use in forensic medicine to identify bodies; accounting record of costs and payments; legal disputes; inaccurate or incomplete records; right to access to their clinical notes; avoid derogatory comments.

Text 4

Storage of dental stock

Stock cupboards should be maintained in a clean and orderly manner at all times. The dentist will quite often leave it to staff to arrange the stock as they see fit, but there should be ground rules.

Read the manufacturer’s instructions for the correct storage temperature of each stock item. Most require storage at no higher than room temperature, but some items should be kept cooler, preferably in a fridge. Solutions in dark-glass bottles should be kept out of sunlight. Several materials commonly used in the dental surgery are hazardous: for example, mercury. All staff should therefore be aware of and follow the recommendations for these items. Other commonly used materials are flammable and should thus be stored in metal cabinets, away from all sources of heat.

If space allows, the easiest storage method for stock is to have one shelf for similar items: for example, filling materials, anaesthetic materials and accessories, etc. These items can then be stored alphabetically, with the oldest items placed to be used first so that shelf-lives are not exceeded.

It helps all staff to mark where each item should be stored, so that it can be seen at a glance whether reordering is necessary.

Details to be recorded on a patient’s record card

• The patient’s full personal details (name and address, home and work telephone number, occupation, name and address of medical practitioner)

• Practice reference details, for filing purposes

• The existence of any serious medical problem, and highlighted

• Accurate charting of the patient on their initial attendance

• All subsequent dental treatment received at the surgery, correctly charted

• A full history of all clinical attendances, with all details of treatment received at each, with the correct date recorded

• All discussions between the dentist and the patient about all aspects of treatment received, recommendations for treatment and non-recommendations for treatment

• All laboratory work should have the name of the laboratory and any shades recorded, as well as any difficulties experienced in the fitting of the work

• Any requests for private/cosmetic treatment, and the outcome

• A full record of charges and payments received, including the method of payment

• A full record of any account letters sent to the patient, and their outcome

• All failed or cancelled appointments should be noted

• A record of any treatment advised by the dentist but refused by the patient for whatever reason

• For child patients, all details of hospital referrals should be recorded, whether for orthodontic or surgical treatment

• A note that post-operative instructions have been given after surgical treatment

• Full details of all prescriptions given

Additional material

• All radiographs, correctly marked and mounted

• All consent forms for NHS (National Health System) or private treatment

• All sedative consent forms, duly signed and dated

• All medical history forms, with signatures and dates as they are updated

• All periodontal charting records, dated

• Copies of all referral letters sent

• All referral letter replies

• All correspondence received from the patient; however, if it is a letter of complaint, this should be kept in the patient’s complaining log

• Copies of extensive and detailed treatment plans, whether provided or not

• Details of any private health insurance to which the patient subscribes

• Copies of any account letters sent

Exercise 3

Answer the following questions. Prepare short talks and/or dialogues on these topics.

1. Write notes on the storage of dental stock.

2. What details should be recorded on a patient’s record card?

3. What additional material should be kept with the patient’s notes?

Translation 3

Translate and/or explain in English.

Correct storage of stock; maintain in a clean and orderly manner; ground rules; keep out of sunlight; hazardous flammable materials; be aware of; recommendations; metal cabinets; away from all sources of heat; alphabetically; not to exceed shelf-lives; see at a glance; reorder; serious medical problem; subsequent dental treatment; follow the recommendations; difficulties experienced; fitting; requests for cosmetic treatment; outcome; charges and payments; failed or cancelled appointment; refuse for whatever reason; hospital referrals; prescriptions given; additional material; mark and mount a radiograph; a letter of complaint; health insurance to which the patient subscribes

Text 5

The non-surgical role of the dental nurse

The non-surgical role of the dental nurse is equally as important as the clinical role in the smooth and legal running of the practice. The efficiency of a dental surgery in correctly organising referral appointments and informing the patient of practice policies is the responsibility of the dental nurse. This person should know the protocol to follow, and should so with maximum effectiveness.

For extractions under general anaesthesia

• Directions to the department, if not known by the parent or guardian

• Patient to be starved of food and drink for six hours before the appointment time

• To attend with a responsible adult

• To have suitable transport arranged both before and after the appointment

• To miss taking any medication that will fall into the six hour zone pre-operatively, unless specifically instructed otherwise

• To follow correctly the post-operative instructions that will be given

• To contact the department directly if the appointment cannot be kept

• To ensure that the medical history form and any radiographs are taken to the appointment and given to the staff as necessary

For emergency cover

The responsibility for emergency out-of-hours advice and treatment is in the process of being transferred to Primary Care Trusts. An out-of-hours telephone number will be provided where dental advice can be given to the patient. A dentist will be available to provide emergency treatment as necessary. Out of normal practice hours, the emergency telephone number is given on the surgery answering machine; that number is also displayed in the window of the surgery.

For orthodontic referral

The appointment arranged should be attended promptly. The patient must take any radiographs and study models taken by the dentist to the referral appointment. Failure to do this may result in the appointment having to be rearranged.

The patient should attend with a clean mouth, as no orthodontic consultant will be willing to recommend treatment to a patient with a dirty mouth. At the appointment, the patient or parent/guardian should be encouraged to voice any concerns they have about orthodontic treatment.

Exercise 4

Answer the following questions. Prepare short talks and/or dialogues on these topics.

What instructions should be given to a patient/guardian when:

1. A child is being sent for deciduous tooth extraction under general anaesthesia?

2. A patient requests information on out-of-hours emergency cover?

3. A patient is to attend for a referred orthodontic consultation?

Translation 4

Translate and/or explain in English.

Responsibility of the nurse; to follow protocol; to be starved of food and drink for six hours before the appointment time; to have suitable transport arranged; to miss taking any medication; out-of-hours emergency; a dentist available; provide a telephone number of the surgery; answering machine; to encourage the patient; to voice any concerns; the storage of stock; expiring date; stockist; prescription pads must be locked away; issue, stamp and sign a prescription; under no circumstances; it is illegal; give an estimate for treatment required; use the oldest stock first; record accidents and injuries; recall appointment; the professional conduct; local rules are concerned with; flammable materials; expired stock should be disposed of safely; petty cash; receipts; telephone for paramedics; empty the waiting room of all patients.

Exercise 5

Match the column A with the column B. Try to learn the expressions and/or sentences by heart.

The sentences have been divided into separate halves. Match the half-sentences in column A with the half-sentences in column B to make sentences which are complete and correct.

A

1. A good stock control policy would ensure that ……

2. An accident book is used to ……

3. Medical history forms should be completed or ……

4. The professional conduct of all dentists is regulated by the ……

5. Local Rules are concerned with ……

6. All flammable dental materials should be stored in a ……

7. Expired stock should be ……

8. All petty cash transactions should be ……

9. Signed consent forms should be stored……

10. A current treatment file should contain ……

11. When a medical emergency occurs, the receptionist should ……

B

a) …… telephone for paramedics on 112 and then quickly and firmly empty the waiting room of all patients

b) …… the oldest stock is used first

c) …… General Dental Council

d) …… accurately recorded in a petty cash book, with receipts wherever possible

e) …… in the relevant patient’s record

f) …… updated at every recall appointment

g) …… record all accidents and injuries to all personnel and patients whilst on the premises

h) …… dental radiation and should be known by all personnel

i) …… metal cabinet

j) …… disposed of safely

k) …… record cards of all patients who are currently undergoing a course of dental treatment

Exercise 6

Fill in the missing words. Choose the correct ones. Try to learn the expressions and/or sentences by heart.

Text 6

Oral assessments

Oral assessments of both the extraoral and intraoral tissues are routinely carried out at dental examination. Extraoral assessments rely on the dentist’s vision for a comparison of normal versus abnormal features and appearances. Points such as skin pigmentation, swelling, abnormal coloration, blemishes and asymmetry will be looked for and recorded as being present or absent.

Intraoral examination includes all of the following areas: soft tissues, deciduous dentition, permanent dentition and periodontal tissues.

Again, vision will be relied upon when assessing the soft tissues for all of the above plus the moisture levels present, as well as touch when assessing texture and mobility of parts such as the tongue.

A mouth mirror is used to help to illuminate the areas under assessment, as well as to retract the soft tissues as necessary. Any abnormalities seen can be recorded on pre-printed, soft tissue assessment sheets, or photographed for further reference.

When assessing the dentition, the dentist may use a variety of special hand instruments called probes to determine the hardness of tooth surfaces, specifically a right-angle probe to run over easily accessible surfaces and restorations, and a briault probe to assess interproximal areas of the teeth. Softened tooth surfaces indicate that some degree of demineralisation or dental caries is present.

Any findings are recorded on the patient’s dental chart (a universal record that indicates all surfaces of all teeth and the restorations, etc. present), as well as any dental treatment required.

Adult teeth are coded 1-8 in each quadrant, and deciduous teeth are coded a-e in each quadrant. Accurate dental charting is an extremely important part of a dental nurse’s job.

The dentist also has specialist equipment available to investigate the hard tissues more extensively:

• To be able to accurately check difficult-to-see surfaces of the teeth and jaws, dental radiation can be used to easily identify dental caries, periapical lesions, periodontal bone levels, and bony lesions, however, all dental exposures must be clinically justified

• Transillumination can be used to determine carious lesions in the anterior teeth, whereby suspected cavities will appear as shadows in the mouth mirror when the curing lamp is shone from the labial surface of the tooth and viewed palatally.

• Various methods are available to test the vitality of a tooth (whether it is alive, dying, or dead), and include stimulation to cold with ethyl chloride, stimulation to hot with warm gutta percha or electrical pulp testing

• The periodontal tissues are assessed visually and with special periodontal probes that record the depth of any pockets present around each tooth. Use of these probes when some degree of periodontal disease is present will induce gingival bleeding, which can also be recorded on special periodontal charts. A basic periodontal examination will determine any sextant of the mouth where deep pocketing is present, by recording from 0 (indicating no periodontal disease) to 4 (indicating deep periodontal pocketing and the presence of subgingival calculus). Any areas scoring 4 can then have individual pocket depths and areas of bleeding recorded.

• In orthodontic cases and complicated restorative cases, the dentist can take alginate impressions to make study models of the patient’s occlusion, sometimes mounted on as an articulator to give accurate jaw movements too. These can be viewed at the dentist’s leisure to determine a treatment plan.

Exercise 7

Prepare short talks and/or dialogues.

Discuss the methods used by the dentists to carry out oral assessments.

Translation 5

Translate and/or explain in English.

Carry out assessments; extraoral and intraoral tissues; dental examination; comparison features and appearances; skin pigmentation, swelling, coloration, blemishes and asymmetry; be present, absent; look for, record; soft tissues, deciduous dentition, permanent dentition, periodontal tissues; rely on vision and touch; texture and mobility; to illuminate the area; to retract the soft tissues as necessary; probes; hardness of tooth surfaces; softened tooth surfaces; demineralisation, dental caries; findings are recorded on the patient’s dental chart; dental treatment required; adult teeth are coded 1-8 in each quadrant; to investigate the hard tissues; identify dental caries, periapical lesions, periodontal bone levels, and bony lesions; clinically justified exposure to radiation; transillumination in the anterior teeth; suspected cavities will appear as shadows in the mouth mirror; to test the vitality of a tooth; a tooth is alive, dying, dead; stimulation to cold, to hot; electrical pulp testing; to record the depth of any pockets present around each tooth; periodontal disease, gingival bleeding, presence of subgingival calculus; orthodontic cases, complicated restorative cases; to take alginate impressions; to make models of the patient’s occlusion.

Text 7

Diet and oral hygiene advice to a small group of 8 year olds

Good teamwork skills amongst the dental team members indicate that they are all able to work together to achieve a common goal, in this case passing correct oral hygiene advice to a group of youngsters.

The ability to work in a team means that members are able to accept authority as necessary (from the team leader) and also are able to take responsibility for the tasks delegated on them.

The team leader will oversee, or facilitate, the project by delegating various tasks to those judged most capable of carrying them out. The delegation decisions will take into account not only members’ previous experience and qualifications, but also important points such as if junior members of staff have siblings of a familiar age group and are therefore comfortable communicating with them.

If the various team members act on their own, the oral hygiene message will be less effective – if it is effective at all. Thus training together as a team is extremely important, so that each other’s actions are reinforced and the desired result is accomplished by all.

This will eliminate any confusion to the audience that would be caused if team members gave opposing oral hygiene messages.

For this age group, good communication skills will revolve around team members being able to discuss the necessary oral hygiene messages at the audience’s level of understanding, possibly using oral health aids depicting current toy heroes, for instance.

There will be variation in the levels of understanding, even in a small group, so the dental team must ensure that the advice given is neither too high intellectually nor too babyish and patronising, and this may mean that the group is split further and advised separately.

Eight year olds will respond well to short sessions of narrative instruction followed by hands-on practice, especially useful when teaching good tooth brushing techniques or disclosing their teeth.

They usually enjoy the opportunity to shout out answers as a group when asked questions, or to be taught catchy phrases that they can repeat by rote. So the team member with responsibility for this area of the session needs to have a pleasant, fun-loving attitude that the group will enjoy, and be able to talk at the group’s level in a friendly and approachable manner.

The oral hygiene messages related can also be turned into a presentation project for the children so that they can pass on the information they have learned to other classmates, and this is especially useful when painting, crayoning and the like are involved.

Team members should be prepared to work at the children’s desk or even on the floor if appropriate, as, again, this relays the ability for the adults to enjoy themselves and have fun with the children. Although the whole atmosphere will be loud and good fun for the children during the session, a delegated person must keep overall control of the group at all times, in a firm but friendly manner.

Exercise 8

Prepare short talks and/or dialogues.

Explain how teamwork and communication skills can be used to give diet and oral hygiene advice to a small group of 8 year olds.

Translation 6

Translate and/or explain in English.

Good teamwork skills; to achieve a common goal; correct oral hygiene; to accept authority; to take responsibility; the team leader will oversee, facilitate the project; by delegating various tasks; take into account; previous experience and qualifications; a familiar age group; comfortable communicating; if the various team members act on their own the message will be less effective; accomplish the desired result; eliminate any confusion; variation in the levels of understanding; aids depicting current heroes; the group is split further; short sessions, narrative instruction, hands-on practice; toothbrushing techniques, disclosing their teeth; to shout out answers, learn catchy phrases, repeat by rote; to talk in a friendly and approachable manner; a presentation project; pass on the information to other classmates; involve painting, crayoning and the like; good fun for the children, loud atmosphere; keep overall control of the group at all times.

Text 8

Smoking in relation to oral health

Smoking has many detrimental effects on oral health, as well as the irrefutable effects it has on general health. The greatest risk is the development of oral cancer, especially in patients who drink alcohol too, as the two habits together produce a significant increase in the likelihood of developing a sinister lesion.

Current evidence also suggests that oral cancer is occurring in younger patients than ever before, so it is no longer classed only as an older person’s disease and always needs to be looked out for at examination.

Smoking also has a vasoconstrictive effect on the periodontal blood vessels so that identifying the presence of periodontal disease is more difficult for the dental team as bleeding gums are not a significant occurrence in smokers.

This means that periodontal disease can be present for some considerable time before being diagnosed, especially in patients who attend irregularly and therefore the damage it does can be hidden until it is very severe. The likelihood of tooth loss in these cases is much greater.

The tar deposits from cigarettes attach to the teeth and cause unsightly brown or black extrinsic staining, removal of which requires great efforts by the dentist or hygienist.

The halitosis produced by smoking is also often severe and offensive to others, and smokers very often suck mints daily in an effort to combat it, with disastrous results for their teeth as carious lesion develop.

The periodontal and carious damage caused in the smoker’s mouth usually means larger bills for dental treatment too.

Communicating with young people v. (versus) adults

Young people have different priorities in life than adults, with general health and oral health not usually being of significant importance to them. They will have little, if any, experience of oral or general health problems themselves, unless the problems involve a close family member.

Some often have a know it all attitude towards professionals, especially when the information being given is not to their liking (such as a smoking advice), and they are unlikely to heed the advice offered.

However they are affected by peer pressure and will be greatly influenced to take actions that will impress their friends. They are unlikely to take dental health advice unless it is backed up by evidence that is directly relevant to themselves so the use of disclosing tablets, for instance, is very important in proving that a problem exists before action can be taken.

Some young people will not be prepared to accept responsibility for their own oral health, despite the best efforts of parents and dental professionals alike, and they are very ready to apportion blame elsewhere as necessary. The amount of parental support towards good oral health will also differ markedly from one young individual to another, as will the example set by their parents with regard to oral hygiene, smoking and the importance of good oral health.

Exercise 9

Prepare short talks and/or dialogues on these topics. Write short notes on each of the following:

1. Smoking in relation to oral health

2. Different factors in communicating with young people in comparison to adults

Translation 7

Translate and/or explain in English.

Smoking in relation to oral health; detrimental effects, irrefutable effects; general health; the risk of oral cancer especially in patients who drink alcohol too; a significant increase in the likelihood; current evidence; a vasoconstrictive effect on the blood vessels; identifying the presence of periodontal disease is more difficult; damage can be hidden until it is very severe; tooth loss; the tar deposits from cigarettes cause unsightly staining; removal requires great efforts; the halitosis, offensive to others; sucking mints daily with disastrous results for their teeth; carious lesion; larger bills for dental treatment; communicating with young people in comparison to adults; different priorities, little experience; health problems are not significant for them; to heed the advice offered; peer pressure, impress friends; relevant evidence; disclosing tablets; be prepared to accept responsibility for their own oral health; apportion blame elsewhere; despite the best efforts of professionals; the parental support and personal example will differ markedly.

Text 9

Oral assessments

Oral assessments are a valuable tool in the regular monitoring and recording of the normality, or any abnormality, of a patient’s oral tissues. The most important role of the dental nurse during the assessment is to record all the findings accurately, as dictated by the dentist. This means that the nurse must be familiar with all written or computerised methods of note-taking and recording of findings.

Details of all extraoral soft tissues must be recorded, often using pre-printed sheets that can be inserted into the patient’s written dental record card, and the measured sizes of any lesions or abnormalities must be accurately recorded.

Tooth charting will also be carried out at the oral assessment, either a full charting of all treatment already carried out and any required, for a new patient, or an update charting for an existing patient.

It is imperative that the correct quadrant is being recorded, as well as the correct tooth and its surfaces, as inaccuracies here may lead to the wrong tooth being treated in the future. Similarly, accurate periodontal recordings should be made, whether they are just BPE (basic periodontal examination) charts, or those involving pocket-depth recordings or bleeding and plaque indices.

A very important role for the dental nurse, then, is to have all the correct patient notes and any assessment sheets ready to be used before the patient enters the clinical area. Nothing looks worse than the nurse scurrying around for the necessary records while the dentist and patient are kept waiting.

Also, all the equipment and hand instruments likely to be required should be laid out ready for use – of course, having been correctly cleaned and sterilised after their last use.

Anticipation by the dental nurse of any extra assessments being carried out for occasional patients, such as alginate impressions for study models or photographs, goes a long way in allowing the assessment to run smoothly and efficiently.

Some dentists rely on the dental nurse to have gone through a medical history with the patient before the assessment begins and to highlight any queries for the dentist to discuss in greater detail, although strictly speaking this is the duty of the dentist.

Finally, the dental nurse must always observe the patient throughout the assessment to ensure they are comfortable and not distressed in any way, and to give support and reassurance as required.

Exercise 10

Prepare short talks and/or dialogues.

Explain the nurse’s role during the carrying out of an oral health assessment.

Translation 8

Translate and/or explain in English.

Regular monitoring and recording; record all the findings accurately, as dictated by the dentist; be familiar with note-taking and recording methods; pre-printed sheets can be inserted into the written record card; the measured sizes of any lesions or abnormalities; a full tooth charting of all treatment already carried out and any required for a new patient; the correct quadrant as well as the correct tooth and its surfaces; basic periodontal examination; examination involving pocket-depth recordings, bleeding and plaque indices; to have all the notes ready before the patient enters the surgery, not to keep the dentist waiting; lay out the equipment and hand instruments; instruments cleaned and sterilised after their last use; to run smoothly and efficiently; go through a medical history with the patient; to highlight any queries for the dentist; to observe the patient throughout the assessment; to ensure the patients are comfortable and not distressed; give support and reassurance.

Text 10

Four types of discrimination:

• age discrimination

• gender discrimination

• social discrimination

• disability discrimination

The race of a people is determined by their common ancestry, and is often characterised by certain physical features, especially their skin colour. Race discrimination occurs when someone is treated detrimentally because of this difference in physical appearance from the majority of the population.

In the dental practice, it is highly likely, in the multi-cultural society that different races of people will attend for dental treatment on a regular basis, but under no circumstances should race discrimination be an issue.

All patients should be made to feel equally welcome to the practice at all times. Differences in culture and religion of patients of different races must be respected by the practice at all times.

For instance, Moslems may object to undergoing any kind of dental treatment during the period of Ramadam, except in dire emergencies, as it is against their religion; while this may be inconvenient to the practice, the concept should be respected none the less.

Many Asian groups routinely tend to add sugar to baby feeds, but the cariogenic effect of this needs to be highlighted and discussed with the parents as soon as possible to prevent their children developing serious dental problems.

Exercise 11

Prepare short talks and/or dialogues on these topics.

1. List four types of discrimination that a patient may experience.

2. Explain how the dental practice can ensure that race discrimination does not occur.

Translation 9

Translate and/or explain in English.

Age discrimination, social discrimination; gender discrimination; disability discrimination; physical features, skin colour; difference from the majority of the population; multi-cultural society; to feel equally welcome at all times; respect differences in culture and religion.

Text 11

The term informed consent

The term informed consent implies that the patient has been told all necessary information about the proposed treatment so that they can decide whether they wish to have that treatment or not. They must be given the following information:

• what the treatment involves dentally

• any risks associated with the treatment

• the likelihood of success of the treatment

• alternative treatments, so options must be given

• the cost of the treatment and whether it is being provided on the NHS (National Health System) or privately

• the likely duration of the treatment

Once all these points have been given and discussed with the patient, the patients can consider whether they wish to proceed or not by making an informed decision.

If they do give consent, it must be given voluntarily and freely, and consent is then considered to be valid. Although consent can be given verbally by the patient, ideally it should be given in writing, especially for extensive or costly courses of treatment.

In dental practice, this means that the patient must agree to the treatment being proposed and to the dentist who wishes to provide the treatment, but only after a comprehensive explanation has been given.

The need for good communication skills while explaining the proposed treatment is imperative, as otherwise the patients can always say they were mislead or did not fully understand what was being proposed.

This may also happen if inappropriate dental terminology is used for the patient’s particular level of understanding. Similarly, no assumptions should be made with regard to the decision the patient may make so that a full explanation is not given because the dentist believes it is unnecessary; not only will the patient then be unable to give informed consent, but the assumptions made will be blatant discrimination. This can especially happen with costly courses of treatment not being offered to patients of lower socioeconomic backgrounds.

Accurate and contemporaneous notes must be made of all discussions with the patient; ideally these should be taken by the practitioner involved, although some rely on the attending dental nurse to take responsibility for note-taking. However, if ever there is a dispute between the dentist and patient about the treatment provided, the dentist carries the full responsibility for any inaccuracies or inadequacies of the notes taken.

Obviously, the dentist must also be totally honest when discussing treatment options with the patient, especially when asked about the likelihood of the proposed treatment’s success.

Under no circumstances should the dental nurse give opinions that may affect the patient’s ultimate decision about the proposed treatment, as the issues of whether they were coerced into accepting treatment or whether they actually then gave valid consent would cause serious problems for the dentist. Similarly, if asked for advice about treatment that is beyond the dental nurse’s experience, they must always refer the patient back to the dentist rather than give an uninformed answer.

Exercise 12

Prepare short talks and/or dialogues.

Describe the term informed consent. What is its relevance in dental practice?

Translation 10

Translate and/or explain in English.

Informed consent, valid consent; tell all necessary information; the proposed treatment; what the treatment involves, any risks associated, the likelihood of success, alternative treatments; the cost of the treatment and whether it is being provided on the National Health System or privately; possible options, the likely duration of the treatment; the patient can consider whether they wish to proceed or not; consent must be given voluntarily and freely to be valid; consent given verbally, in writing; extensive or costly course of treatment; a comprehensive explanation, understand fully; be mislead; inappropriate terminology; responsibility for note-taking; a dispute between the dentist and patient about the treatment provided; inaccuracies, inadequacies; ultimate decision; refer the patient to the dentist.

Text 12

The patient’s rights

It is very important to ensure that the patient’s rights are preserved at all times. Under no normal circumstances can the dentist refuse to allow the patient access to their own records, and if they contain any kind of dental jargon or shorthand that is not obviously apparent, the dentist must also provide a translation for the patient.

It is clear, therefore, that the records must be completely accurate, truthful and in the correct date sequence, and must not be altered in any way after a request for access has been received. However, only the dentist can approve access, so staff must never hand over any records without the dentist’s permission. The case must never be discussed where other patients can hear what is being said. The dentist must check the identity of the person before releasing the records. They must never be handed over to a third party without the written permission of the patient involved.

Only under the following circumstances can the dentist legally refuse to disclose some or all of the records:

• the record disclosure would cause serious harm to the patient

• another person is referred to in the records, and they have not given their consent

• the records have a note to say that access is not to be granted in the event of the patient’s death

The handling of complaints

The handling of complaints is another very important area in the successful running of the practice.

Procedure for handling a verbal complaint

A verbal complaint is very often made initially to staff at reception, rather than to the dentist, so the staff must be aware of the correct complaints procedure and act accordingly. The designated person or their deputy who deals with the complaints should be summoned and they should take the complainant to a private area where other patients cannot hear the conversation.

Good body language is imperative to show the complainant that they are being both listened to and taken seriously. This is achieved by being polite, listening to what is being said without interrupting, clarifying points as necessary, wearing a sympathetic facial expression without being patronising and putting them at their ease by both parties being seated.

A well-modulated tone of voice is also required, as otherwise voices can often become raised and the situation can spiral completely out of control.

If necessary, written notes can be taken to ensure the accuracy of the discussion, and a copy can be offered to the complainant at the time, so they are aware of the truthfulness of the records.

The staff member can then determine what action is likely to be taken and discuss this with the complainant, and assure them that they will be informed when the action has been carried out.

If appropriate, a verbal apology can be given as very often this is all the complainant requires for the situation to be diffused, and this can be given without fear of admitting liability or negligence. The complaint must be recorded in the practice complaints book accurately, with the final outcome recorded too.

Procedure for handling a written complaint

A written complaint will usually be addressed to the senior dentist and marked private and confidential to ensure that it is not unwittingly disposed of beforehand. Its receipt must be acknowledged to the complainant, ideally within two working days. The matter must be investigated thoroughly by the designated person in the practice, taking written notes of all information received from the staff involved, and other witnesses if appropriate.

The complainant must receive a written report of these investigations within ten working days, hopefully clarifying the situation and resolving the matter. No blame must be apportioned, nor personal comments and opinions expressed, as these could be used against the practice if legal action is taken. The response must be open and sympathetic towards the complainant, but never defensive. Again, an apology can be offered if appropriate, without admitting liability or negligence.

All details must be entered in the complaints book, including the original letter and all other correspondence. The complainant should be given the opportunity to discuss the matter further at the practice if they wish. Where appropriate, the practice should use any form of complaint as an opportunity to review practice procedures, and alter them as necessary.

Exercise 13

Prepare short talks and/or dialogues on these topics.

1. Discuss the actions that must be taken by the dentist if a patient requests access to their dental records.

2. Talk about procedure for handling a verbal complaint and procedure for handling a written complaint.

Translation 11

Translate and/or explain in English.

Preserve the patient’s rights; to allow the patient access to their own records; translate jargon or shorthand; the records completely accurate, truthful, in the correct date sequence; approve access; without the dentist’s permission; check the identity of the person before releasing the records; never hand over the records to a third party without the written permission of the patient involved; legally refuse; disclosure would cause serious harm to the patient; a note to say that access is not to be granted; in the event of the patient’s death; the handling of complaints; the correct complaints procedure; summon the designated person or their deputy; take the complainant to a private area; be polite, listen without interrupting, clarify points; a sympathetic facial expression, a well-modulated tone of voice; offer a copy of written notes; to inform what action is likely to be taken; give apology; admit liability, negligence; final outcome; marked private and confidential; acknowledge the receipt; to investigate the matter, resolve the matter; not to express personal comments and opinions; legal action against the practice; the original letter and all other correspondence; to review practice procedures, and alter them as necessary.

Exercise 14

Fill in the missing words. Choose the correct ones. Try to learn the expressions and/or sentences by heart.