Craig Broughton explains the many benefits of hiring an associate clinical dental technician (CDT) for the practice, the patients, and the CDT.
Clinical dental technicians (CDTs) are a relatively new area to the dental care profession. They were first recognised by the General Dental Council (GDC) in 2007 and, as of January 2022, there are 346 CDT’s registered.
Although the role of a CDT primarily consists of seeing and treating patients for the provision of complete and partial dentures, their abilities can be utilised in other areas.
What can CDTs do?
Providing the CDT is competent, trained and indemnified, the scope of practice for a CDT is as follows:
- Prescribe complete dentures directly to the public
- Provide other dental appliances, such as removable partial dentures, on the prescription of a dentist
- Record medical and dental history
- Perform technical and clinical procedures in relation to removable partial dentures
- Carry out clinical examinations
- Take and process radiographs and other photographs in relation to removable partial dentures
- Distinguish between normal and abnormal consequences of aging
- Give appropriate patient advice
- Recognise the difference between normal and abnormal mucosa and underlying structures
- Refer patients to necessary healthcare professionals
- Fit removable appliances
- Provide mouth guards
- Record keeping, full contemporaneous notes
- Vary the detail but not the direction of a prescription according to patient’s needs.
Along with these core tasks that a CDT can perform, they can also further their scope of practice to enable them to complete tasks such as:
- Oral health education
- Providing anti-snoring devices upon prescription of a dentist
- Re-cementing crowns with temporary cement
- Removing sutures after wound has been checked by a dentist
- Prescribing radiographs
- Replacing implant abutments for removable dental appliances on the prescription of a dentist
- Providing tooth whitening treatment on the prescription of a dentist.
Are there any associate CDTs?
In a poll carried out that included 60 CDTs I found that 68% owned their own clinic. This means they are seeing and treating edentulous patients directly and taking referrals from dental clinics for removable partial dentures.
In addition, 17% of CDTs are employed by either dental practices or laboratories with their own clinic and the remaining 14% work within dental practices on an associate basis. Nearly all CDTs operate on a private basis only.
I practice as an associate in a private practice in the north east of England. After obtaining my CDT qualification in 2019, I decided to start my own laboratory, CMB Dental Laboratory. With a small sum of money behind me, it seemed uneconomical to start a laboratory and then have to fit out a surgery room along with buying new laboratory equipment. With no real reputation behind me at this point and zero client base, it was too risky.
I approached a dentist that I had worked quite closely with in the past and asked if he had a spare clinic room within his practice which was free a day a week for me to run a denture clinic from. After explaining my scope of practice, I proposed that I made use of that surgery room on an associate basis.
The benefits for the practice
The response was that of intrigue as much as it was confusion. I went on to explain that the aim would be that with any denture case that comes into the practice, once deemed dentally fit, the patient would be referred over to myself to complete the prescription. This saves the surgeons time to complete more lucrative, less time-consuming work.
At the end of the month the practice owner then takes a percentage of what I have made that month. In essence, the prescribing clinicians save time to generate more income and then make money off my work. This has the potential to make the prescribing clinician a couple of hundred pounds for what is a 10-minute appointment.
As well as this, personally, I don’t work with a nurse. However, there may be times when I may require assistance, particularly with photographs, or a chaperone.
Everyone’s a winner
From the perspective of the practice, all note recording by the CDT can be kept within the practice. This ensures that both the clinician and CDT have access to up to date notes made by each other. All treatment plans, medical history, X-rays and other imagery are easily accessible for both parties to refer to at any time.
Referring the patient to an external CDT clinic would mean that all of these relative documents will need to be sent over to the CDT completing the treatment which has the potential to delay treatment.
If referring patients within the practice for treatment with a CDT, the CDT may generate further interest from perspective patients that approach them directly for treatment through marketing and word of mouth. This has benefits for both parties, as the more patients seen by the CDT, the greater the income for both the practice and the CDT.
In addition, in the unfortunate event of patient dissatisfaction resulting in a remake or potential refund, it is the CDT’s responsibility to remedy the situation, not the practice.
The benefits for patients
There are benefits for the patients also. An existing patient at the practice can have the reassurance of being seen by the CDT in the same practice where they receive their dental treatment. This not only allows the patient to receive denture treatment within familiar surroundings, but it can also make the process far more streamlined.
Taking medical history into consideration, in the case of a medical emergency a CDT will have extra hands to assist in such event. Clinicians, nurses and reception staff will be on hand to assist the CDT in providing basic life support.
An external CDT clinic may not have access to emergency medicine such as midazolam, glyceryl trinitrate, and epinephrine unless they work within a dental practice alongside dentists. The Medical Regulations 2012 states that prescription-only emergency medication is prohibited to CDT’s working within their own practice.
The benefits for the CDT
A CDT can benefit from the experience too, such as working closer with the prescribing clinician in regards to treatment planning and possible outcomes for the patient. Complex treatment plans may include guide plains and/or rest seats incorporating into natural dentition or crown work which would benefit from both clinician and CDT input.
To work amongst a wealth of experience of other clinicians can be priceless. Sharing knowledge and experiences can greatly improve skills, confidence and ultimately the standard of care given to a patient.
In respect of the dental practice as a whole, I only operate during practice opening hours. Working outside these hours may cause potential implications in regards to security, insurances and safety of both the CDT and the patient.
Personally, I prefer working when a surgeon is present in the building. In the unlikely event the fitting of a removable partial denture that becomes difficult to remove and requires cutting, I am not allowed to enter the mouth with an instrument to cut it out.
In addition, for any concerns in regards to questionable tissue/tooth anomalies, I have another set of eyes to take a look.
A CDT has the potential to be a valuable asset in any dental practice and expand the multidisciplinary team. Associate CDT’s have the ability to increase the revenue of a practice and free up dental surgeons’ time to increase a practice earning potential even further.
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