Time management is very important in dentistry. All dental procedures take a certain amount of time to complete for a quality result. With NHS healthcare being under pressure, time management becomes the centre of micro-management for every associate dentist. The full surgery time should be used in order to help all patients who need to be seen on that day and reduce waiting lists. Here is why.
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First, there has been a rise in NHS corporate dentistry in UK introducing annual targets. Achieving those targets requires time to be allocated for patient visits (check-ups, treatment etc). Second, an increase in recruitment of foreign-trained dentists who have never worked within the NHS system is observed. Third, there is a real pressure in NHS dentistry with great demand for the service and dentists are expected to deliver predictable quality care within set time constraints, which is not always possible and patients need to be re-booked.
A quick overview of NHS Bands Of Treatment reveals what's included in primary care services and what dentists are expected to deliver. Let's not forget that dental laboratories manufacturing NHS appliances may take between 7-10 working days to deliver each stage of treatment. In this article we are going to give you a few tips on how to help more patients who need to see you by delivering what's best for them and reduce patient frustration due to long waiting lists.
Examinations - Routine adult check-ups can take, for example, between 15-30 minutes, depending on clinician's experience. Patients below the age of 18 usually take 5-10 minutes to examine. On this appointment the dentist has to:
- update medical history (MH) and record any changes
- perform Extra-Oral and Intra-Oral examination of the patient
- take any x-rays, provide scaling and polishing, prescribe medication and/or deliver treatment (all if necessary)
Your nurse may be able to help complete some steps (such as updating MH). Sometimes patients expect treatment on this appointment so you and your nurse need to be prepared -- usually patients will leave a note at reception if they need anything done. Otherwise, ask reception to find out for you. For example, you could give the patient an injection and do the scaling and polishing in the meantime or take additional x-rays. In reality, pain is not always expected so you need to check with your patient if they are happy to have their treatment without anaesthetic (some cervical caries lesions, chipped enamel etc). Most patients will be okay with this.
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Treatment - Most types of dental treatment are available on the NHS. Here are a few tips on how you can better manage your time with certain procedures in general practice. Of course, you can take as much time as you believe is necessary to complete your treatment with the best of quality.
- Fillings - Check if pain is expected or if the patient has sensitive teeth. If the cavity is superficial to medium depth, you can suggest carrying this treatment on their exam appointment. If the patient needs to return for one filling only, you can book, for example, 15-20 minutes (with local injection); 2-3 teeth - 20 to 30 min depending on depth. Again, you can do scaling and polishing on treatment appointment while the tooth is getting numb. If some teeth don't need to be numb then start working on these while the others are getting numb. Decay in the fissures can also be treated by sandblasting the tooth -- explain to the patient what that is and how quick and painless it will be.
- Crowns - Usually 25-30 mins for preparation and 20 minutes are enough for most dentists to deliver quality result; laboratory time is about 7 days. You need to consider crown margin design. For most metal crown cases the vertical (shoulderless) preparation is a good conservative option (1). Numb the tooth up (if vital) and take opposing arch impression to maximise surgery time. If there is little tooth structure you may have to do an inlay/onlay/overlay with cuspal coverage.
- Dentures - Usually take 4 visits to complete: preliminary impressions (10 minutes), bite and special tray impressions (20 minutes), try-in (5 mins) and fit (15-20 minutes). Patients will expect to be also offered immediate type dentures. Make sure the patient consents for these as immediate dentures may need to be relined in the future and quickly become loose after fit. Most cases will need special trays however some partial cases can be taken from preliminary impressions to try-in. Exercise your own clinical judgement when planning all treatment.
In conclusion, the demand for NHS service will be increasing as demographics in the country are changing. It is dentists' responsibility to fulfil their part of the associate contract by providing care for an increased number of patients, especially in a corporate setting. Ultimately, each dentist can combine clinical experience with time management skills in order to find out what works best in practice.
Alternatively, why don't you consider doing more private dentistry? Read our comparison between NHS and Private dentistry.
DISCLAIMER: All information provided here is personal expert opinion. This is not a diagnostic or treatment planning guide. Every dentist should take into consideration high level evidence when planning and delivering treatment. Every dentist is solely responsible for their own actions when delivering dental treatment. The author of this article does not carry any liability for any malpractice as a result of reading this article.
- Vertical or Shoulderless Preparations in Contemporary Prosthodontics; http://www.dentalxp.com/course/vertical-or-shoulderless-preparations-1182768.aspx