Standard 31: Dental Care

Why it matters. Dental instruments that are not properly sterilised carry blood and infection from one patient to the next. A validated process, applied to every instrument, is what makes them safe to reuse.

Sample. Review the sterilisation cycle register and the validation records for the last 3 months, with the instruments processed.

1. Sterilisation uses a validated process for each instrument type.

Method. Check the validation or load-release record for each cycle type in use.

Evidence to show. Sterilisation cycle and load register (DEN-REG-001).

Pass when. Every cycle type in use has a current validation record.

2. Packs are sealed and the sterile barrier is intact until use.

Method. Inspect sampled packs for seal integrity and the use-by date.

Evidence to show. Sterilisation of reusable dental instruments (DEN-SOP-001).

Pass when. Every sampled pack is sealed and in date.

3. Each instrument is processed as its manufacturer instructs.

Method. Check the cycle recorded for sampled instruments against the manufacturer instructions.

Evidence to show. Sterilisation of reusable dental instruments (DEN-SOP-001).

Pass when. No instrument is processed outside its manufacturer instructions.

Immediate fail (any one means the criterion is not met)

• Handpieces processed in a cycle that was never validated for them.

Why it matters. A sterilisation cycle can run and look correct while the instruments inside are not sterile. Monitoring every load, with chemical and biological indicators, shows the cycle actually worked.

Sample. Review the monitoring records (biological, chemical and cycle printouts) for 30 sterilisation cycles.

1. Each cycle is monitored with the required indicators.

Method. Check each sampled cycle for its indicator results.

Evidence to show. Sterilisation cycle and load register (DEN-REG-001).

Pass when. Every sampled cycle has indicator results recorded.

2. A failed indicator stops the load and triggers action.

Method. Check each failed indicator for the load quarantine and the action recorded.

Evidence to show. Sterilisation cycle and load register (DEN-REG-001).

Pass when. Every failed indicator has quarantine and action recorded.

3. Biological indicators are tested on a set schedule.

Method. Check the biological indicator log for missed tests.

Evidence to show. Sterilisation cycle and load register (DEN-REG-001).

Pass when. No scheduled biological test is missing.

Immediate fail (any one means the criterion is not met)

• A load released after a failed biological indicator.

Why it matters. Instruments that go back and forth between dirty and clean areas can be recontaminated at the point where they cross. A one-way flow keeps the clean and dirty steps apart.

Sample. Observe the decontamination area and review the cleaning check for 10 working days.

1. Processing follows one direction, from dirty to clean.

Method. Observe the layout and the route of a sample of instruments.

Evidence to show. Decontamination area flow and cleaning check (DEN-FRM-001).

Pass when. Instruments move from dirty to clean without backflow.

2. Dirty and clean areas are physically separated.

Method. Observe the separation and the barrier or marking used.

Evidence to show. Decontamination area flow and cleaning check (DEN-FRM-001).

Pass when. The separation is in place and used.

3. The daily cleaning check is recorded.

Method. Check the daily entries for the sample period.

Evidence to show. Decontamination area flow and cleaning check (DEN-FRM-001).

Pass when. Every working day has a recorded check.

Immediate fail (any one means the criterion is not met)

• Clean instruments returned to the dirty side of the room.

Why it matters. A needle, bur or file made for one use that is cleaned and used again can break, transmit infection or fail in the mouth. Single-use items must be discarded after one patient.

Sample. Review the single-use item stock, purchase records and the reprocessing log for the last 3 months.

1. Single-use items are used once and then discarded.

Method. Observe a sample of sessions for reuse of disposable items.

Evidence to show. Single-use items and reprocessing limits (DEN-POL-001).

Pass when. No sampled session shows reuse.

2. Items labelled single-use are not reprocessed.

Method. Check the reprocessing log for any single-use item.

Evidence to show. Single-use items and reprocessing limits (DEN-POL-001).

Pass when. No single-use item appears in the log.

3. Reprocessing is done only where the manufacturer permits it, and is recorded.

Method. Check each reprocessed item for the manufacturer permission and the cycle record.

Evidence to show. Single-use items and reprocessing limits (DEN-POL-001).

Pass when. Every reprocessed item has permission and a cycle record.

Immediate fail (any one means the criterion is not met)

• A disposable bur cleaned and reused on the next patient.

Why it matters. Dental unit waterlines are a known source of bacteria, and the water sprayed in the mouth passes through them. Treating and testing the water keeps it safe.

Sample. Review the waterline treatment and test records for the last 12 months.

1. Waterlines are treated with a documented regime.

Method. Check the treatment product log against the schedule.

Evidence to show. Dental unit waterline management (DEN-SOP-002).

Pass when. Every scheduled treatment is logged.

2. Water quality is tested at set intervals and results are acted on.

Method. Check each result above the limit for the action taken.

Evidence to show. Waterline test register (DEN-REG-002).

Pass when. Every out-of-limit result has action recorded.

3. Each dental unit has a recorded set-up.

Method. Check each dental unit against its set-up entry.

Evidence to show. Waterline test register (DEN-REG-002).

Pass when. Every dental unit has a set-up record.

Immediate fail (any one means the criterion is not met)

• Patients treated for months with contaminated unit water and no test.

Why it matters. A dental chair that is not cleaned properly between patients can carry infection to the next. A documented method, followed every time, makes the turnover reliable.

Sample. Review the chair turnover records for 20 patient appointments.

1. The chair is cleaned and disinfected between patients.

Method. Check each sampled appointment for the turnover entry.

Evidence to show. Between-patient chair turnover record (DEN-FRM-002).

Pass when. Every sampled turnover is recorded.

2. Barriers are changed between patients.

Method. Check the record for a barrier change against each appointment.

Evidence to show. Between-patient chair turnover record (DEN-FRM-002).

Pass when. Each barrier change is recorded.

3. A second person checks the turnover at set intervals.

Method. Check the audit entries for the second-person check.

Evidence to show. Between-patient chair turnover record (DEN-FRM-002).

Pass when. The checks happen at the set interval.

Immediate fail (any one means the criterion is not met)

• A chair left with the previous patient’s barrier in place for the next patient.

Why it matters. Dental drills and scalers make a fine spray that carries bacteria and blood into the air and onto staff. Measures such as high-volume suction and protective equipment reduce that spread.

Sample. Observe 5 treatment sessions and review the aerosol control procedure and the evacuator checks.

1. High-volume evacuation and rubber dam are used where aerosol is generated.

Method. Observe sampled procedures for their use.

Evidence to show. Aerosol and splatter control (DEN-SOP-003).

Pass when. The control is used for every sampled procedure that generates aerosol.

2. Staff wear personal protective equipment for aerosol-generating work.

Method. Observe the use of protective equipment in the sample.

Evidence to show. Hand hygiene and standard precautions (HH-SOP-001, existing, reused).

Pass when. Protective equipment is worn in every observed case.

3. The fallow time between patients in a room is kept.

Method. Check the room log for the fallow time after aerosol-generating procedures.

Evidence to show. Aerosol and splatter control (DEN-SOP-003).

Pass when. The fallow time is kept in every sampled case.

Immediate fail (any one means the criterion is not met)

• An aerosol-generating procedure in a shared room with no evacuation and no fallow time.

Why it matters. Dental X-rays give a dose of radiation. A radiograph that is not needed adds risk without benefit, and a dose that is too high can be avoided by setting the machine correctly.

Sample. Review the radiograph justification and dose records for 30 radiographs.

1. Each radiograph has a documented justification before exposure.

Method. Check each sampled radiograph for the justification entry before the exposure.

Evidence to show. Radiograph justification record (DEN-FRM-003).

Pass when. Every sampled radiograph has a justification before exposure.

2. Dose is optimised with the right receptor and collimation.

Method. Check the receptor and collimation settings for a sample against the protocol.

Evidence to show. Radiograph justification record (DEN-FRM-003).

Pass when. Settings match the protocol in every sampled case.

3. Repeat exposures are reviewed and recorded.

Method. Check repeat-exposure entries against the image review.

Evidence to show. Radiograph justification record (DEN-FRM-003).

Pass when. Each repeat is reviewed and recorded.

Immediate fail (any one means the criterion is not met)

• Full-mouth radiography on a patient with no clinical reason and no justification.

Why it matters. Staff who take X-rays are exposed to radiation every day. A radiation protection programme, with shielding and dose monitoring, keeps that exposure within limits.

Sample. Review the radiation protection programme, the equipment dose audit register and the staff monitoring records.

1. A written radiation protection programme is in place and reviewed.

Method. Check the programme for the date of its last review.

Evidence to show. Radiation protection programme for dental imaging (DEN-PLN-001).

Pass when. The programme is current and reviewed in the last 12 months.

2. Equipment is checked for dose and performance on a schedule.

Method. Check the register for each check date against the schedule.

Evidence to show. Radiation equipment and dose audit register (DEN-REG-003).

Pass when. Every scheduled check is recorded.

3. Staff exposure is monitored where the programme requires it.

Method. Check the monitoring records for staff who take radiographs.

Evidence to show. Radiation protection programme for dental imaging (DEN-PLN-001).

Pass when. Every radiographer has a monitoring record where required.

Immediate fail (any one means the criterion is not met)

• The X-ray unit has not been checked for dose in three years.

Why it matters. Dental amalgam contains mercury. Waste from it, if thrown out or washed down a drain, releases mercury into the environment. Collecting and storing it safely prevents that.

Sample. Review the amalgam waste records and the separator and collection records for the last 12 months.

1. Amalgam waste is collected in a closed, labelled container and not flushed.

Method. Observe the amalgam waste containers and check the disposal route for the sample.

Evidence to show. Dental amalgam waste and mercury handling (DEN-SOP-004).

Pass when. No amalgam waste is flushed to drains.

2. A separator or equivalent collection is in use and serviced.

Method. Check the service record for the separator.

Evidence to show. Dental amalgam waste and mercury handling (DEN-SOP-004).

Pass when. The separator is serviced on schedule.

3. Disposal is by a licensed contractor and recorded.

Method. Check the disposal record for the last disposal.

Evidence to show. Waste management (WST-SOP-001, existing, reused).

Pass when. Each disposal has a contractor record.

Immediate fail (any one means the criterion is not met)

• Mercury-containing amalgam waste flushed into the drain.

Why it matters. Mixing sharps, infected waste and general waste makes the whole load a hazard. Separating them at the point of use keeps staff and the public safe.

Sample. Observe sharps and clinical waste segregation at the chairs and the store for 10 working days.

1. Sharps go into puncture-proof containers at the point of use.

Method. Observe sharps disposal at the chair for the sample.

Evidence to show. Waste management (WST-SOP-001, existing, reused).

Pass when. All sampled sharps go to the container at the point of use.

2. Clinical waste is segregated by category and labelled.

Method. Observe the bins for labelling and separation.

Evidence to show. Waste management (WST-SOP-001, existing, reused).

Pass when. Each bin is labelled and holds only its category.

3. Containers are not overfilled and are closed and dated.

Method. Check the containers for fill line and closure on each sampled day.

Evidence to show. Waste collection record (WST-FRM-001, existing, reused).

Pass when. No container is overfilled or open.

Immediate fail (any one means the criterion is not met)

• Used needles recapped and put in an open bin with general waste.

Why it matters. A dental patient can faint, have an allergic reaction or stop breathing. The emergency equipment must be in the room and checked, or the team cannot respond.

Sample. Review the emergency equipment check register and walk through the surgeries for the last 3 months.

1. Emergency equipment is on site and working.

Method. Walk through and check each item against the list.

Evidence to show. Dental emergency equipment and drug check register (DEN-REG-004).

Pass when. Every listed item is present and working.

2. Emergency drugs are in date and stored correctly.

Method. Check the expiry dates against the register.

Evidence to show. Dental emergency equipment and drug check register (DEN-REG-004).

Pass when. No drug is out of date.

3. An AED is available and checked on schedule.

Method. Check the AED check entries for the last 3 months.

Evidence to show. Dental emergency equipment and drug check register (DEN-REG-004).

Pass when. Every scheduled AED check is recorded.

Immediate fail (any one means the criterion is not met)

• An oxygen cylinder empty and no one aware of it during a patient collapse.

Why it matters. A dental emergency happens quickly, and the first minutes decide the outcome. Every clinical staff member, not only the dentist, must be trained to respond.

Sample. Review the training records for medical emergencies and the rehearsal records for the last 12 months.

1. All clinical staff are trained in dental medical emergencies.

Method. Check the training record for each staff member on the rota.

Evidence to show. Dental medical emergency response (DEN-SOP-005).

Pass when. Every rota member has the training.

2. Emergency drills are rehearsed at a set interval.

Method. Check the rehearsal record for the interval.

Evidence to show. Dental medical emergency response (DEN-SOP-005).

Pass when. Rehearsals happen at the set interval.

3. Staff know their role in an emergency.

Method. Ask two staff members to describe their role in a sampled emergency scenario.

Evidence to show. Dental medical emergency response (DEN-SOP-005).

Pass when. Both describe their role correctly.

Immediate fail (any one means the criterion is not met)

• A patient has a seizure in the chair and no staff member knows the emergency sequence.

Why it matters. Too much local anaesthetic can be toxic to the heart and brain. The dose should be worked out for each patient from their weight, age and medical history, and recorded.

Sample. Review the local anaesthetic records for 20 procedures.

1. The dose is calculated against the patient and the maximum for the agent.

Method. Check each sampled record for the calculation.

Evidence to show. Local anaesthetic dose calculation and record (DEN-FRM-004).

Pass when. Every sampled dose is calculated and within the maximum.

2. The agent, dose and volume are recorded.

Method. Check each record for the agent, dose and volume.

Evidence to show. Local anaesthetic dose calculation and record (DEN-FRM-004).

Pass when. Every record shows all three.

3. A repeat dose is checked against the total already given.

Method. Check the records where a repeat dose was given.

Evidence to show. Local anaesthetic dose calculation and record (DEN-FRM-004).

Pass when. Each repeat dose is checked against the total given.

Immediate fail (any one means the criterion is not met)

• A child given a full adult dose of local anaesthetic with no calculation.

Why it matters. Sedation and general anaesthesia in a dental clinic carry the same risks as in hospital. They must be given only by staff with the competence to manage them, with continuous monitoring.

Sample. Review the sedation records and the competence records for 10 sedated patients in the last 12 months.

1. Sedation is given only by a clinician competent in the technique.

Method. Check each sedation record against the competence register for the clinician.

Evidence to show. Sedation policy (DEN-POL-003).

Pass when. Every sedation is given by a competent clinician.

2. Monitoring is continuous and recorded through recovery.

Method. Check each sedation monitoring record for continuous entries to discharge.

Evidence to show. Sedation monitoring record (DEN-FRM-005).

Pass when. Every record is continuous to discharge.

3. Emergency equipment for sedation is present and checked.

Method. Check the equipment check for the sedation room on the day of each sampled case.

Evidence to show. Dental emergency equipment and drug check register (DEN-REG-004).

Pass when. Equipment is checked before each sedation.

Immediate fail (any one means the criterion is not met)

• A patient sedated with no pulse oximeter and no one watching during recovery.

Why it matters. Simple extractions are minor, but they can cause bleeding, infection or reactions. Assessing the patient, getting consent and following up keep them safe.

Sample. Review the assessment, consent and follow-up records for 10 minor oral surgery procedures.

1. Each patient is assessed for fitness and risk before surgery.

Method. Check each record for the pre-operative assessment.

Evidence to show. Minor oral surgery: assessment, consent and follow-up (DEN-SOP-006).

Pass when. Every sampled procedure has an assessment before it starts.

2. Consent is obtained and recorded before surgery.

Method. Check each record for signed consent dated before the procedure.

Evidence to show. Consent record (CON-FRM-001, existing, reused).

Pass when. Every procedure has signed consent before it starts.

3. Follow-up is arranged and documented.

Method. Check each record for the follow-up appointment and outcome.

Evidence to show. Minor oral surgery: assessment, consent and follow-up (DEN-SOP-006).

Pass when. Every sampled record has follow-up arranged.

Immediate fail (any one means the criterion is not met)

• A tooth extracted in an anticoagulated patient with no check on the medicine.

Why it matters. A dental record that uses different symbols for each tooth, or is incomplete, is hard for the next dentist to read. Standard charting, with the FDI tooth numbering, makes records clear.

Sample. Review 20 dental clinical records for charting and completeness.

1. Charting uses the standard notation for each tooth and finding.

Method. Check each sampled record for the notation used.

Evidence to show. Dental chart and clinical record (DEN-FRM-006).

Pass when. Every sampled record uses the standard notation.

2. The record is complete for each visit.

Method. Check each record for the visit fields completed.

Evidence to show. Dental chart and clinical record (DEN-FRM-006).

Pass when. Every visit field is completed.

3. Each treatment entry is signed by the clinician who did the treatment.

Method. Check each entry for a clinician signature.

Evidence to show. Dental chart and clinical record (DEN-FRM-006).

Pass when. Every treatment entry is signed.

Immediate fail (any one means the criterion is not met)

• A tooth extracted with no entry in the chart.

Why it matters. A patient must know the diagnosis, the options, the risks and the costs before each dental procedure begins, not only at the first visit. Consent is a conversation, recorded before the work starts.

Sample. Review 20 consent records for dental procedures in the last 3 months.

1. Consent is obtained before each procedure.

Method. Check each sampled procedure for consent dated before the procedure.

Evidence to show. Consent record (CON-FRM-001, existing, reused).

Pass when. Every sampled procedure has consent before it starts.

2. Consent covers the risks and the alternatives explained.

Method. Check each consent for the risks and alternatives recorded.

Evidence to show. Informed consent before significant care (CON-SOP-001, existing, reused).

Pass when. Every consent records risks and alternatives.

3. Consent is renewed when the plan changes.

Method. Check the records where the plan changed for a new consent.

Evidence to show. Consent record (CON-FRM-001, existing, reused).

Pass when. Every changed plan has a new consent.

Immediate fail (any one means the criterion is not met)

• Crown and root canal treatment done under a general form only.

Why it matters. Patients who receive a bill far above what they were told often feel cheated, and may refuse to return. Fees published and a written estimate before treatment prevent surprises.

Sample. Review the fee schedule and 15 treatment estimates and invoices for the last 3 months.

1. Fees are published and shown before treatment starts.

Method. Check the public fee list and the estimate given before each sampled treatment.

Evidence to show. Fee disclosure and treatment estimate (DEN-POL-004).

Pass when. Fees are shown before treatment in every sampled case.

2. A written estimate is given for planned treatment.

Method. Check the estimates for each planned course.

Evidence to show. Written treatment estimate and fee agreement (DEN-FRM-007).

Pass when. Every planned course has a written estimate.

3. Invoices match the estimate, or a change is agreed in writing.

Method. Compare each invoice with its estimate.

Evidence to show. Written treatment estimate and fee agreement (DEN-FRM-007).

Pass when. Each difference has a written agreement.

Immediate fail (any one means the criterion is not met)

• A patient charged for treatment that was never estimated or agreed.

Why it matters. Dental implants and prosthetic parts come with batch or lot numbers. If a batch is found faulty, the clinic can only find the affected patients if it recorded which batch each patient received.

Sample. Review the implant and prosthetic traceability register for the last 12 months, and 10 placed components.

1. Each implant or component is recorded with its lot and supplier.

Method. Check each placed component against the register.

Evidence to show. Implant and prosthetic component traceability register (DEN-REG-005).

Pass when. Every placed component is recorded with lot and supplier.

2. The patient record links to the component.

Method. Check the clinical record for the component reference.

Evidence to show. Implant and prosthetic component traceability register (DEN-REG-005).

Pass when. Every component is linked to the patient record.

3. A lot can be traced to its patients within one working day.

Method. Trace one lot to its patients as a test.

Evidence to show. Implant and prosthetic component traceability register (DEN-REG-005).

Pass when. The trace is completed within one working day.

Immediate fail (any one means the criterion is not met)

• An implant lot recalled and the clinic cannot say which patients received it.

Why it matters. Dental laboratories make crowns, dentures and other work that goes in the patient’s mouth. The clinic must specify the work on a written prescription, use a quality-assured lab, and disinfect the work on return.

Sample. Review the laboratory work orders and the disinfection records for 10 laboratory items received in the last 3 months.

1. Each laboratory order states the specification and material.

Method. Check each order for the specification and material.

Evidence to show. Dental laboratory work specification, traceability and disinfection (DEN-SOP-007).

Pass when. Every order states specification and material.

2. Items are disinfected before fitting and the step is recorded.

Method. Check each item record for the disinfection step.

Evidence to show. Laboratory work order (DEN-FRM-008).

Pass when. Every item shows disinfection before fitting.

3. Only approved laboratories are used, and their records are kept.

Method. Check the approved laboratory list and the supplier records.

Evidence to show. Dental laboratory work specification, traceability and disinfection (DEN-SOP-007).

Pass when. Every laboratory used is on the approved list.

Immediate fail (any one means the criterion is not met)

• Dentures fitted from a laboratory the clinic has never checked.

Why it matters. A dentist or dental care professional who is not registered to practise is not authorised to treat patients. Checking the registration, and renewing it, confirms every clinician is entitled to practise.

Sample. Review the licence and competence records for all clinicians in post.

1. Each clinician holds a current licence to practise.

Method. Check the licence register against the licence certificate for each clinician.

Evidence to show. Staff credential register (STF-FRM-001, existing, reused).

Pass when. Every clinician has a current licence recorded.

2. Competence is assessed for each procedure type performed.

Method. Check each clinician’s competence record against the procedures they perform.

Evidence to show. Annual competency assessment procedure (WRK-SOP-001, existing, reused).

Pass when. Every procedure has a competent clinician recorded.

3. Licences and competence are renewed on time.

Method. Check the renewal dates on the register.

Evidence to show. Staff credential register (STF-FRM-001, existing, reused).

Pass when. No licence or competence has lapsed.

Immediate fail (any one means the criterion is not met)

• A clinician performing implant surgery with no training record for it.

Why it matters. Children, and people with a disability or other needs, may need more time, a different approach or a different setting. Care provided by staff trained for them is safer and more humane.

Sample. Review the care records and staff preparation records for 10 children and 10 people with special needs in the last 12 months.

1. Care is planned for the age, weight or need of the patient.

Method. Check each record for the planning entry.

Evidence to show. Care of children and people with special needs (DEN-SOP-008).

Pass when. Every record shows planned care for the patient’s age or need.

2. Carers and supports are recorded and involved.

Method. Check each record for the carer or support recorded.

Evidence to show. Care of children and people with special needs (DEN-SOP-008).

Pass when. Every record names the carer or support where needed.

3. Staff who see these patients are trained for them.

Method. Check the training record for staff who see these patients.

Evidence to show. Annual competency assessment procedure (WRK-SOP-001, existing, reused).

Pass when. Every staff member who sees these patients is trained.

Immediate fail (any one means the criterion is not met)

• A child with a disability treated with no adaptation and no carer present.

Why it matters. When a dental patient needs a specialist, such as an oral surgeon, the referral must be written, sent and followed up. Otherwise the patient is lost between services.

Sample. Review 20 referrals to other specialists in the last 3 months.

1. Each referral states the reason and the urgency.

Method. Check each referral letter for the reason and urgency.

Evidence to show. Specialist referral letter and reply record (DEN-FRM-009).

Pass when. Every referral states reason and urgency.

2. The referral is sent and its receipt is recorded.

Method. Check each referral for the sent date and the receipt.

Evidence to show. Specialist referral letter and reply record (DEN-FRM-009).

Pass when. Every referral shows the date sent and the receipt.

3. The reply is recorded and acted on.

Method. Check each referral for the reply and the action taken.

Evidence to show. Specialist referral letter and reply record (DEN-FRM-009).

Pass when. Every reply is recorded and acted on.

Immediate fail (any one means the criterion is not met)

• A suspected oral cancer referred verbally and never written down.

Why it matters. Most dental disease can be prevented with simple advice. Giving advice that matches the patient’s treatment and their risk, and recording it, helps them keep their teeth.

Sample. Review 20 patient records for oral health education and the education record.

1. Education is given and recorded at relevant visits.

Method. Check each sampled record for the education entry.

Evidence to show. Oral health education record (DEN-FRM-010).

Pass when. Every relevant visit has an education entry.

2. The advice is specific to the patient’s risk.

Method. Check each entry for the risk addressed.

Evidence to show. Oral health education record (DEN-FRM-010).

Pass when. Each entry names the risk addressed.

3. The patient understands the advice.

Method. Ask a sample of patients to repeat the main advice.

Evidence to show. Oral health education record (DEN-FRM-010).

Pass when. Most sampled patients repeat the main advice.

Immediate fail (any one means the criterion is not met)

• A patient with severe gum disease sent home with no advice recorded.