MFDS Part 1 - Membership of Faculty of Dental Surgery Law, Ethics and Professionalism Questions and Answers — Questions and Answers
Question 1: A dentist explains the procedure for placing a crown but only mentions common risks like temporary sensitivity. The patient later suffers from irreversible pulpitis, a rare but serious complication that was not discussed. According to the principles established by the UK Supreme Court in *Montgomery v Lanarkshire Health Board*, has the dentist obtained valid consent?
- Yes, because the dentist acted in line with what a responsible body of dentists would have disclosed (the Bolam test).
- No, because the dentist failed to disclose a material risk that a reasonable person in the patient's position would likely attach significance to. (Correct answer)
- Yes, because the risk of irreversible pulpitis was too rare to be considered a mandatory disclosure.
- No, because all possible risks, however minor or rare, must be disclosed for consent to be valid.
Correct answer: No, because the dentist failed to disclose a material risk that a reasonable person in the patient's position would likely attach significance to.
The *Montgomery* ruling shifted the standard for consent from the professional-focused 'Bolam test' to a patient-centric model. [3, 12, 18] For consent to be valid, a dentist must take reasonable care to ensure the patient is aware of any material risks and of reasonable alternatives. A risk is 'material' if a reasonable person in the patient's position would likely attach significance to it, or if the practitioner knows (or should know) that this particular patient would attach significance to it. [3, 34] A rare but serious risk like irreversible pulpitis would likely be considered material by a patient, and therefore failure to discuss it invalidates consent.
Question 2: A dental nurse posts a photograph on their private, personal social media account. In the background, a patient's unique and identifiable tattoo is visible on their arm, although their face is not shown. A colleague recognises the tattoo and identifies the patient. Which principle from the General Dental Council's (GDC) 'Standards for the Dental Team' has primarily been breached?
- Principle 2: Communicate effectively with patients.
- Principle 6: Work with colleagues in a way that is in patients' best interests.
- Principle 4: Maintain and protect patients' information. (Correct answer)
- Principle 8: Raise concerns if patients are at risk.
Correct answer: Principle 4: Maintain and protect patients' information.
GDC Standard 4.2.3 explicitly states: 'You must not post any information or comments about patients on social networking or blogging sites.' [8] Even if unintentional, on a private account, and without showing a face, posting an image from which a patient can be identified (in this case by a unique tattoo) is a breach of the duty to protect patient confidentiality. [14, 33, 36] The standards of professional conduct apply in both online and offline environments. [8, 14]
Question 3: A dental hygienist is working under 'Direct Access' arrangements. A new patient attends requesting treatment. According to the GDC's 'Scope of Practice' and relevant UK legislation, which of the following procedures requires a prescription from a dentist before the hygienist can proceed?
- Applying a topical fluoride varnish.
- Taking bitewing radiographs to check periodontal bone levels.
- Providing tooth whitening treatment using a 6% hydrogen peroxide gel. (Correct answer)
- Undertaking a routine scale and polish.
Correct answer: Providing tooth whitening treatment using a 6% hydrogen peroxide gel.
While 'Direct Access' allows dental hygienists to perform much of their scope of practice without a dentist's prescription, tooth whitening is a specific legal exception. [6, 11] The Cosmetic Products Enforcement Regulations 2013 stipulate that products containing or releasing between 0.1% and 6% hydrogen peroxide can only be used on the prescription of a dentist after a clinical examination. [6, 13] The first use of a cycle must also be carried out by a dentist or under their direct supervision. [6, 11]
Question 4: An 8-year-old child attends for a check-up. The dentist observes multiple bruises of varying colours on the child's arms and notes that the child seems unusually anxious. The parent dismisses this as clumsiness. What is the most appropriate immediate action for the dentist to take in line with UK safeguarding principles?
- Confront the parent directly about the suspicion of non-accidental injury.
- Document the findings meticulously and discuss concerns immediately with the practice's designated safeguarding lead. (Correct answer)
- Treat the child's dental needs and schedule a review in one month to monitor the situation.
- Immediately telephone the police to report a case of child abuse.
Correct answer: Document the findings meticulously and discuss concerns immediately with the practice's designated safeguarding lead.
GDC Standard 8.5 states dental professionals must raise concerns about possible abuse or neglect. [2] UK safeguarding procedures require a structured approach. The correct first step is to make a detailed, contemporaneous record of all clinical findings and concerns and then to discuss the situation with the practice's designated safeguarding lead. [2, 23] This individual is trained to advise on the next steps, which typically involves referral to the local authority's children's social care services. Confronting the parent or simply waiting are inappropriate and could place the child at further risk. [2, 35]
Question 5: A patient in England is dissatisfied with the outcome of their NHS dental treatment. Having exhausted the practice's in-house complaints procedure without resolution, which independent body should the patient be advised to contact next to escalate their complaint?
- The General Dental Council (GDC).
- The Care Quality Commission (CQC).
- The Dental Complaints Service (DCS).
- The Parliamentary and Health Service Ombudsman (PHSO). (Correct answer)
Correct answer: The Parliamentary and Health Service Ombudsman (PHSO).
The NHS complaints procedure in England has two main stages. After local resolution with the practice fails, the complaint can be escalated to the Parliamentary and Health Service Ombudsman (PHSO). [5, 17, 27] The PHSO makes the final decision on unresolved complaints about the NHS in England. [5, 27] The GDC investigates fitness to practise, not patient redress; the CQC regulates services but doesn't handle individual complaints; and the Dental Complaints Service (DCS) is for private dental treatment. [10, 27]
Question 6: Under the General Dental Council's (GDC) Enhanced CPD scheme, dentists must complete 100 hours of CPD over a five-year cycle. Which statement accurately describes a core requirement of this scheme?
- All 100 hours must be classified as 'verifiable' CPD. (Correct answer)
- A minimum of 50 hours must be from hands-on clinical courses.
- CPD hours are only valid if the activity is undertaken within the UK.
- Dentists must submit their full CPD log to the GDC annually for approval.
Correct answer: All 100 hours must be classified as 'verifiable' CPD.
A fundamental change introduced with the Enhanced CPD scheme is that all claimed hours must be 'verifiable'. [16] This means there must be evidence of completion and the activity must have clear aims, objectives, and learning outcomes. The previous system allowed for non-verifiable CPD, but this is no longer the case. [16] Dentists must make an annual statement of hours completed but are only required to submit the full log if requested for an audit. [7] There is no prescribed split between types of activity or geographical location.
MFDS Part 1 - Membership of Faculty of Dental Surgery Law, Ethics and Professionalism Questions and Answers
A dentist explains the procedure for placing a crown but only mentions common risks like temporary sensitivity.
The patient later suffers from irreversible pulpitis, a rare but serious complication that was not discussed.
According to the principles established by the UK Supreme Court in *Montgomery v Lanarkshire Health Board*, has the dentist obtained valid consent?