Download Hearing held in public Summary Name: SANDOR, Marianna Type of

Hearing held in public
Summary
Name:
SANDOR, Marianna
Type of case:
Registration Appeal Committee (initial)
Outcome:
Appeal Dismissed
Date:
3 March 2017
Miss Sandor: This is an appeal hearing of the Registrations Appeal Committee, which has
been convened in accordance with the General Dental Council (GDC) (Registration Appeals)
Rules 2006 (the Rules), pursuant to Schedule 4A of the Dentists Act 1984 (as amended) (the
Act). You are present at this appeal hearing. Ms Stewart, Counsel, appears on behalf of the
GDC.
The Committee has been provided with the factual background to your application for
registration as a dental hygienist with the GDC and the reasons for your appeal against the
Registrar’s decision not to register you.
You qualified as a dental nurse in 1997 and then as a dental hygienist in May 2005 in
Budapest, Hungary. You came to work in the United Kingdom in 2008. You have been on the
GDC register as a dental nurse since 24 October 2008.
On 18 August 2016 you applied to the GDC for registration as a dental hygienist. Your
application for registration was assessed by the GDC under matter B, in accordance with the
provisions contained in Section 36C(3) of the Act. Matter B provides that a person shall only
be entitled to be registered in the dental care professionals register if he/she satisfies the
Registrar that he/she:
(a) is an exempt person: and
(b) is permitted to practise in the United Kingdom as a member of the profession
pursued by clinical dental technicians, dental hygienists, dental nurses, dental
technicians, dental therapists or orthodontic therapists (as the case may be) by virtue
of Part 3 of the General Systems Regulations (having, in particular, successfully
completed any adaptation period, or passed any aptitude test, that he may be required
to undertake pursuant to that Part of those Regulations).
As part of your application you provided the GDC with a number of documents, including your
completed “Assessment of Learning Outcomes Dental Hygienist Form”; a certificate
evidencing that you are a qualified “clinical dental hygienist”, issued by Szentagothai Janos
Vocational and Training School for Healthcare Workers, Budapest (awarded on 16 June 2005)
as well as a copy of the course syllabus from the Training School. The hours of training shown
on the certificate show a total of 856 hours. In the United Kingdom training courses run for a
total of 3,000 – 3,400 hours.
The Registration Assessment Panel (RAP) considered your application on 3 November 2016.
It was not satisfied that the content of the training course which led to the award of your
qualification met the standards in “Preparing for Practice” and that the shortfalls had not been
compensated for by your experience or additional training. The RAP considered that you had
not demonstrated the requisite knowledge and skill to be eligible for registration as a dental
care professional within the GDC. The RAP recommended that you be offered an adaptation
period.
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The GDC wrote to you on 11 November 2016, informing you of the Registrar’s decision that
you were not eligible for registration. The letter stated that the following Learning Outcomes
appeared not to have been studied as part of your training and were not evidenced in your
application: 1.2.2, 1.2.6, 1.2.7, 1.5.4, 1.7.3, 1.7.4, 1.7.5, 1.11.3, 1.11.6, and 1.11.8. The GDC
acknowledged that with regards to Learning Outcome 1.11.6 (placing temporary dressings
and re-cement crowns with a temporary cement), you had undertaken a course in this area.
However, because the course was undertaken in a laboratory, the Registrar considered that
it was not comparable with UK dental hygiene training where this experience would be gained
on patients.
In order to compensate for these substantial differences, the GDC offered in their letter dated
11 November 2016 for you to complete an adaptation period of 6 months with a successful
assessment at the end of the period. You were also informed of your right to appeal and the
option to apply for a new assessment if you had new or additional information to address the
deficiencies found in your training.
On 6 December 2016 you appealed against the Registrar’s decision not to register you. In
support of your appeal you say that you do have the requisite knowledge and skills to practise
as a dental hygienist. You set out the courses you have attended and the reading you have
completed in the identified Learning Outcomes. You also appealed against the length of your
adaptation period on the basis that dental practitioners find it too long a period to supervise.
You provided the GDC with further evidence in support of your appeal, as set out in the
documents sent in on 20 February 2017.
At today’s hearing the Committee has considered all the documents before it. This includes
your letter to the GDC dated 6 December 2016, and the further documents accompanying
your letter dated 20 February 2017. It has had regard to the submissions made by Ms Stewart
on behalf of the GDC as well as your own evidence and submissions.
In your evidence, you confirmed the dates when you qualified as a dental nurse in 1997 and
then undertook a training course to become a clinical dental hygienist between September
2004 and May 2005, which you successfully completed. Since qualifying you have only worked
as a dental nurse. You have also undertaken a number of appropriate Continuing Professional
Development courses between 2001 and 2016. You explained the problems you have
experienced in trying to undertake a period of adaptation. You told the Committee that you
have found an adaptation course at the University of Essex which is relevant to training as a
dental hygienist.
The GDC’s position is that, notwithstanding the additional documents you have provided to
the GDC, you still do not hold the requisite knowledge and skills to practise as a dental
hygienist.
The Committee has considered the submissions carefully. It has accepted the advice of the
Professional Adviser. The Committee has also accepted the advice of the Legal Adviser,
during the course of which he set out the options available to this Committee, in accordance
with Paragraph 4(8) of Schedule 4A of the Act.
The Committee has considered carefully each of the Learning Outcomes noted as not being
evidenced by the RAP on 3 November 2016. Its opinion on each is as follows:
1.2.2 – Recognise the importance of and record a comprehensive and contemporaneous
patient history
This is not identified as covered in the syllabus in your original qualification, nor is it evidenced
in your further documents. The RAP indicated that satisfactory completion of this Learning
Outcome would be evidenced in a logbook through at least 30 patient records. There is
therefore no evidence to satisfy this Committee that this Learning Outcome has been
completed.
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1.2.6 – Assess patients’ levels of anxiety, experience and expectations in respect of dental
care
Although you have not treated patients yourself under sedation, the Committee notes that that
requirement is not explicit in this Learning Outcome. In September 2014 you completed the
certificate for Dental Sedation Nursing. The National Examining Board for Dental Nurses
(NEBDN) syllabus for their certificate in dental sedation states that successful completion
includes patient assessment, including assisting in the management of anxious patients.
Given your successful completion of the certificate, the Committee is satisfied that this
Learning Outcome has been completed.
1.2.7 – Discuss the importance of each component of the patient assessment process
The Committee recognises that you have read a suitable dental hygiene textbook, which is
one of the requirements of this Learning Outcome. However, there is no evidence that you
have carried out any clinical work in this area. The RAP indicated that satisfactory completion
of this Learning Outcome would be evidenced by the provision of a logbook showing at least
30 patient histories had been taken (including dental history, medical history, dental
fears/phobias, social history, age of each patient). There is therefore no evidence to satisfy
this Committee that this Learning Outcome has been completed.
1.5.4 – Identify where patients’ needs may differ from the treatment plan and refer patients for
advice when and where appropriate
This is not identified as covered in the syllabus of your original qualification. Furthermore, the
Committee considers that your experience as a dental nurse would not be sufficient as a dental
hygienist carries a greater level of responsibility. This includes identifying and articulating a
patient’s needs and problems in a referral letter. The RAP indicated that satisfactory
completion of this Learning Outcome would be evidenced with at least 25 patients (including
a wide-range of treatment plans and a wide-range of patients/age groups). There is therefore
no evidence to satisfy this Committee that this Learning Outcome has been completed.
1.7.3 – Recognise the need to monitor and review treatment outcomes
This is not identified as covered in your original syllabus and there is no further evidence that
you have managed patients with dental caries and periodontal disease and how the patients
were monitored and reviewed. There is therefore no evidence to satisfy this Committee that
this Learning Outcome has been completed.
1.7.4 – Manage patient anxiety and pain through effective communication, reassurance and
relevant behavioural techniques
The RAP indicated that satisfactory completion of this Learning Outcome would be evidenced
by managing at least 10 anxious patients and providing a piece of self-reflection on this, as
well as providing comments from the supervisor about the execution of the treatment plan.
There is therefore no evidence to satisfy this Committee that this Learning Outcome has been
completed.
1.7.5 – Manage patient pain through the appropriate use of analgesia
The Committee notes that you have undertaken a one day course on the theoretical process
of analgesic provision dated 3 February 2015 but that you have not performed this on patients.
There is therefore no evidence to satisfy this Committee that this Learning Outcome has been
completed.
1.11.3 – Undertake non-surgical treatments, under prescription where appropriate, to remove
hard and soft deposits and stains using a range of methods
You contend that this was covered in the syllabus on your training. However, the Committee
considers that there is insufficient detail in that it only refers to preventative interventions. The
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RAP indicated that satisfactory completion of this Learning Outcome would include
undertaking supragingival and subgingival scaling and root debridement, using both powered
and manual instrumentation on at least 30 patients. There is therefore no evidence to satisfy
this Committee that this Learning Outcome has been completed.
1.11.6 – Place temporary dressings and re-cement crowns with a temporary cement
You told the Committee that you had undertaken a course on this, but only on manekins and
not on patients. The RAP indicated that satisfactory completion of this Learning Outcome
would include re-cementing at least 4 crowns with a variety of temporary cements and place
at least 4 temporary dressings on patients. There is therefore no evidence to satisfy this
Committee that this Learning Outcome has been completed.
1.11.8 - Describe the risks related to dental implant therapy and manage the health of periimplant tissues.
While noting the further evidence you provided to the GDC on 20 February 2017 in connection
with this Learning Outcome, the Committee has seen no evidence to satisfy it that you have
completed the Learning Outcome in its practical application of treating implant patients.
The Committee agrees with the RAP’s recommendation that you should undertake a period
of adaptation for 6 months with a successful assessment at the end of the period.
Taking all of these matters into consideration, save for Learning Outcome 1.2.6, the
Committee is not satisfied that you have demonstrated that you have achieved the remaining
9 Learning Outcomes as set out above and thus it is not satisfied that you hold the requisite
knowledge and skills to practise as a dental hygienist. Accordingly, in accordance with
Paragraph 4(8)(a) of Schedule 2A of the Act, the Committee dismisses your appeal.
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