A practice using a dental therapist-led system shares what this involves, and why it has been invaluable to both patients and the dental team.
Jade Campbell, dental therapist
In June this year, my principal dentist, Ali Abdelbagi, launched a dental therapist-led practice in Pontarddulais, a small town in South Wales.
The practice aims to provide a service to those who currently lack access to dental care.
In the short time since the practice has been open, I’ve seen numerous patients who either haven’t seen a dentist in many years or cannot get appointments with their current dentist due to the limited services available in the area.
On our opening day, there were many questions about what a dental therapist-led service can offer. Some people were wary of a service without a dentist.
However, they were soon reassured as we explained the range of treatments a dental therapist can provide, while also emphasising the importance of assessments that include oral cancer checks.
Medical links
Over the last decade, there has been an increase in oral cancer-related deaths, which many believe is due to reduced access to dental services.
In November 2023, British Dental Association (BDA) chair Eddie Crouch stated: ‘Every dental check-up doubles as an oral cancer screening. When late detection can radically reduce your chances of survival, the access crisis millions face will inevitably cost lives.’
Our single-chair practice is housed in a pharmacy that also provides pharmacy-led clinics. Given the numerous systemic diseases linked to oral health, this setting seemed ideal for helping those most in need.
By collaborating with the pharmacy, patients receive leaflets about these links along with their prescriptions, such as the connection between diabetes and gum disease. This approach aims to bridge the gap between medicine and dentistry, providing better care for patients who may be unaware of such systemic links.
Although this is a therapist-led clinic, the owner is a dentist. This means I can have radiographs reviewed and refer patients for treatments beyond my scope of practice.
Making informed choices
More importantly, I have support for obtaining second opinions, managing exposures, or handling patients with dental pain. Together, we have developed protocols and simple diagrams to refer to in such cases.
The practice is entirely private but strives to offer affordable dental care. I provide both dental exams and direct access hygiene appointments, depending on the patient’s needs.
When referring for more complex treatments, patients can choose to be referred directly to the principal practice or receive copies of their X-rays to find an appropriate practice on their own.
Initially, I thought the cost of additional treatments like root canals and dentures would be a barrier for many patients in the area. Surprisingly, many people chose to be referred for care, especially knowing they can maintain their dental health with me afterward.
Ultimately, it’s about giving patients the information they need to make informed choices.
I also currently work under a Patient Group Directive (PGD) that allows me to prescribe local anaesthetic and fluoride treatments. With new legislation coming into effect in June, dental hygienists and therapists will legally be able to supply and administer these treatments without a dentist’s prescription or PGD.
Ali Abdelbagi, practice principal
Seeing is believing! I was once that dentist who neglected the periodontal aspect of treatment planning. It was either a single visit for the famous scale and polish, or it was tacked on at the end of a treatment plan as a mere checkbox exercise.
Reflecting on this, I realised it was due to my unfamiliarity with properly treating perio.
It took seeing patients dramatically reduce their pocket depths, watching bleeding scores diminish, and witnessing patients return genuinely happier with their oral health to change my perspective.
Jade quickly became the most referred-to clinician in the building, and rightly so.
Emphasising periodontal health in your practice is crucial because it is the proper way to approach treatment planning – stabilise first.
After a short but highly successful start of a thorough perio pathway at Mumbles, we decided to launch a unique therapist-led clinic in Pontarddulais, powered by Mumbles Dental House and in partnership with the award-winning Medihub pharmacies.
Effective system
Jade and I developed a traffic light system for our work together. Green means the patient is stable and can proceed with elective treatment, while red indicates the need for stabilisation.
At the new clinic, Jade essentially ensures everyone turns green before treating them within her scope or referring them to their dentist to continue with treatment.
This approach covered many patients’ essential needs, including radiographs, oral cancer screenings and periodontal assessments. In an area where there’s a four-year waiting list to see a dentist, this service is invaluable.
While it may not offer Invisalign or implants, at least your mouth gets a comprehensive check-up.
With the latest IT, Jade and I can simultaneously review scans, radiographs or photos of a patient even when we’re on opposite sides of Swansea. This allows Jade to get a second opinion within seconds, ensuring she stays comfortably within her scope of practice.
Utilising skills
I love using analogies to help explain things to patients. When we initially introduced Jade for advanced perio treatments, a small number of patients wondered, ‘Why can’t you do it? You’re the dentist after all.’
Our collective response was, just as a GP sends a diabetic patient to a diabetes nurse who specialises in their care, we have Jade for perio. She’s our gum saviour!
Our patients’ needs have never been better looked after. From accurate pocket charts and thorough non-surgical periodontal treatments (NSPTs) to joint consultations with Ali and Jade before proceeding with a cosmetic plan, utilising the skills of therapists and hygienists is essential to our patient journey.
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