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A ll NHS and private dentists have to register with The Care Quality Commission in 2011, and CQC has developed a set of outcomes around personalised care, treatment and support. How many times have you been to a practice building seminar which tells you that your hygienist is the key to your practice’s success? Well, here is an opportunity to tie this success back to CQC requirements, demonstrate how you provide per- sonalised care for all patients and free your time up for higher pro- duction dentistry – the dentistry you trained to do. Practice management gurus tell you time and time again that most of your practice’s success is sitting unclaimed in your filing cabinet, and your hygienist can help you unlock it. The key, however, is elusive unless you develop systems to monitor how you deliver care and use your teams effectively. The previous article explored how patients can be risk assessed and patient databases can be profiled ac- cording to need to develop clinically driven practice management systems. This provides a system to tailor care to the patient’s needs...and fits well with private practice profits, the Care Qual- ity Commission and the care pathways outlined in the Steele Review. And why wouldn’t it? Af- ter all it’s just “good dentistry” ! Green (low needs) patients do not need to clog your diary up by coming in for a chat and a check-up! Send them away for a two-year ‘NICE re- call’ but remember a recall is a “re- view of oral health”, not a scale and polish, so that is not going to take care of their dental and periodontal maintenance requirements or your risk of unwittingly providing super- vised neglect. A lot can happen in two years! Bring them back with your hy- gienist for their interim care at least six-monthly for younger patients, and 12 monthly for older patients with no disease and no risk factors. Amber (moderate needs) patients are at a higher risk of dental disease because they have risk factors, but not necessarily active disease. They are often the patients you will need to pro- vide the most high end treatment for such as whitening, implants, cosmet- ic dentistry etc, because they do not have active disease precluding treat- ment but they are not problem free. Such patients should be on a four- or six-monthly regime with the pre- ventive care team who can play an invaluable role by devoting TIME to motivating and education patients, just as a personal trainer can some- times be the only motivator for weight loss. Their work can be funded by a payment plan, an innovative NHS contract or the patient themselves...it does not matter as long as your whole team’s communication skills en- sure that the patient understands the BENEFIT of a preventive approach for long term comfort, aesthetics and avoidance of unexpected bills, and signs up to your advice. Red (high needs) patients have ac- tive disease which can preclude you from undertaking any advanced work until their oral environment is fit to receive more complex treatment. The preventive care team really comes into it’s own here as they enable you to keep your diary time reserved for disease management and therapy. Delegate personalised diet analysis, quarterly fluoride varnish applications on kids (yes, that’s in the evidence base!), flossing demos and all the other aspects of care that can be deliv- ered by dental care professionals and would otherwise require you to work every night... and on Sundays. Just pop the guide below on the wall in your surgery and in your hygi- enist’s surgery, delegate effectively, get your whole team delivering person- alised care, treatment and support and do the dentistry you enjoy. DT Is your PCT ( preventive care team) ready ? asks Seema Sharma Countdown to CQC registration Preventive Care Team Amber Medium risk Advice & Intervention 4-6 MONTHLY PROFESSIONAL CARE With hygienist/preventive care team PERIO RISK (poor plaque control, diabetes, smoker) As for green plus • detailed OHI/TBI/IDC/signposting • Disclose plaque & bioﬁlm • Debridement CARIES RISK ( No caries but poor sugar control or plaque control) As for green plus- • Diet Recording & Analysis • Fissure sealants on eruption of permanent molars • (55+) artif saliva if dry mouth INCREASE FLUORIDE AVAILABILITY • (0-7) Fluoride supplements • (7+)Fluoride mouthrinse FLUORIDE VARNISH ( Age 3-18) 3-4 x annum ( Age 18+) 2 x annum CANCER RISKS • Smoking/tobacco cessation • Alcohol consumption advice Advice/intervention by Dentist reinforced by practice team, website and literature SKILL MIX • Dental Nurse (F V apps) • OHE (Oral Health Advice) • Hygienist ( perio control) • Therapist (caries control) Maintenance Programme SELF CARE Brush twice daily systematically, last thing at night and one other time, with ﬂuoridated toothpaste at least 1350 ppm ﬂuoride. Spit out after brushing, do not rinse. DIET The frequency and quantity of sugary food and drinks should be reduced( no more than 4x a day) and, when consumed, limited to mealtimes, never in the last hour before bedtime. CANCER RISKS Do not smoke or chew tobacco/betel Limit alcohol intake 6-12 MONTHLY PROFESSIONAL CARE With hygienist/preventive care team • OHI/TBI/IDC • Scaling and polishing FLUORIDE VARNISH ( Age 3-18) 2 x annum Advice by the Dentist reinforced practice team and literature SKILL MIX • Dental Nurse ( extended training for F Varnish apps) • Hygienist (maintenance) Green Low risk Intensive Advice & Intervention 3 MONTHLY PROFESSIONAL CARE – with hygienist/preventive care team IF PERIODONTAL DISEASE As for amber plus • Consider chlorhexidine mouthrinse • Debridement • 6ppc in aﬀected sextant, active treatment , bioﬁlm control • Referral as necessary IF CARIES As for amber plus- • Referral to oral health educator for caries control programme FlUORIDE AVAILABILITY & VARNISH As for amber plus • (10+) 2800 ppm F toothpaste • (16+) 5000 ppm F toothpaste CANCER RISKS As for amber Advice/intervention initially by Dentist reinforced by practice team, website & literature SKILL MIX • Dental Nurse (F V apps) • OHE (Oral Health Advice ) • Hygienist (perio control) • Therapist (caries control) Red High risk April 19-25, 201012 Feature United Kingdom Edition