Could dental therapists bridge the access crisis?

dental therapistsDentistry should utilise the full capabilities of dental therapists to resolve the dental crisis, Amber Ojak says.

Recently I have noticed an increase in focus on the impact Brexit may have on the dental sector.

At the end of 2017, 16.3% of dentists registered in the UK were from the European Economic Area. Yet the impact of Brexit could see new obstacles for the movement of workers.

A potential fall in overseas recruitment has recently been highlighted in the news in both Wales and Yorkshire. As well as shortages in the south west.

It has also been suggested that there is difficulty in recruiting dentists for rural areas. And how hiring EU dentists may become more difficult if recognition of EU titles/qualifications is not maintained.

A recent documentary on BBC Look North in east Yorkshire claimed 30% of dentists working in socially deprived areas qualified in the EEA, not the UK.

Dental therapists

In selected media coverage, there seems an underlying tone of panic. Yet the solution is quite simple.

Every year, 350 dental therapists graduate from multiple dental schools. They are fully qualified, ready to go into the workplace to utilise their full scope of practice.

A dental therapist can:

  • Complete oral health assessments within their scope of practice
  • Oral cancer screenings
  • Root surface debridement/non-surgical periodontal therapy
  • Take dental radiographs
  • Place fissure sealants and fluoride varnish
  • Take dental impressions
  • Extract primary teeth
  • Provide restorative fillings on adult and children’s teeth
  • Place primary metal crowns on children’s teeth
  • Administer local anaesthetic including infiltrations and ID blocks.

Utilising dental therapists’ scope of practice

Many therapists are still not utilising their full scope of practice.

This is often due to various barriers within practice. As well as the fact that, despite persistent requests to government and direct lobbying, we are not able to open a course of treatment.

Numerous qualified dental therapists often utilise their dental hygiene scope, but not the dental therapy part.

With this wonderful and broad skillset that we possess, surely fully utilising dental therapists to their full potential can provide a solution to a lack of dentists.

NHS prototype contract

In 2015 the first prototype of what could form the new NHS contract was established. It focuses on prevention rather than UDAs.

The prototype addresses the changing dental requirements of the population. It therefore takes a more holistic approach, which focuses on the prevention of oral disease.

The idea of the protocol is to enhance a skill mix within the practice. Where dentists could lead teams comprised of dental care professionals.

The Department of Health endorsed this approach, also supporting how a patient’s treatment plan would be based upon their oral health assessment.

With this treatment plan, until a patient’s oral health improves, they are only offered a largely preventive service with dental care professionals.

Fast forward to 2021

This strategy is still a long way off in multiple practices. These practices do not utilise dental care professionals in this preventative pathway.

It was envisaged that the demand for dental care professionals, especially dental therapists, would be on the rise. Now we have an opportunity to fill this gap.

This would mean bringing more dental therapists into practice. They can help meet the vision set out in 2015 and reduce the potential shortage of dental services available to the population. 

To achieve this, a shift in practice needs implementing.

Shifting focus

A dental therapist can take on all the procedures in their remit, as well as using direct access to reduce the workload on other dentists.

Dentists can then focus on more time-consuming procedures. They can let therapists work to their full scope of practice, which we are highly qualified to do.

This perhaps comes at the correct time.

Giving dental therapists a performer number is a great advantage to the dental work force. It would mean we could have our own list of NHS patients. In turn this will ease waiting times and make access to care quicker. Especially with the back log in treatment due to COVID-19.

In findings published at the end of 2020, more than seven in 10 are struggling to access dentistry. Many patients report being told they can be treated privately if there are no NHS appointments.

These findings also emphasise the impact of issues with NHS dentistry and how access to dentistry needs improving.

Grabbing the opportunity

Opening up NHS lists for dental therapists means therapists can see patients immediately. It also means dental professionals can screen more people for oral cancer. 

Further to this, if ‘Exemptions’ is approved and implemented, it would provide a mechanism that would enable dental therapists and dental hygienists to supply and administer prescription only medicines such as local anaesthetic and fluoride varnish. As well as provide Duraphat toothpaste. All without the need for a prescription by a dentist.

BSDHT and BADT collaborated on Exemptions and there has recently been a public consultation for this.

I really believe this is the ideal time and opportunity, for dental practices to utilise dental therapists to their full potential.

There are many dental professionals already in the UK waiting for this perfect opportunity to use their skills.

We can bridge this approaching gap in dental treatments.

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