The role of dental hygienists and therapists

Female hygienstMichaela O’Neill, president of the British Society of Dental Hygiene and Therapy (BSDHT) asks are hygienists and therapists playing a more integral role in a successful dental practice?

I can remember a time when having a dental hygienist in your practice was a status symbol! It doesn’t seem that long ago to me but things have changed greatly since then. Dental hygiene is now not a novel, or new expression but something most people are very aware of. The dental hygienist is now deeply embedded in the structure of every dental team. Since the dual education of dental hygiene and therapy, it has never been more important to highlight just how valuable an asset this role plays in practice today.

Positive role

Initially the role of the dental hygienist as perceived by patients was to provide a scale and polish! As time has moved on they are now more aware of the need for periodontal health. People are more likely to use interdental cleaning aids and a large proportion asks to be referred to the dental hygienist and expect to see them regularly. This is a very positive step for our profession as a whole.

The role of a dental hygienist and therapist is hugely varied; and each practice utilises this skill mix in varying ways. Their role is an important cog in the machine of a successful dental practice. Their vital job cannot be understated and this is becoming ever more obvious as the profession evolves to take on more and more responsibilities.

Employing a hygienist or dually qualified dental hygienist and therapist is no longer becoming a choice for many practices; the ever developing world of dentistry has been reflected in the way they are being utilised, offering more and more not only to patients but also other dental professionals. A major factor which has driven this change is the increasing demands from patients to get more from their dental teams than ever before. Information is available wherever people go and the public need to have someone trusted they can turn to who can make sense of all this information.

This has meant that the dental team have to be knowledgeable about all aspects of dental health to reassure patients and ensure that they get the best and most up to date advice

The integral role

One way to successfully utilise skill mix in practice is to abide by the prudent health care slogan ‘only do what only you can do’. Why would the principle dentist spend their time on treatments and skills others in the team can provide? To fully benefit you need to look at the skills of the others in your team and play to their strengths and yours.

Good communication skills, a high level of manual dexterity and an ability to work well within a team, are some of the qualities of a good dental hygienist and therapist provide. Full utilisation of these qualities, not only applies to their role in oral health promotion, treating and preventing dental diseases, but also within clinical practice.

A dental hygiene and therapist’s primary role is to provide preventative care to patients; this is undoubtedly the most important role in any dental practice. Prevention is about giving your patients control of their oral health. Making sure that your patients have a stable and periodontally healthy mouth before embarking on expensive restorations will give the patient the tools to help these restorations last. This in turn allows you the benefit of providing more accurate and detailed work for your patient.

This is also being recognised as important in the field of implants. Most prosthodontist practices will ensure that the implant patient has acquired the knowledge, skills and oral health needed to aid the successful placement of implants. The maintenance of the implant patient is of the utmost importance for the rest of the implant life. Because of this many of the hygienists working in this area have increased their education in this field and have quite a wide range of skills and knowledge in how to aid the patient in maintaining oral health.

The foundation block of prevention is still at the very heart of our role but this is now cultivated alongside a more diverse skill set. Perhaps the most important, yet the most varying part of any dental hygienist/therapist’s job is that of a clinical practitioner. Clinically they help to prevent periodontal disease by assessment, treatment and monitoring disease levels. They can take dental radiographs and undertake monitoring and screening procedures and also apply topical fluorides and fissure sealants in order to reduce dental caries.

Those with the additional skills of a therapist are also permitted to treat the dentition with simple restorations and place preformed crowns and pulp treatments on deciduous teeth. They can carry out routine amalgams and composite fillings. Providing an adult tooth does not require treatment to the nerve of the tooth, a dental therapist can fill or restore any part of the tooth that requires treatment. Those with therapy skills have a great deal of experience in treating children.

Anyone would agree that this is a very large and varied workload, one which is being added to constantly. In 2008, the GDC’s Scope of Practice stated that dental hygienists and therapists could add ‘tooth whitening to the prescription of a dentist’ to their skill set with appropriate training. This is yet another example of the ever important role dental hygienist and therapists play in dental practices.

Many BSDHT members work alongside a dentist who after an initial examination refers all patients to them that need to have their teeth whitened. This is obviously more financially beneficial as the hygiene/ therapy time is less expensive but it also means that the dentist’s chair is freed up for more elaborate needs.

Direct Access has been the biggest change in present times. Now patients can go directly to the hygienist /therapist to be assessed within their remit and treated accordingly. This saves time in any dental practice as the old pattern of having to see the dentist first and then being referred had so many time ramifications.

The educator

As previously highlighted a dental hygienist and therapist is known for their communication skills. The ability to deliver messages that call into question a person’s habits and ask them to be changed takes great skill and is a learning curve that develops over years. The longer a patient is being treated the more likely the relationship between patient and clinician develops. People turn to them when they are in need of advice. Patients trust and respect the advice they give on things such as tooth brushing technique, dietary advice, smoking cessation and other important information on oral health. They are usually the team member that patients feel more at ease with to ask what they feel are questions they don’t want to bother the dentist with.

Being able to educate all age groups has its advantages when speaking to different community groups as demonstrated by BSDHT First Smiles initiative. Again this can be used as a practice builder.

Our profession have to keep themselves up to date on the latest developments in the wider dental field as well as their speciality, through continued professional development (CPD).

Dental hygienists and therapists are often some of the most informed and outspoken voices on the latest developments in dentistry. Patients have increasingly complicated needs and demands and through CPD and research dental hygiene and therapists are able to provide the most up to date information and advice to keep them healthy, safe and happy.

In all of the roles that a dental hygienist and therapist have they are perfectly placed to act as a great advocate for good dental health and therefore good general health. A combination of their extensive knowledge of their profession and their patients means they are often the best people to support and help people to navigate the minefield which is dentistry.

There is no doubt that these roles will evolve as dentistry also evolves but for now it is clear to see why so many dental practices feel that dental hygienists and therapists are integral to their daily running. They are able to take some pressure away from dentists and build relationships with patients through trust, knowledge and familiarity, which all work towards better dental health.

Building a great reputation

Dentistry is such a dynamic profession full of knowledge and ideas so it is important that all of these voices are heard and listened to. This allows for the continued good reputation to run throughout the dental therapist profession, firmly cementing its place as a major influence on dentistry in the future.

The British Society for Dental Hygienists and Therapist (BSDHT) was setup precisely to meet these needs. Working to represent the needs of the profession in a wider environment the BSDHT represents over 4000 members and helps them to work towards giving the best possible service while enabling professional development. We have seen how integral this profession has become to dental practices and it important that they do not stay still, we need to push the boundaries of knowledge as the role they have to play in improving patients dental health is huge.

Through campaigns such as First Smiles, an initiative which called on BSDHT members to make a difference to young children’s dental health, the reputation of dental hygienists and those dually qualified is going even further than before and they are not only becoming integral to dental practices but also to everyone’s dental health.

Michaela O’Neill president, BSDHT has lectured throughout the UK and internationally on topics of interest to the practising dental hygienist and therapist. More recently she has held a research dental hygienist role and currently works in a specialist restorative practice.
Joining the Association in 1997 when she returned to NI, Michaela has been involved with BSDHT ever since, and in 2009 took up her second term as the Northern Ireland Representative on Council. As a member of the Executive, Michaela was responsible for creating and establishing the BSDHT Educational Accreditation Scheme with the aim of ensuring a consistency of quality and standard for CPD educational material used by members in the future. She has also been an active participant in the Society’s bid for direct access. Her term as president began in November 2014.

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