Dental Block Manual

Licensed for use by JK LA ESTETICA TRAINING

All Rights Reserved

No part of this publication, document or any part thereof may be reproduced or

Course Details
transmitted in any form or by any means, electronic or mechanical, including
photocopying,
Aims
recording, storage in a retrieval system, or otherwise without the prior
permission of the author.
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The course aims to ensure you; the student understands the basics of health and safety
and anatomy and physiology of the treatment. This manual covers the treatment
background, benefits, consultation and contra-indications, contra-actions, aftercare and
equipment and products required to perform the treatment. The practical techniques will
be covered on the practical session to ensure competency in the procedure.

Objectives

At the end of the course, you will be able to perform a treatment in a professional, safe
and hygienic manner in a commercially acceptable time, along with experience in
carrying out a thorough consultation with the knowledge of the background, benefits,
consultation, contra-indications, contra-actions, aftercare, equipment and the products
needed.

Accreditation

This course is accredited by:

 The CPD

Insurance

Students will be able to gain insurance from the following provider(s) listed below, upon
successful completion of your training:

Insurer name:
Contact Number:
Email Address:
Website:
Reference:

Insurer name:
Contact Number:
Email Address:
Website:
Reference:

Medical Disclaimer

It is advised that you take medical advice if you or any of your clients have a health
problem. Any qualification from (INSERT ACADEMY NAME HERE) will not qualify you to
advise on or diagnose any medical condition.

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Contact Details

Trainer: Joanna Kuszneruk

Address:

Phone Number: INSERT PHONE NUMBER

Email Address: INSERT EMAIL ADDRESS

Website: INSERT WEBSITE ADDRESS

Facebook Page: INSERT FACEBOOK PAGE

Instagram Account: INSERT INSTAGRAM ACCOUNT

Health & Safety

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You will need to maintain a high standard of hygiene as well as health and safety, not
only for yourself but also for your employees, clients and any visitors to your business.

It is a legal requirement for employees to display an approved health and safety poster
or to provide employees with an equivalent leaflet or information.

All businesses are required by law to comply with the following acts, which are monitored
and managed by The Health & Safety Executive (HSE). You should also get copies of the
following regulations from your local council or off the HSE website.

Health and Safety at Work Act 1974

This protects your rights as an employer or employee. The law states that the employer
must provide a safe working environment, provide health and safety training for staff,
produce a written policy of the company’s health and safety policy and ensure that
anyone on their premises is not exposed to any health or safety risks.

Trade Descriptions Act (1968 and 1972)

These Acts prohibit the use of false descriptions of goods or services. The information
must always be accurate, false comparisons must not be made, and misleading price
comparisons must not be made. A product may not be described as being of a 'reduced'
price if it has not been available at a higher price for a minimum of 28 days.

General Data Protection Regulation GDPR

If you are collecting and storing personal data as a therapist, then you will need to
comply with GDPR. You will need to decide which of the six lawful bases on which you will
collect and store personal data and inform your clients of how and why you will retain
their data and for how long. The Independent Commissioners Office will provide you with
all relevant information.

Sale and Supply of Goods Act 1994

This states that goods must be as described and of satisfactory quality. They should be
fit for purpose and safe for use. It is the responsibility of the retailer to correct a problem
where the goods are not as described.

COSHH Regulations and Risk Assessment (Control of Substances Hazardous to

Health)
COSHH regulations cover the essential requirements for controlling exposure to
hazardous substances, and for protecting people who may be affected by them. You
should carry out a COSHH assessment to identify all chemicals, products or other
substances which could cause harm.

A substance is considered to be hazardous if it can cause harm to the body. It poses a

risk if it is inhaled, ingested, in contact with the skin, absorbed through the skin, injected
into the body or introduced to the body through cuts.

Always check the ingredients and instructions of all products to see what they contain
and ensure they are correctly stored. If the product could cause harm, it should be listed
on your COSHH assessment, together with what the risk is and who is at risk from it.

Next, decide on the degree of risk and who to minimise that risk. If you can, try to
replace high-risk products with lower risk ones. Never leave chemicals identified as
hazardous in areas accessible to the general public. Do not forget, COSHH substances
include both those used for treatments and cleaning.

Local Government (Miscellaneous Provisions) Act 1982

A special treatment licence will be required if you carry out any form of massage,
electrolysis or ear piercing and tattooing as they may produce blood and body tissue

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fluid. Each borough council in the UK has different requirements, so you should contact
them to see whether they require you to hold a licence for the treatments you offer.

The Management of Health and Safety at Work Regulations 1999

Employers should make formal arrangements for maintaining and improving safe
working conditions and practices. This includes competency training and risk
assessments.

Management of Health and Safety at Work Regulations 1999

Employers should make formal arrangements for maintaining and improving safe
working conditions and practices. This includes competency training and risk
assessments.

The Manual Handling Operations Regulations 1992

This is relevant wherever manual lifting occurs to prevent skeletal and muscular
disorders. The employer should undertake a risk assessment for all activities involving
manual lifting.

The Personal Protective Equipment at Work Regulations 2002

This requires employers to identify activities which require special protective clothing,
which must then be made available.

The Health and Safety (Display Screen Equipment) Regulations 1992

This covers the use of display screens and computer screens. This specifies the
acceptable levels of radiation emissions from the screen, as well as identifying the
correct posture and the number of rest periods.

The Electricity at Work Regulations 1992

Electrical items are potentially hazardous and should be used and maintained properly.
You should always ensure that you are fully trained on a piece of equipment before
operating it.
All electrical equipment should be regularly PAT tested to ensure it is safe to use. If any
equipment is deemed to be faulty or unsafe, you should stop using it immediately and
report the problem. Make sure the equipment is clearly marked as faulty until the
problem has been corrected to avoid it being used by other members of staff.

Health and Safety (First Aid) Regulations 1981

Whatever the size of your business, you should always make sure you have a First Aid kit
on-site, as well as an eyewash bottle. You should ensure this is fully stocked at all times.
You should have at least one 'Appointed Person' on hand to take charge in an emergency
who holds an HSE-approved basic first aid qualification. You can contact the HSE on 0845
345 0055 for a list of suitable training providers.

RIDDOR-The Reporting of Injuries, Diseases & Dangerous Occurrences

Regulations 1995
Employers should report any such cases to the HSE Incident Contact Centre. This
includes loss of sight, amputation, fracture and electric shock. In all cases where a
personal injury of any type occurs, it should be recorded in an accident book.

The Regulatory Reform (Fire Safety) 2005

All premises must have adequate means of dealing with a fire, and all members of staff
should know where these are. This can include fire extinguishers and blankets; however,
you should only operate a fire extinguisher if you have been properly trained to do so. All
equipment should be checked and maintained regularly.
Fire Drill notices should be clearly displayed and should inform people of what to do in
case of a fire. All staff should be trained in the location of alarms, exits and meeting
points.

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Consumer Protection Act 1987
This Act aims to protect the customer from unsafe or defective services or products. All
staff should be trained in using and maintaining products.

The Provision and Use of Work Equipment Regulations 1998

This states the duties of any users of the equipment. It identifies the requirements in
selecting and maintaining suitable equipment, as well as the training and safe use of it.

Cosmetic Products (Safety) Regulations 2008

These regulations require that cosmetics and toiletries are safe for their intended
purpose and comply with labelling requirements.

Disability Discrimination Act 1996

These Acts prohibit the use of false descriptions of goods or services. The information
must always be accurate, false comparisons must not be made, and misleading price
comparisons must not be made. A product may not be described as being of a 'reduced'
price if it has not been available at a higher price for a minimum of 28 days.

The Equality Act 2010

gives disabled people important rights of access to everyday services. Service providers
have an obligation to make reasonable adjustments to premises or to the way they
provide a service. Sometimes it just takes minor changes to make a service accessible.
What is considered a reasonable adjustment for a large business such as a bank, may be
different from what is a reasonable adjustment for a small local salon. It is about what is
practical in the service provider’s individual situation and what resources the business
may have. They will not be required to make adjustments that are not reasonable
because they are unaffordable or impractical.

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Reporting Accidents

All accidents and near misses should be recorded in an Accident Report Book, which
should be kept with a first aid kit on the premises.

The following information must be recorded:

 Full name and address of the person(s) involved in the accident.

 Circumstances of the accident.
 Date and time of the accident.
 All details of what may have contributed to the accident.
 The type of injury that occurred and treatment provided on or off-site.
 Details of any witnesses.

The Personal Protective Equipment at Work Regulations 1992

This act covers your requirements under the COSHH regulations. You are required to
wear or provide to your employee's protective clothing or equipment (PPE) to ensure
their health and safety when handling chemicals or coming into contact with bodily
fluids.

What PPE will you need?

 Powder-free non-latex Gloves that must be changed for each new client.
 Disposable aprons.
 Face Masks
 Eyewear (optional)

Some therapists like to wear eye protection, although the risk is very low from spillages
or splashes. However, a new apron, facemask and gloves should be worn before each
new client.

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Salon Hygiene, Health & Safety

 The salon should be cleaned thoroughly every day.

 The working area must be cleaned before and after every client.
 Fresh towels and linen should be used for every new client that has been
laundered at a minimum of 60°C.
 Couch roll, disposable plastic sheeting or waterproof bed sheets need to be used
to protect the couch and keep the area as clean as possible.
 Products should be dispensed from purpose-specific pump or spray bottles.
Creams can be removed from jars or bottles with clean spatulas.
 Replace all lids on products securely after use.
 All tools that are non-disposable should be sterilised prior to use.
 Bins should be metal and have foot pedal operations and be emptied every day.
Bins should be collected by an appropriate commercial waste disposal company.
 All fire exits should be clearly marked and accessible at all times.
 Read all labels and follow manufactures instructions.
 Know the hazardous warning signs on products.
 Store products safely and in accordance with safety data sheets.
 Ensure equipment is placed on a sturdy surface and cannot fall off.
 Check wires and plugs regularly on any electrical equipment. Ensure electrical
equipment is PAT tested annually. Faulty equipment should not be used.
 A first aid kit that complies with the Health and Safety (First Aid) Regulations
1981.

Appearance of the Therapist

A therapist should ensure that they look well presented at all times. Therapists will be
working in close contact with a client, and it is important that a professional image is
observed.

A therapist should:

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  Wear clean, freshly laundered and ironed uniform each day.
 Wear clean, flat, closed-toe shoes.
 Have short, clean, manicured nails.
 Have a fresh breath.
 Wear antiperspirant.
 Apply modest makeup for a natural look.
 Wear hair up and away from the face.
 Wear minimal jewellery.

Professional Ethics and Standards of Practice

Therapists should:

 Maintain the highest possible standards of professional conduct.

 Always be courteous and show respect for clients, colleagues and other
professionals.
 Never gossip or criticise another therapist, salon or brand.
 Never talk across a client to another member of staff.
 Not to engage in conversations about politics, religion or race that may cause
offence.
 Maintain a good reputation by setting an example of good conduct in all your
communication with clients, team members and visitors to the business.
 Ensure to make the treatment or service special for every client.
 Respect client confidentiality.
 Explain the treatment to the client and answer any questions and queries prior to
carrying out the treatment.
 Treat all clients in a professional manner at all times regardless of their race,
colour, religion, sexual orientation or ability.
 Not to treat minors or clients with limited mental capacities, such as those with
Alzheimer's or dementia without prior written consent from a parent or carer.

Practising good ethics is essential for the reputation of the therapist and the welfare of
the clients. The following is an example of standards and ethics for therapists:

 Conduct yourself in a professional, honest and ethical manner.

 Promote professionalism
 Establish a treatment plan with your client and evaluate the outcome at the end
of every session.
 Truthfully represent your credentials, qualifications and education, experience,
training and competence relevant to practice.
 Maintain the confidentiality of the client.
 Take a full medical history of the client and ensure that they are suitable for
treatment and the treatment is the best solution for their concerns.
 Give full aftercare advice.

Precautions Taken in the Salon to Prevent Contamination and Cross-Infection

Hands
Wash with soap/disinfectant and warm water before and after each client—dry hands
with a paper towel or blower.
Surfaces
Wipe over with disinfectants, e.g. Alcohol, Surgical spirits.
Treatment of Wounds
If the skin bruises or bleeds after the insertion of a needle, a small pad of dry cotton wool
should be used over the area to cover it and apply pressure until the bleeding stops.
Apply aftercare solution to the area and work in a different area. The same applies to
extractions or any other form of skin piercing. Use disinfectant to clean area.

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Disposal
Sharp metal instruments, e.g. needles, lancets, should be placed in a sharps box after
use. When the box is about 3/4 full, it may be disposed of by special arrangement.
Usually collected by local health office and incinerated at a local hospital.
Metal Instruments
Sterilised before and after each client in Autoclave or in Glass bead steriliser, and wipe
with Chlorhexidine Gluconate or Methylated spirits.
Skin Preparation
Do not use sharp or pointed instruments on or at least near areas of a client's skin that
are obviously diseased, infected or inflamed. Except in facial treatments during the
extracting phase (a tile with a lancet and cotton wool dampened with methylated spirits
and an antiseptic solution containing Chlorhexidine Gluconate must be prepared, hands
should be washed before and after extractions and finger cots or gloves must be used).
Cuts on your Hands
Cover existing wounds with a waterproof dressing, wash fresh cuts and encourage
bleeding under running water and then cover with a waterproof dressing. Clean with an
antiseptic. Always have a box of plasters/waterproof dressing available. No salon should
be without a first aid kit.
Needles
Do not test needles on yourself. Test needles on a damp of cotton wool held with
tweezers. Needles should only be used once, and needles must not be used on more
than one client.

Creams
Tubes are better than jars. Always use a spatula to obtain creams from containers. Never
use fingers and always close a container after use. Excess product must not be returned
to containers.

Blood
Anything that has come into contact with blood must be disposed of in the correct
manner. Pay attention to the following: Hands, lancets, tweezers, surface, disposal
gloves, bin liners, cotton wool or gauze and needles)
Colds/Flu
Wear a surgical mask. Wash your hands regularly, especially after sneezing or blowing
the nose. Also, wash hands in general after touching other surface areas. General advice
- stay at home when feeling ill or send employees home if they develop cold/flu
symptoms at work.
Waste Bins
Bin liners. Emptied regularly. Bins should have lids.
Gloves
Surgical gloves can be used, e.g. epilation or, to prevent contamination. Used always
when performing any procedure that breaks the skin and any action that may come into
touch with blood.
Instruments
Must be cleaned, sanitised and sterilised or where appropriate disposable tools should be
used.

Sterilisation Methods

Autoclave

 Works like a pressure cooker.

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  Consists of 2 chambers. Water in the lower chamber and instruments on the
upper chamber.
 The principle of sterilisation is moist heat.
 The water boils in the lower chamber and steam is released towards the upper
chamber. Instruments are left in the unit for 10 - 20 min. Afterwards, instruments
must be placed in a sterile and clean container.
 The moist heat autoclave operates at 121°C and is considered a very effective
means of sterilisation.
 Other types available, e.g., dry heat autoclave, vacuum autoclave, flash
instrument autoclave.
 The time and temperature of dry heat autoclave is 160°C (320°F) for 2 hours or
180°C (356°F) for one hour.
 Consult manufacturer's instructions and local government laws and regulations on
sterilisation times and temperatures.

Advantages of an Autoclave

 Economical and very effective

 Non-toxic on instruments
 Easy to operate

Disadvantages of an Autoclave

 Sharp instruments can become blunt.

 Metal instruments might rust. Recommend use of stainless-steel instruments.
 Expensive
 Plastic instruments will be damaged.
 Autoclaves will need to be kept clean.
 Regular servicing and calibration are required of the device.

Glass Bead Steriliser

 Operates at approximately 300°C.

 Metal instruments will thus be completely sterilised within minutes.
 Only the parts covered with beads will be sterilised.
 The unit takes + 20 - 30 minutes to warm up before sterilisation
can take place.
 If more than one instrument is placed in the container, a longer
time must be added for sterilisation.
 Consult manufacturers` instructions and local government laws and
regulations on sterilisation times and temperatures

Wet Sterilisation (Chemical)

Asepsis can be obtained by washing down all surfaces, walls, floors, treatment beds,
tiles, trolleys, work surfaces, basins etc. after basic cleaning with an antiseptic solution.
EG: Antiseptic solution concentrates, diluted according to manufacturers' instructions.
Towels can also be disinfected in this method. If metal tools are sterilised by this method,
the liquid must contain a rust inhibitor.

UV Cabinet

 They are used for the maintenance of your

sterilisation process.
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  Basically, used as a storage unit.
 They are not used for sterilisation only for sanitation.
 This cabinet will keep your item as clean as it was when you first inserted it.

Antiseptics and Disinfectants

Antiseptic

A diluted disinfectant that is safe to apply to the skin. Its' task is to slow down
multiplication, growth and in some cases may destroy/kill micro-organisms if the strength
of the solution is correct, e.g. some soaps (hands), alcohol and hydrogen peroxide etc.

Disinfectant

A chemical agent which destroys or kills all micro-organisms. Safe to apply on surfaces
but too toxic to be applied directly onto the skin, e.g. Quaternary Ammonium
compound/Quats, formalin, ethyl or grain alcohol.

Ergonomics

Posture is important, whether you are sitting or standing up to do a treatment. Try to find
a working position that is comfortable for you and reduces the need to lean over to just
one side.

Using height adjustable treatment couches and chairs. Choose a height that reduces your
need for bending over the client. Ideally, your back should be at a 90-degree angle. Your
chair should be comfortable to avoid pressure point sores or injury.

Try to avoid twisting the neck, keep your head upright and keep your shoulders relaxed.

Never ignore pain; look at ways to alleviate the symptoms. If you cannot take a break
during treatment, then you can adopt gentle stretching techniques.

Repetitive strain injuries can be caused by using the same movements over and over
again. Try to avoid repetitive flexing of the wrist and instead alternate by bending elbows
or shoulders instead. Equipment should feel comfortable in your hand and have as
minimal vibration as possible.

Storage

 Make sure you receive a copy of Material Safety Data Sheets (MSDS) from your
suppliers.
 All staff must be trained on the use of products and equipment.
 Training manuals and information leaflets should be accessible to all staff.
 Store your products correctly by following the guidance on the MSDS.
 Carry out a risk assessment on each product or COSHH report if required.
 Keep products in original containers where possible and ensure any decanted
products are fully labelled in smaller, purpose-built containers.
 Keep all flammable products out of direct sunlight and at room temperature or
below.
 Mobile therapists must make suitable travel arrangements to avoid spillage and
ensure safe working practice and be professional in appearance.

Insurance

There are several types of insurance that are potentially relevant to you as a therapist.
The most important is the 'Professional Indemnity Insurance' and 'Public Liability

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Insurance'. Both of these are necessary in the unlikely event that a client decided to sue
you.

Public Liability Insurance - This covers you if a member of the public, i.e. a client or
passer-by is injured on your premises or if their personal property is damaged in any
way.

Professional Indemnity Insurance - This protects you should a client decide to sue
you claiming personal injury or damage as a result of treatments carried out by you.

Employer’s Liability Insurance - This is only necessary if you hire others to work for
you. This type of insurance would cover you should a member of your staff have an injury
on your premises.

Product Liability Insurance - This insurance is important if you plan to use,

manufacture or sell products as part of your business. This will protect you in the event
that a client is dissatisfied with the product or experiences a reaction to using the
product.

Car Insurance - If a car is used for business purposes, ensure that this is covered by the
policy and that theft of equipment is included.

Aesthetics Health & Safety

Advertisements on Prescription-Only-Medication (POM) Treatment

New enforceable guidelines for advertising Prescription-Only-Medication such as

Botulinum Toxin or Vitamin Injections such as B12, C & D came into effect on the 31st
January 2020. This is regulated by the Committee of Advertising Practice (CAP), who will
use specialist new monitoring technology to discover non-compliant ads and take action.
One such outcome may be the reporting of specific ads or posts on social media
platforms like Instagram.

The Advertising Standards Authority (ASA) was established in 1963 as an industry

watchdog to monitor and adjudicate any breaches of the British Code of Advertising
Practice (CAP Code) with the primary objective of protecting the public from inaccurate,
inappropriate, or misleading adverts, whether online, in print or via broadcast.

Any promotion of a POM to the public is a breach of the CAP Code and an offence under
the Human Medicines Regulations 2012.

Code 12.12 of the CAP states that "Prescription-only medicines or prescription-only

medical treatments may not be advertised to the public."

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Administration of Prescribed Products

The Medicines and Healthcare products Regulatory Agency (MHRA) states that any
person can administer certain prescribed products, i.e., Botulism Toxin, in accordance
with the guidance of an appropriate practitioner. This means that according to the
MHRA, Non-prescribers and non-medics can administer procedures using prescribed
products following instruction from either a doctor, dentist, or appropriately qualified
independent prescriber.

Beyond the administration of these products, they are prescribed drugs, and therefore
there are strict guidelines as to who can prescribe the medication. Prescriptions should
only be issued after adequately assessing the client and giving client-specific instructions
(ideally written). Non-medics or nurses are not allowed to prescribe these products for
use, but if they have been given a prescription with specific instructions by the prescriber
for the client, then the non-medic or nurse may administer the treatment. Prescriptions
should not be done remotely as most products used are being used 'off-label' for non-
essential purposes. The client should be seen in person by the prescriber.

Remote prescribing of Botulinum Toxin is now banned under the NMC, GMC,
and GDC and absolutely should not be considered as an alternative to a face-
to-face consultation.

In general, products required cannot be supplied in advance but on a per-client basis.

However, the MHRA does state that doctors can supply advance stocks to 'nurses and
others who are employed within the same legal entity. Even though the items can be
supplied in advance stocks under these circumstances, client-specific advice must still be
given to the person administering the procedure.

It is important to note that the manufacturers of many products used in aesthetic

procedures state that the treatments should be administered by medical practitioners.
Non-medics should consider these guidelines carefully and ensure they have the correct
and appropriate training and professional indemnity insurance in place.

Medications are intended to be for the person in which they are prescribed too and
should be administered as such. Full records should be kept for up to 6 years, including
the prescriptions and batch numbers and full details of the treatments and outcomes.

Storage of Medicines

Practitioners should know how to correctly store the products they use and administer to
clients at their clinics, and this includes the use of a dedicated medical fridge.

There are several reasons for this.

Storing products at the correct temperature:

Many of the products used in non-invasive cosmetic procedures must be stored within a
certain temperature range. For Botulinum Toxin, this is between +2°C to +8°C.

The only way to accurately maintain this temperature range is by using a dedicated
medical fridge, which provides unrivalled levels of temperature control and monitoring.

This is achieved by using special thermometers that can measure the temperature inside
the fridge as well as the temperature of the products that are being stored.

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They are also fitted with alarms that will be triggered to make noise if the temperature
falls outside of the required range, allowing practitioners to intervene and save products
from damage.

Added security:

Dedicated medical fridges provide greater levels of security than standard domestic
fridges as they can also be locked to prevent any unauthorised access.

They can have either a glass or solid door. The former allows practitioners to look inside
the fridge without the need to open the door and risk a rise in temperature.

The latter provides added security as people cannot see what is being stored inside the
fridge, mitigating the risk of theft.

How to store products in a medical fridge:

In order for the medical fridge to be work to its best

ability, practitioners must store products in a certain
way. This includes:

 Leave 1cm of space between products

 Ensure products do not touch the back of
the fridge
 Ensure the fridge is never more than 75%
full
 Clean the outside of the fridge daily
 Clean the inside of the fridge twice a month

Practitioners should also conduct a weekly stocktake of the products that are being
stored inside the fridge and ensure that products with the shortest shelf life are at the
front and used first.

Temperature monitoring is the key to correct storage:

It is good practice if practitioners monitor and log the temperature of their fridges to
ensure they do not fall outside of the minimum/maximum range.

Temperature logging should be done by a qualified and experienced practitioner at least

once per day. They should record min, max and current temperatures on a log and sign
their name against it.

If the temperature has fallen outside of the range at any point during the day, they must
intervene and take the necessary action to ensure the products inside remain safe to
use.
How to choose the right medical fridge for your needs:

There are medical fridges to suit every requirement. When thinking about which best
meets your needs, you will need to consider the following:

 The space you have available

 The amount of product you need to store
 Your budget
 Whether you require a glass door or a solid door

Disposal of Medicines

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All clinics should have a written policy for the safe disposal of surplus, unwanted or
expired medicines.

Disposal of waste is subject to legislation and regulated by the Environment Agency. You
might need to dispose of medicines when:

 a person's treatment changes or stops

 Safely dispose of remaining supplies (with the person's consent where possible).
 the medicine reaches its expiry date
 Make sure you read about expiry dates in the product information leaflet. Some
medicines expire before their' use by' dates because you've opened the
packaging. Other expiry dates are shortened if they're removed from controlled
temperature storage.

Risk

Clinics must dispose of unwanted medicines appropriately to avoid placing people who
use services at risk.

Examples

A person who is no longer a client has previously prescribed medication. You must not
administer medicine to a person if it was prescribed to another person.

A prescriber has stopped prescribing a medicine. If you continue to administer the

medicine, you could place people at risk.

If you administer medicine beyond the expiry date, the product could have chemically
changed. This may make it clinically ineffective or could cause actual harm.

Process

You should record the process for disposing of medicines in your medicines policy. Store
medicines for disposal securely and separately to in use medicines. Control access until
they are collected or taken to the pharmacy. Do not dispose of medicines on-site through
the sewage system.

NICE SC1 says, "Medicines for disposal should be stored securely in a tamper-proof
container within a cupboard until they are collected or taken to the pharmacy."

You should dispose of medicines by returning them to the supplier. This would usually be
the community dispensing pharmacy. The supplier should dispose of the medicines in
line with current waste regulations.

Keeping records

You must keep records to ensure that medicines are handled properly during disposal.
Records could include:

 date of disposal or return to the pharmacy

 name and strength of the medicine
 quantity removed
 the person for whom medicines were prescribed or purchased
 signature of the member of staff who arranges the disposal of the medicines
 signature of the person collecting the medicines for disposal

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Providing consultations for aesthetic procedures using prescribed products

It is important to ensure that a full consultation is undertaken prior to any procedure, and
the client is aware that:

 The product used requires a prescription, and that the medicine is used off-
licence.
 Treatments provided are done so on a cosmetic basic only and not on the basis of
improving health.
 Clients should seek the advice of their GP if they are seeking a procedure for
improving any aspect of their health or quality of life.
 All risks associated with the treatment.
 Treatments must be maintained or kept up to continue to see the results, as well
as ongoing costs and outcomes for non-maintenance.

The client will need to fill in the treatment form prior to the procedure and sign the key
facts to the risks, aftercare and techniques used.

Before and after photographs must be obtained and kept on record for use at later
appointments in the event of a complication or claim.

What information should be recorded:

 Clients name, address, contact number and email.

 Clients medical history
 Signed consent and key facts
 Before and after images
 Details of the prescriber, date of prescription and batch number of products used
 Details of the site/area of administration, mix ratio, units/MLS injected
 Date of review

Working with Sharps

The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 Prior to the
publication of European Directive 2010/32/EU, a framework agreement was developed
that brought together a number of existing health and safety requirements in order to
make the legal framework to protect workers from sharps injuries more explicit. The UK
went down the legislative route, and The Health and Safety (Sharp Instruments in
Healthcare) Regulations 2013 came into force on the 11th May 2013.

The regulations apply to employers whose primary activity is to organise, manage and
provide treatment to others that involve the use of sharps. Those covered under the act

17
include not only those that undertake the procedure but all others that may come into
contact with any sharps, which will include all employees, servicemen and cleaners.
The main requirements of the regulations mean Employers need to assess the risk of
sharps injuries under the COSHH regulations. Where risks are identified, the regulations
require the employer to take specific risk control measures detailed below:

 where the employer has identified a risk, steps must be taken to avoid the
unnecessary use of sharps (Regulation 5 (1)(a))
 where it is not reasonably practicable to avoid the use of medical sharps, the
sharps regulations require employers to: -
 use safe sharps (incorporating protection mechanisms) where it is reasonably
practicable to do so (Regulation 5(1) (b)) –
 prevent the recapping of needles (Regulation 5 (1) (c))
 - place secure containers and instructions for safe disposal of medical sharps
close to the work area (Regulation 5 (1) (d)
 Provide information to employees on the risks from injuries, relevant legal duties
of employers and employees; good practice in preventing injuries; the benefits
and drawbacks of vaccination and the support available to an injured person from
their employer.
 Provide appropriate training to ensure employees know how to work safely. The
training must cover the correct use of safe sharps, safe use and disposal of
sharps, what to do in the event of an injury and the employer's arrangements for
health surveillance. (Regulation 6 (4))
 Have arrangements in place in the event of an injury, which includes keeping a
record of the incident, investigation of the circumstances of an incident and to
take action to prevent a reoccurrence. The HSE advise that records of the incident
should include details of the type of sharp involved, at what stage of the
procedure the incident occurred and the severity of the injury.
 ensure that injured employees who may have been exposed to a blood-borne
virus have immediate access to medical advice; are offered post-exposure
prophylaxis or other treatment as advised by a doctor, and offered counselling
where appropriate. (Regulation 7 (2))
 Review, at suitable periods, the effectiveness of procedures and control measures
(Regulation 5 (2)).

Work practice controls

These controls aim to change the behaviour of workers to reduce exposure to

occupational hazards. Examples include:

 no needle recapping or resheathing

 safe construction of sharps containers
 placing sharps containers at eye level and within arm's reach
 disposing of sharps immediately after use in designated sharps containers
 sealing and discarding sharps containers when they are three-quarters full
 establishing means for the safe handling and disposal of sharps devices before
the beginning of a procedure.
 Safe storage of full sharps containers, which should be stored in a safe place and
carried away from the body with the lid firmly closed.

The Environmental Protection Act 1990

Under this act, anyone that disposes of waste has a duty of care to ensure that waste is
disposed of safely.
Subjects covered by the Environmental Protection Act 1990 are as follows:

 Waste management
 Noise pollution

18
  Neighbourhood pollution
 Radioactive substances
 Genetically Modified organisms
 Nature Conservation

Under the Environmental Protection Act 1990, it is unlawful to deposit, recover or dispose
of controlled (including clinical) waste without a waste management licence, contrary to
the conditions of a licence or the terms of an exemption, or in a way which causes
pollution of the environment or harm to human health. Contravention of waste controls is
a criminal offence. Section 34 of the act places people concerned with controlled
(including clinical) waste under a duty of care to ensure that the waste is managed
properly, recovered or disposed of safely and is only transferred to someone who is
authorised to keep it. Householders are exempt for their own household waste.

Hazardous healthcare waste is subject to the requirements of the Hazardous Waste

Regulations 2005. [Extract is taken from [Link]
website [Link] 30th June 2014]

All commercial businesses must have a waste removal contract with either the council or
a private waste removal company. If you produce less than one bin bag full of clinical
waste per collection, then you can dispose of clinical waste such as cotton wool and
tissues in with a normal waste collection. If you produce more than this per collection,
then a suitable clinical waste contract must be obtained.

Sharps Disposal

Anything sharp that could pierce or has pierced skin should be put into the correct
category of sharps disposal. We can give you a hand if you're not sure what kind of
sharps disposal you need. Any of the below should be disposed of in a sharps bin:
 Needles
 Scalpels
 Stitch cutters
 Glass ampoules
 Sharp instruments
 Shards of bone and teeth
 Syringes
 Lancets
 Razor blades
Your Sharps waste needs to be disposed of in a dedicated sharps bin of a suitable size
which we will provide you with as part of your contract. From there, it is incinerated.
If you're producing hazardous waste, you have a duty of care to ensure that it's housed
and disposed of in the most appropriate way.

You will need to employ the services of a specialist waste disposal company that will
safely remove your sharps boxes when full, along with any other hazardous waste.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

1995

These regulations are commonly referred to as RIDDOR, and their main purpose is to
alert the enforcing authorities to incidents and causes of ill health that may need further
investigation. Their second role is to collate statistics and to assist in the implementation
of initiatives to reduce accidents in the workplace.

19
If any of your employees or trainees suffer a personal injury at work that results in either;

 Major Injury
 Death

Then you must contact the Incident Contact Centre on 0845 3009923.

Less serious injuries have to be reported using form F2508 available on the HSE website.
Less serious injuries include:

 More than 24 hours in a hospital

 Incapacity for more than 7 days.

Other incidences that are reportable include:

 A member of the public or client is injured and admitted to hospital.

 Any member of staff that is injured due to an act of violence that is work-related.

All records of injuries, minor or major, must be recorded in your accident book.

Further guidance can be found on the HSE website [Link]/riddor.

Health & Safety (First Aid) Regulations 1981

Your environmental health officer may ask if you have a completed First Aid training. The
HSE recommends that businesses with fewer than 50 staff members should have at least
one qualified and appointed First Aider.
First Aid courses can last anything from half a day to 3 days. The half-day courses are not
usually accredited, so it is highly recommended to at least complete a full day of First Aid
training.

These regulations also require that every employer provides equipment or facilities for
providing First Aid to their employees. Even if you do not have employees, having a First
Aid Kit to hand when required is good practice.

A First Aid box and an eyewash station with single-use pods should be enough, with extra
items kept aside for restocking.

Your First Aid box should contain the following:

Number of Employees 1-5 6-10 11-50

Contents QTY QTY QTY
First Aid Guidance Notes 1 1 1
Individually wrapped sterile adhesive dressings 20 20 40
Sterile Eye Pads, with attachment 1 2 4
Sterile triangular bandages 1 2 4
Safety Pins 6 6 12
Medium sized sterile unmedicated dressings 3 6 8
Large sterile unmedicated dressings 1 2 4
Extra Large sterile unmedicated dressings 1 2 4

First Aid boxes must not include any form of medication. Such as Paracetamol or
Ibuprofen

Bloodborne Pathogens

What are bloodborne pathogens?

20
Bloodborne pathogens are infectious microorganisms in human blood that can cause
disease in humans. These pathogens include, but are not limited to, hepatitis B (HBV),
hepatitis C (HCV) and human immunodeficiency virus (HIV). Needle sticks and other
sharps-related injuries may expose workers to bloodborne pathogens. Workers in many
occupations, including first aid team members, housekeeping personnel in some
industries, nurses and other healthcare personnel, may be at risk of exposure to
bloodborne pathogens.

What can be done to control exposure to bloodborne pathogens?

In order to reduce or eliminate the hazards of occupational exposure to bloodborne

pathogens, an employer must implement an exposure control plan for the worksite with
details on employee protection measures. The plan must also describe how an employer
will use a combination of good work practice and ensure the use of personal protective
clothing and equipment, provide training, medical surveillance, hepatitis B vaccinations,
and signs and labels, among other provisions. Engineering controls are the primary
means of eliminating or minimising employee exposure and include the use of safer
medical devices.

AIDS – Acquired Immune Deficiency Disease:

AIDS is caused by a human immune-deficiency virus (HIV). The virus attacks the body’s
natural immune system and makes it vulnerable to infections, which will eventually
cause death. Some people are known to be HIV positive, which means that they are
carrying the virus without any symptoms of AIDS. HIV carriers are able to pass on the
virus to someone else through infected blood or tissue fluid, for example, through cuts or
broken skin.
The virus does not live for long outside the body.

Hepatitis B:

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic
disease. The virus is most commonly transmitted from mother to child during birth and
delivery, as well as through contact with blood or other body fluids, including sex with an
infected partner, injection-drug use that involves sharing needles, syringes, or drug-
preparation equipment and needle sticks or exposures to sharp instruments.

As of 2016, 27 million people (10.5% of all people estimated to be living with hepatitis B)
were aware of their infection, while 4.5 million (16.7%) of the people diagnosed were on
treatment. According to the latest WHO estimates, the proportion of children under five
years of age chronically infected with HBV dropped to just under 1% in 2019, down from
around 5% in the pre-vaccine era ranging from the 1980s to the early 2000s.

Hepatitis B can be prevented by vaccines that are safe, available and effective.

Hepatitis C:

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can cause
both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few
weeks to a serious, lifelong illness.

The hepatitis C virus is a bloodborne virus: the most common modes of infection are
through exposure to small quantities of blood. This may happen through injection drug
use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and
blood products, and sexual practices that lead to exposure to blood.

Globally, an estimated 71 million people have chronic hepatitis C virus infection. A

significant number of those who are chronically infected will develop cirrhosis or liver
cancer.

21
There is currently no effective vaccine against hepatitis C; however, research in this area
is ongoing.

Dealing with body fluids:

If blood or body fluids have to be mopped, ensure that disposable gloves, apron and
disposable paper are used. All disposable items should then be placed in a yellow plastic
sack and destroyed by incineration.

Neat chlorine bleach should be used as the sterilising agent on blood spills. The bleach
treatment will destroy the viruses, which will cause AIDS and Hepatitis B.

Anaphylaxis
Some allergies can lead to a severe allergic reaction - known as anaphylaxis. Anaphylaxis
can be life-threatening.

Symptoms can occur quickly or within hours following contact with an allergen. Prompt
treatment can save a life. If you have an adrenaline auto-injector - use it immediately.

Common causes

Common causes of anaphylaxis are wasp and bee stings as well as food, such as
peanuts, nuts, sesame seed, fish and shellfish, dairy products and egg. Other causes
include latex, penicillin and some other medications.

For some, fatigue or exercise may cause anaphylaxis - alone or in combination with other
triggers like food or medication. Cold can also be a cause. In rare cases, a reaction can
occur without apparent cause.

Symptoms
 Itching, especially under the feet, in the hands or on the head
 A stinging feeling in the mouth
 Swelling in the mouth, throat, lips or eyes
 Itching, redness or nettle-rash anywhere on the body
 Dizziness, anxiety, cold sweating
 Abdominal pain, nausea or vomiting
 Shortness of breath or asthma symptoms
 Sudden fatigue, decreased blood pressure or fainting
 Disorientation or loss of consciousness

Critical symptoms: difficulty to breath, mouth and throat swell, sudden fatigue or
dizziness, experiencing a steady worsening of symptoms.
If your client experiences these critical symptoms, inject adrenaline immediately. Call
999 and say “anaphylaxis”.

Treatment

Adrenaline is the first-line treatment for anaphylaxis. If you have an adrenaline auto-
injector - use it immediately. Adrenaline injected into the outer mid-thigh muscle works
rapidly to reduce throat swelling, open up the airways and maintain heart function and
blood pressure. It is the only medication available for the immediate treatment of severe
allergic reactions.

Antihistamine and steroid tablets. Antihistamine reduces hives, itching and irritation.
Cortisone reduces the risk of late-onset reactions that can occur some hours following
contact with allergens.

22
Who is at risk of anaphylaxis?

A person who has previously experienced anaphylaxis - irrespective of cause - is at risk in

the future.
If the reaction was caused by peanuts, shellfish or fish, it should not be ignored, even if
mild. This is especially important if the reaction was caused by peanuts. This is also the
case for certain drugs, insect stings or latex. Your doctor will give you essential
information and prescribe suitable medication.

When your client suffers from anaphylaxis

Do not underestimate the severity of an allergic reaction. Use your adrenaline auto-
injector according to its instructions. If in doubt, use your adrenaline auto-injector -
it can save their life. Then lay them down with their legs slightly elevated.

Call 999 and say, “anaphylaxis.” State your name, location and telephone number.

If possible, someone should wait outside to show the ambulance crew where you are.

Let ambulance personnel know about the client’s medical history and treatment
undertaken.

Managing Complications

Anyone working in aesthetics or undertaking treatments that break the skin, i.e.
injectables or involve the injection of application of a product that could cause an allergic
reaction, should undertake appropriate training in managing complications. Training
should be taken regularly to ensure you stay up to date with current regulations and feel
confident in dealing with any issues that should arise.

Complications training is usually in addition to first aid and anaphylaxis training.

Understanding the array of issues that could be presented from aesthetic procedures will
allow you to confidently provide treatments to your clients.

Invasive procedures always carry more risk than other treatments in a salon, and it is
important that we are able to identify risk and know how to avoid it.

Emergency Plan

The emergency plan is the responsibility of the regulated independent prescriber. The
emergency plan includes the appropriate onsite response, healthcare referral process
and access to an emergency kit suitable to deal with adverse reactions or incidents. The
regulated independent prescriber has a duty of care to their patients to follow regulatory
guidelines set by their Professional, Statutory and Regulated Body.

The client may contact you directly with any issues, and you must also raise any
concerns to the prescriber to arrange a care plan for the client.

23
Local anaesthetic
A local anaesthetic is essential in the daily practice of aesthetic practitioners. Local
anaesthesia provides temporary 'numbness' and reduces anxiety, and increases client
comfort during aesthetic procedures. The interesting thing is we all know that local
anaesthesia can also be a source of pain itself, a fear of needles and painful injections is
a significant contributing factor to anxiety and is a commonly reported concern amongst
our clients. There is an ethical and practical case for ensuring the provision of painless,
effective local anaesthesia for the reduction of anxiety and for improving client comfort.
This course provides training in delivering effective and comfortable local anaesthesia
and will aim to also ensure that you are confident in the science behind local
anaesthetics. You will learn the armamentarium available and the steps on selecting and
administrating local anaesthesia and, importantly, also discuss what to do when it fails or
complications arise.

History of Local Anaesthetic

The original local anaesthetic was cocaine; it

was derived from the Coca plant by Alfred
Neiman in 1859 and was first used in surgery
by Karl Kolller in 1884; by this time, two
crucial parts of the local anaesthetic
armamentarium were already in place when
Zopher Jaynes' innovation of hypodermic
syringes in 1841 and Alexander woods'
invention of the first hypodermic needle in
1853 which could be combined for the
injection of morphine. However, it was more
than 60 years after the development of
cocaine when the glass dental cartridge by
Harvey cook was introduced, and this was
finally painted in 1925 as the carpulel system.

When it comes to dentistry William Halstead was credited with dentistry's first use of
cocaine as a local anaesthetic after he successfully injected a colleague. Some of the
most common injection techniques still in use today paid tribute to this dental pioneer
are still in use today; for example, the Inferior Alveolar nerve block is also known as the
Halstead technique. However, cocaine was not quickly adopted by dentists despite its
effectiveness because of all the unwanted systemic side effects such as increased pulse
rate, giddiness, and exhilaration.

The first substitute for cocaine was tropacocaine, discovered in 1891; this was followed
by eucaine which was introduced in 1896; both of these agents were just as effective as
cocaine but exhibited less toxicity. Until this time, local anaesthetic research continued
to be focused on the active ingredient in cocaine that was thought to be responsible for
the anaesthetic properties of ecgonine because of the systemic toxicity and the habit-

24
forming properties of cocaine research at the end of the 19 century shifted towards the
alcohol components of the esters of the amino acids, ester compounds.

The first ester local anaesthetic was called

orthiform and was developed by Alfred Einhorn
and Robert Heinz in 1898. Several other ester
formulations followed; however, all these early
esters suffered from insolubility in water and
resulted in tissue irritation when injected. The
next major step in local anaesthesia formulation
came from anesthesin, which included the ethyl
ester of p-aminobenzoic acid. Anesthesin
presented with excellent anaesthetic properties
but was prohibited for hypodermic injection
because it caused tissue irritation and was
therefore limited to topical use.

Finally, in 1905 the culmination of Einhorn's research resulted in the development of the
ester local anaesthetic procaine, marketed in the United States as Novocain. Advantages
of Novocain included improved patient safety compared to cocaine derivatives, no risk of
dependence, solubility in water so it could be injected with less irritation to tissues and
suitability for combination with preparation such as epinephrine. The disadvantages
included allergenicity, short duration of action and local vasodilation. The breakthrough
came in 1943 when Nils Lofgren and Bengt Lundqvist in Stockholm, Sweden, discovered
a new compound labelled LL30, which would later become the first amide local
anaesthetic; Lidocaine.

Compared to Novocain, Lidocaine featured less allergenicity, a longer duration of action,

better potency and less tissue irritancy. In November 1948, lidocaine marketed as
Xylocaine was approved by the Food and Drug Administration. A common misconception
is that there is a pharmacological relationship between cocaine and the other
medications containing the 'Caine' suffix; in reality, there is no pharmacological
relationship between the earliest anaesthetics based on ecgonine and the local
anaesthetics ester's and amides. Following the successful introduction of Lidocaine or
Lignocaine, several other local anaesthetics were developed, including Mepivacaine and
Bupivacaine in 1957 Prilocaine and Articaine and Etidocaine in 1972.

25
The science

The definition of local anaesthesia is defined as a loss of sensation in a circumscribed

area of the body by a depression of excitation in nerve endings or an inhibition of the
conduction process in the peripheral nerves. In clinical practice, a localised loss of pain
sensation is desired to ensure client comfort.

Local anaesthetic agents can be classified in two main ways one by their chemical
structure, so they are classified usually as ester's or amides and by their duration of
action, so short-acting, intermediate-acting or long-acting. In terms of their chemical
structure, the difference between ester's or amides is largely the means by which the
body biologically transforms the active drug into the one that is pharmacologically
inactive. Metabolism or biotransformation of local anaesthetics is important because the
overall toxicity of the drug depends on a balance between its rate of absorption in the
bloodstream and the site of injection and its rate of removal from the blood through the
process of tissue uptake and metabolism.

The ester group (metabolised in plasma) contains chloroprocaine, procaine and

tetracaine. The amide group (metabolised primarily in the liver) contains more commonly
used local anaesthetics such as articaine, prilocaine, lidocaine, mepivacaine and
bupivacaine etc. Practitioners prefer the amide agents to the ester's as the amides
produce more profound anaesthesia and more rapidly and reliably with fewer sensitising
reactions than ester anaesthetics.

The injectable local anaesthetics used have a common core structure, consisting of a
hydrophilic amino-terminal, intermediate chain and lipophilic aromatic terminal. The
combination of hydrophilic and lipophilic properties in one molecule is essential for an
injectable local anaesthetic to be effective. The hydrophilic portion of the molecule
consists of a substituted secondary or tertiary amine. Solubility in water is essential for
two reasons:

 to allow for the dissolution in a solvent to permit injection and;

 to allow penetration through the interstitial fluid following administration

26
The intermediate chain consists of either an amide or ester linkage. This allows spatial
separation of the hydrophilic and lipophilic components of the molecule. The older
agent's procaine and cocaine are ester-based drugs.

The lipophilic part of the local anaesthetic agent is an aromatic residue that is essential
for its ability to penetrate fatty tissues such as the lipid sheet of the nerves in order to
gain access to the nerve cell membrane to reach its site of action.

Different drugs have different proportions or hydrophilic and lipophilic components.

These differences modify the characteristics and properties of the anaesthetic agents in
various ways, including their;

 intrinsic potency
 onset of anaesthesia
 duration of action
 effects on other tissues and;
 rate of degradation

So what's actually in your typical anaesthetic? The general constituents include:

1. Local anaesthetic agent – such as lidocaine.

2. A vasoconstrictor - all clinically effective, injectable local anaesthetics
possess some degree of vasodilating activity. The vasodilation leads to an
increase of absorption of the local anaesthetic agent from the local
injection site into the cardiovascular system, and that may increase
plasma levels. It also increases the risk of local anaesthetic toxicity, and it
decreases the depth and duration of anaesthesia, and increases the
bleeding at the site of injection, so vasoconstrictors are very important to
oppose these dilatory actions and counter out these problems associated
with the use of local anaesthetic alone. The two most common
vasoconstrictors include epinephrine or adrenaline.

Oliver Wendell Holmes coined the term 'anaesthesia' in 1846 to describe a drug-induced
insensibility to sensation – particularly pain. Two broad classes of pharmacological
agents, local and general, can result in anaesthesia. Local anaesthetics block nerve
transmission to pain centres in the central nervous system by binding to and inhibiting
the function of an ion channel in the cell membrane of nerve cells known as the sodium
channel. This action obstructs the movement of nerve impulses near the site of injection,
but there are no changes in awareness and sensation perception in other areas.

In contrast, general anaesthetics induce a different sort of anaesthetic state, one of a

general insensibility to pain. There is a total loss of awareness, yet vital physiologic
functions, such as breathing and maintenance of blood pressure, continue to function.
Less is known about the mechanism of action of general anaesthetics compared to
locals, despite their use for more than 150 years.

27
Oral Cavity Anatomy & Physiology

The cheeks, tongue and palate frame the mouth, which is also called the oral cavity or
buccal cavity. At the entrance to the oral cavity are the lips, or labia (singular labium).
The outer covering of the lips is skin, which transitions into a mucous membrane inside
the mouth. Lips are very vascular with a thin layer of keratin which is the reason for their
red colour. The lips cover the orbicularis oris muscle that surrounds the opening of the
mouth. The labia frenulum is a midline fold of mucous membrane that attached the inner
surface of each lip to the
gums.

The cheeks make up the

sidewalls of the oral cavity.
Internally they are covered
by a mucous membrane
made up of non-keratinised,
stratified squamous
epithelium cells. Between
the skin and the mucous
membrane of the cheek are
connective tissues and the
buccinator muscle.

The pocket-like part of the

mouth that is framed by the
gums and teeth and on the
outside by the cheeks and

28
lips is called the oral vestibule. Further inside the mouth, the opening between the oral
cavity and throat (oropharynx) is called the fauces.

The arch of the mouth is called the anterior region of the palate, serves as a wall (or
septum) between the oral and nasal cavities, as well as a rigid shelf against which the
tongue can push food. It is created by the maxillary and palatine bones of the skull and,
due to its bony structure, is known as the hard palate. The hard palate ends at the
posterior oral cavity, and the tissue becomes fleshier. This part of the palate is known as
the soft palate and is composed primarily of skeletal muscle.

The uvula is a fleshy bead of tissue that drops down from the centre of the posterior
edge of the soft palate. The uvula helps to keep food and liquids from entering the nasal
cavity. Two muscular folds extend downward from the soft palate on each side of the
uvula. Towards the front, the palatoglossal arch lies next to the base of the tongue;
behind it, the palatopharyngeal arch forms the superior and lateral margins of the
fauces. Between the two arches are the palatine tonsils, clusters of lymphoid tissue that
protect the pharynx. The lingual tonsils are located at the base of the tongue.

The Tongue

The tongue is one of the most hardworking muscles in the body, being responsible for
ingestion, mechanical digestion, chemical digestion, a sensation of taste and textures,
swallowing and vocalisation.

The tongue is attached to the mandible, the styloid processes of the temporal bones, and
the hyoid bones. The hyoid is unique in that it only distantly and indirectly articulates
with other bones. The tongue sits on the floor of the oral cavity. A medial septum
extends the entire length of the tongue, dividing it into symmetrical halves.

Underneath the mucous membrane covering, each half of the tongue is comprised of the
same number and type of intrinsic and extrinsic skeletal muscles. The intrinsic muscles
within the tongue are the longitudinalis inferior, longitudinalis superior, transverses
linguae and verticalis linguae muscles. These muscles allow the tongue to change size
and shape, which helps with swallowing and speech.

The extrinsic muscles of the tongue are the mylohyoid, hyoglossus, styloglossus, and
genioglossus muscles. These muscles originate from outside the tongue and insert into
the connective tissues within the tongue. The mylohyoid raises the tongue, the
hyoglossus pulls it back down, the styloglossus pulls the tongue up and back, and the
genioglossus pulls it forward. Working together, these muscles help with chewing,
gathering food into a bolus and swallowing.

The top and sides of the tongue are studded with papillae, extensions of lamina propria
of the mucosa, which are covered in stratified squamous epithelium. Fungiform papillae
are mushroom-shaped and cover a large area of the tongue; they tend to be larger
towards the rear of the tongue and smaller on the sides and tip. Filiform papillae are also
present on the tongue, and in contrast, they are long and thin. Fungiform papillae
contain taste buds, and filiform papillae have touch receptors that help the tongue to
move food around the mouth. Lingual glands in the lamina propria of the tongue secrete
mucus and watery fluid that contains the enzyme lingual lipase, which works to break
down triglycerides when it reaches the stomach. A fold of mucous membrane on the
underside of the tongue called the lingual frenulum tethers the tongue to the floor of the
mouth cavity.

Salivary Glands

There are many small salivary glands within the mucous membranes of the mouth and
tongue. These minor exocrine glands are constantly secreting saliva either directly or
indirectly into the oral cavity through ducts. Around 1-1.5 litres of saliva us secreted

29
every day. Saliva is secreted to moisten the mouth and teeth and increases its
production during eating to breakdown carbohydrates. Small amounts of saliva are
secreted by the labial glands in the lips. The buccal glands in the cheeks, palatal glands
in the palate and the lingual glands in the tongue help to ensure that all areas of the
mouth are supplied with adequate saliva.

Outside of the oral mucosa are three pairs of major salivary glands, which secrete the
majority of saliva into the ducts that open into the mouth.

The submandibular glands are located on the floor of the mouth and secrete saliva into
the oral cavity through the submandibular ducts.

The sublingual glands lie beneath the tongue and use the lesser sublingual ducts to
secrete saliva into the mouth.

The parotid gland lies between the skin and the masseter muscle, near the ears. They
secrete saliva into the oral cavity through the parotid duct, located near the second
upper molar tooth.

The Teeth

The teeth of dentes are organs similar to bones that are used to tear, grind and
mechanically break down food.

During the course of a human's lifetime, two sets of teeth are presented. The first set
appears at around six months of age and consist of 20 deciduous teeth or baby teeth.
Between the ages of 6 and 12, these teeth are replaced by 32 permanent teeth. The
adult human mouth consists of:

 Eight incisors.
 Four cuspids
 Eight premolars
 Twelve molars

The trigeminal nerve

The trigeminal nerve is the largest of the cranial nerves and incredibly complex. It has
three major branches, the ophthalmic, the maxillary and the mandibular. The main
functions of the trigeminal nerve are to provide sensation to the face, the nasal cavity
and the oral cavity and provides motor supply to the muscles of mastication. The
trigeminal nerve consists of:

Ophthalmic nerve

The ophthalmic nerve gives rise to three

terminal branches: frontal, lacrimal and
nasociliary, which innervate the skin and
mucous membrane of derivatives of the
frontonasal derivatives:

 Forehead and scalp

 Frontal and ethmoidal sinus

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  Upper eyelid and its conjunctiva
 Cornea
 Dorsum of the nose

Parasympathetic supply

 Lacrimal gland

Maxillary Nerve

The maxillary nerve gives way to fourteen terminal branches, which innervate the skin,
mucous membranes and sinuses of derivatives of the maxillary prominence of the first
pharyngeal arch:

 Lower eyelid and its conjunctiva

 Cheeks and maxillary sinus
 Nasal cavity and lateral nose
 Upper lip
 Upper molar, incisor and canine teeth and the associated gingiva
 Superior palate

Parasympathetic supply

 Lacrimal gland
 Nasal glands

Mandibular nerve

The mandibular nerve gives rise to four terminal branches in the infra-temporal fossa:
buccal nerve, inferior alveolar nerve, auriculotemporal nerve and lingual nerve.

These branches innervate the skin, mucous membrane and striated muscle derivatives of
the mandibular prominence of the first pharyngeal arch.

Sensory supply

 Mucous membranes and floor of the oral cavity

 External ear
 Lower lip
 Chin
 Anterior two, thirds of the tongue
 Lower molar, incisor and canine teeth and associate gingiva

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Local anaesthetic technique

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There are several methods of obtaining pain relief with local anaesthetics. Three major
types of local anaesthetic can be obtained from local infiltration, field block and nerve
block. The site of injection determines the type of anaesthetic pain relief achieved.

Local infiltration

Small terminal nerve endings are flooded with a local anaesthetic.

Field block

The local anaesthetic solution is deposited near the larger terminal nerve branches to the
anaesthetised area will be circumscribed to prevent nerve impulses to the central
nervous system.

Nerve block

A local anaesthetic is deposited close to the main nerve trunk.

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Contraindications:

 Hypersensitivity or allergy to local anaesthetic agents

 Distortion of landmarks needed to perform local infiltration
 Uncooperative client due to anxiety, altered mental status or under the influence
of drugs or alcohol
 Injecting through infected tissues.
 Presence of cardiac disease
 History of bleeding disorders
 Pre-existing neurological damage

Equipment needed:

 1% or 2& lidocaine
 1ml Syringe
 25-27g Needle
 Gauze or dental cotton swabs
 Saline mouth rinse
 Sharps box

Client positioning:

 The client should be positioned at a 75-degree angle

 They should be sat comfortably and be of a calm disposition
 Good lighting should be focused on the working area

Injection protocol

The treatment consists of four injection points in total:

 Two at the superior (upper)

 Two at the inferior (lower) aspects

Superior aspect nerve block

1. The mucobuccal fold should be located; this is where it intersects with the apex of
the canine tooth by retracting the
membrane with gauze and pulling
out and down.
2. While retracting the lip, insert the
needle into the intersection of the
mucobuccal fold and apex of the
canine at a 45-degree angle, insert
around 1 cm into the tissue and
aspirate.
3. Slowly inject 0.2ml of local
anaesthetic and massage the area
for 10 to 20 seconds.
4. Repeat on the other side

Inferior aspect nerve block

1. Locate the mental foramen and

retract the cheek and lip. Locate the junction of the mandibular premolars one
and two and down 1cm inferior to the gum line.
2. Insert the needle 1cm inferior to the second premolar at a 45-degree angle. Insert
the needle into the tissue towards the mandible. Withdraw the needle slightly and
aspirate.

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 3. Inject 0.2ml of anaesthetic adjacent to the foramen and massage for 10-20
seconds.
4. Repeat on the other side.

Contra-actions and complications

 Infections can occur if the needle is inserted through infected tissue.

 Clients should avoid hot food and drinks post-treatment and be aware that the
area will remain numb and could result in injury.
 If the needle is inserted into the nerve or the anaesthetic is injected into a
foramen/nerve, neurological damage can occur secondary to either pressure
necrosis or chemical injury of the tissues. A sudden increase in pain can indicate
that the needle is within the nerve bundle. Should this occur, then pull out the
needle by 1-2mm and wait 10-20 seconds for the pain to subside before injecting
the anaesthetic.
 Hematomas can form if a venus plexus or arterial supply is damaged by the
needle. The area can be treated with cold packs for 24 hours post-treatment, then
heat packs to disintegrate the clot. There are no long-term consequences.
 Avoid higher gauge needles and always ensure the hub of the needle is not
touching the area; force on the needle can cause the needle to break.
 Risks of allergic reactions and anaphylaxis increase with the use of local
anaesthetics. Ensure you are aware of the signs and symptoms of anaphylaxis
and have the correct training and emergency kits to hand should a
client experience an allergic reaction during the procedure.

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Client Consultation

A client consultation is a one to one talk with your client. During this time, you will find
out very important and confidential information that will allow you to advise and provide
the best treatment for the client.

It is important to always introduce yourself to the client as this removes any barriers and
relaxes them. Consultations should always be undertaken in a private room or area
where you cannot be overheard by others.

A client should first fill out a client consultation which helps identify any contra-
indications that may mean you have to alter the treatment or be unable to treat them at
all. If their form shows no reason why they cannot proceed with the treatment, then you
can move onto verbal questioning.

Verbal questions would be to establish why the client has visited the salon and what their
expectations and outcome of the treatment may be. Asking what they want ensures you
can provide customer satisfaction as the client should be pleased with the outcome of
their treatment. It is good practice to speak to the client in front of a mirror and explain
the treatment to them and see if that meets their requirements.

Once you have established what the client is after, then a physical examination should
be undertaken. This allows you to further check for any undeclared contra-indications
and get a better overview of any issues that you may face during the procedure.

Allow around 15 minutes for the client's first salon visit. Ideally, you should sit face to
face or next to the client to create an open atmosphere. Avoid barriers such as a couch
or table between you.

Use open questions to tactfully encourage the client to give you information that you
may need rather than using interrogating questioning techniques. Use the consultation
form to work from and record anything you may discuss.

Record Keeping

Records must be maintained and updated for a number of reasons.

 They provide contact details in case you need to alter or cancel an upcoming
appointment.
 So that you can track client’s progression.
 To record the products used and timings so you can use these at further visits and
adjust the treatment plan if required.
 Tracks any aftercare you provide the client.
 Records patch test history.
 As a backup in case, the client has an adverse reaction to treatment.
 For legal reasons if the client brings a claim against you.

Client records can be stored electronically or filed away manually and should be updated
at every visit. If consultation forms are not updated and do not contain a history of
services and dates, then you may find your insurance invalid.

Forms should be kept for the timeframe suggested by your insurance company. This may
be for up to six years. If a client is under 21 at the time of service, then it is
recommended to keep the forms for six years past their 21st birthday.

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Client confidentiality must be protected at all times. Forms need to be locked away in a
secure cabinet, and electronic records should be held on a password-protected
computer. You may also need to register with the ICO as a data controller.

 All information must be accurate and necessary for the service or treatment being
performed.
 Individual client records must be available for the clients to view if requested.
 Data should not be passed on or sold without the client’s prior written permission.

The following details should be recorded on the client consultation form:

 Personal details – name, address, contact details

 Results of any patch tests
 Contra-indications
 Contra-actions
 Reasons for the treatment
 Any reactions to treatments/previous treatments
 Home care advice/suggested retail items.
 Any sales
 Treatment timings/products used etc.
 Next appointment or recommendations

Any contra-indications and possible contra-actions should be identified and discussed

prior to the treatment. In the case of a medical referral, the therapist should keep a copy
of the GP's letter with the client's record card.

Consultation forms must be signed and dated to prove that you have covered everything
and given the correct advice and treatment plan.

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Treatment Form – Dental Block

Title (Mr, Mrs, Miss, Ms.): .........

First Name: ......................................

Surname...............................................................

Address:...................................................................................................................

...................

................................................................................................................................

...................

Post Code: .......................... Date of

Birth.............................................................

Tel: ........................................

Mobile: ....................................................................

E-

Mail: ........................................................................................................................

...............

_____I am voluntarily consenting to having a dental block/local anaesthetic for the purpose of
aesthetic treatment.

_____I understand that the procedure involves an injection into a small area of the mouth with the
intent of numbing the area to receive an aesthetic treatment. They also can be injected near a
nerve to act as a nerve block causing numbness to a larger area of the mouth beyond just the site
of injection.

_____ I am aware that it is normal for the numbness to take time to wear off after treatment,
usually two to three hours. This can vary depending on the type of medication used. However, in
some cases, it can take longer, and in some rare cases, the numbness can be permanent if the
nerve is injured.

____ I acknowledge that I will remain awake and can respond to directions and questions. Pain is
lessened or eliminated during the treatment.
_____I understand that the treatment can cause Infection, swelling, allergic reactions, discoloration,
headache, tenderness at the needle site, dizziness, nausea, vomiting, and cheek, tongue, or lip
biting can occur.

_____ If symptoms persist or become worse, I agree to seek medical advice.

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____ I understand that individual results may vary, and no guarantees are made in regard to the
expected outcomes of this procedure. I am happy to proceed with this treatment on this basis.

____ I confirm that the treatment and product being used has been explained to me in full and that
I am happy to proceed with the treatment on that basis. I have asked all questions that I may have
and received all appropriate aftercare.
____ I understand that I am undertaking this treatment knowing the full facts, side effects,
treatment outcomes and complications and I will not hold the clinic responsible should any issues
mentioned above occur.
____ I give full consent to the use of my before and after images for marketing purposes, providing
all identifying features are covered and that there is no way to identify myself from the image.
Images will be kept for 6 years and may be used in the event of a claim being brought against us.
They will be stored on a password encrypted hard drive.
____ Under GDPR rule I understand that I have full access to all data held on me. This data will be
held by the clinic for no longer than 6 years for insurance purposes, after which, digital information
will be deleted permanently, and paper documents will be destroyed. All information on myself is
kept on password encrypted hard drives or locked in filing cabinets to which only selective staff
members have access. None of my personal data will be sold or used for anything other than to
provide the services of this clinic.

Please ensure you understand the potential complications and personal requirements of the procedure indicated below
and please acknowledge or answer the points and questions:
YES NO
Are you allergic to steroids or corticosteroids?
Do you suffer from anaphylaxis causing allergies?
Are you diabetic?
Are you currently pregnant or breastfeeding?
Have you ever had a keloid scar from surgery, injections or
injury?
Do you have high blood pressure or suffered from heart failure?
Are you taking Aspirin, Warfarin, other anti-coagulant treatments
or any other medication or dietary supplements such as Omega-
3 that can affect platelet function and bleeding time?
Do you have or have you had any form of skin cancer?
Are you taking/receiving steroids, chemotherapy or
radiotherapy?
Are you taking any other medication? If Yes, please specify on
the next page of this form.
Have you had a recent infection (within the last 6 months)?
Do you have any illness that affects your immune system?
Do you suffer from bowel or stomach disorders?
Are you currently or have you previously been treated for any
mental health disorders?
Do you have Glaucoma?
Do you have Osteoporosis?
Do you have active cancer, or undergoing chemotherapy?

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 Have you had any recent surgery?
Additional comments:

I confirm that to the best of my knowledge that the information that I have supplied is
correct and that there is no other medical information I need to disclose.
I understand that treatments and products is not an exact science and therefore that no
guarantee can be given as to the results of the treatment referred to in this document. I
accept and understand that the goal of this treatment is improvement, not perfection,
and that there is no guarantee that the anticipated results will be achieved.
Patient/Client Signature: ................................................................. Date: .......................
Practitioner Signature: ..................................................................... Date: .....................

Treatment No. Date. Needle Batch No. Product Batch

No.

Notes: Injection Site:

Next Visit Date:
Administered by:
I __________________ (Client Name) have checked Clients Signature:

that there are no changes to my medical

history since my last appointment.

Treatment No. Date. Needle Batch No. Product Batch

No.

Notes: Injection Site:

Next Visit Date:
Administered by:
I __________________ (Client Name) have checked Clients Signature:

that there are no changes to my medical

40
history since my last appointment.

Treatment No. Date. Needle Batch No. Product Batch

No.

Notes: Injection Site:

Next Visit Date:
Administered by:
I __________________ (Client Name) have checked Clients Signature:

that there are no changes to my medical

history since my last appointment.

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