Exploring the possibilities

Dental therapists are specially trained, key members of the dental team that provide a patient focused comprehensive model of care, incorporating both primary and secondary prevention, utilising a preventative ethos which underpins clinical intervention. Dental therapists are currently being used in 54 countries as a means of improving access to care and reducing oral health disparities  

 

The First World War highlighted the extent of dental disease in the UK. Women were trained as dental dressers, and they were employed to clean, fill and extract teeth of school children. Following the establishment of the NHS the Government recognised the extent of dental disease in the population and the shortage of dental manpower. Investigations were carried out into the possibility of training dental auxiliaries to carry out simple routine dental treatments. In New Zealand dental nurses had been created to undertake such tasks and it had been shown that their work was of a very high standard.

With a change in legislation and government funding The New Cross School was set up in Southeast London. Sixty dental therapists (auxiliaries) were trained each year, the studentshad to sign up and confirm in writing that once qualified they would work anywhere in the country where there was a shortage of dental manpower.

1983 saw the closure of The New Cross School. However, The London Hospital began a course to train both dental hygienists and dental therapists and has been successfully training dental hygienists and dental therapists for 30 years. In the 1990s a number of new schools were established across the country, which led to the increase in the number of dental therapists being trained. Currently there are 18 training schools in the UK.

 

A dental therapist is an asset to the dental team, and is the way forward, their skills can be utilised to the widest extent within the dental team, allowing the dentist to carry out more specialised treatments, enabling greater choice and flexibility for the patient.

Figure 1 was provided by Nick Taylor from his presentation on skill mix, it shows the extent of work other members of the dental team can carry out. Dental therapists can clearly play a significant role within the primary care setting. Direct access gives the patient the option to see a dental care professional who than refers to the dentist. Physicians turned to auxiliary personnel long ago to provide special services for patients, both physicians and surgeons have been relieved of many time consuming tasks and this has enabled more patients to be treated and more complex procedures to be undertaken by them. Dental therapists have improved access to oral health care in increasing numbers of countries. Multiple studies have documented that dental therapists provide quality care within the confines of their scope of practice. Is direct access a threat to the profession? Well let’s look at figures from the 2013 GDC register (fig 2) and I will leave it for you to decide.

Personally, I do not see dental therapists and hygienist as a threat. Let’s embrace this and work together as a team for the best interest of our patients. Dental therapists make up five per cent of the clinical team and not all of them wish to work under direct access. Even if you group hygienists and therapists together, that is still only 18 per cent, and at a guess I would say less than 50 per cent will perhaps work under direct access. Fig 1. Fig 2: Dentists - 38800 (82 per cent); Dental therapists - 2165 (five per cent) ; Dental hygienists - 6319 (13 per cent).

 

 

Good dental care is delivered by a dental team. The quality of teamwork is closely linked to the quality of care the team provides. All members of the dental team contribute to the patient’s experience of dental treatment, and all have a role to play in making the best possible contribution to patient care (GDC Principles of Dental Team Working).

I strongly believe that dental therapist undertake their role safely and appropriately; this can be evidenced by the lack of fitness to  practise cases heard by the GDC. Patient satisfaction is demonstrated through contemporary research which concluded that patients reported a positive experience when seen by a dental therapist. In considering restorative care, the narrower and more defined curriculum is considerably higher for dental therapists, than those undertaken by BDS students in the same areas of clinical practice, enabling a high standard of supervised care which is continued on qualification.

 

There are limitations to a dental therapist’s role. Even after direct access a therapist cannot provide all the treatments a dentist can, for example they are not able to provide prescription only medicines. However the advantages of employing a therapist are numerous.

Using a dental therapist is often more cost effective than an associate dentist, and can free up a GDP’s time by sharing the workload. It can increase access and reduce waiting times and allows the patient more choice.

Patient safety is not an issue, there are no problems when comparing the like for like work of a therapist and dentist, and DCPs are more likely to over- rather than under-refer. So remember that dental therapists are not a threat. They want to be a part of the dental team and not a branch of the dental tree. As Winston Churchill said, “There is nothing wrong with change, if it is in the right direction.”