With the GDC’s scope of practice review soon to be released, Cat Edney proposes how the scope of dental therapists could be modernised to align with the realities of 21st-century dentistry.
The General Dental Council’s (GDC) scope of practice document is a cornerstone of UK dentistry, defining the clinical boundaries for dental professionals. However, since its last major revision in 2013, dentistry has undergone significant advancements.
From the integration of digital technology to modern approaches in minimally invasive care, the field has outpaced the existing scope for many dental professionals, especially dental therapists.
With a much-anticipated review expected in early 2025, there is a unique opportunity to modernise the scope of practice for dental therapists, aligning it with the realities of contemporary dentistry. Doing so would not only address limitations faced by dental therapists, but also enhance access to care, improve efficiency, and better utilise the full skill set of therapists.
There are a number of additions and edits to the scope of practice document that would not only be progressive, but also practical, considering the current difficulties faced by those wishing to implement dental therapy in practice.
1. Performing non-osseous gingivectomies and crown lengthening
Currently, dental therapists are limited in their ability to address gingival overgrowth into cavities, around deep subgingival lesions and in aesthetic anterior regions. Expanding the scope to include non-osseous gingivectomies (removal of excess or diseased gum tissue without involving bone) would empower therapists to manage soft tissue conditions more comprehensively, improving patient outcomes and reducing referrals for minor procedures.
Especially with advancements in technology, minimally traumatic removal of overgrown tissue and digitally guided aesthetic crown lengthening would fit comfortably in a new remit for dental therapists.
2. Interproximal reduction (IPR) and orthodontic attachment placement and removal
As orthodontic treatments like clear aligners become increasingly common, therapists are well-placed to support dentists in managing orthodontic cases. There is much confusion about what role dental therapists can currently play in the patient orthodontic journey.
With the outdated scope of practice making no mention of IPR, the jury is out on a consensus agreement as to whether the adjustment of an unrestored surface is specifically within scope (this obviously seems wildly frustrating as dental therapists adjust unrestored surfaces routinely to manage disease and aesthetic anterior restorations).
Adding IPR to the scope, or a wording which is less ambiguous on the matter, would streamline workflows, allowing therapists to manage these routine tasks under the dentist’s supervision, enhancing practice efficiency.
3. Providing passive splints and appliances
Dental therapists are already skilled in fabricating and fitting appliances for tooth whitening procedures.
Expanding their scope to include passive splints and appliances, such as passive orthodontic retainers, sci (sleep clench inhibitoror) or Michigan splints for bruxism management, would allow therapists to support patients more effectively, particularly in general practice settings where demand for these devices is increasing.
4. Placing lab-made composite veneers with digital guidance
The rise of digital dentistry has revolutionised how aesthetic treatments are delivered. With digital tools enabling guided preparation and precise veneer placement, dental therapists could confidently place laboratory-made composite veneers for patients seeking minimally invasive cosmetic solutions.
Adding this to the scope would capitalise on therapists’ existing restorative skills while addressing growing patient demand for cosmetic treatments. Lab-made composite veneers are arguably more predictable, longer lasting and could be less invasive than direct composite options.
5. Suturing following deciduous extractions and removing mobile retained root fragments
Deciduous extractions are a routine procedure for dental therapists, yet the inability to suture creates unnecessary limitations. A difficult lower E extraction can be a risk for extensive bleeding and discomfort for the patient. Expanding the scope to include suturing in these cases would ensure better haemostasis and post-operative care, reducing reliance on other clinicians for a procedure that is wholly within the current scope of the dental therapist.
Therapists often encounter mobile retained root fragments during restorative or periodontal procedures. Currently, therapists must defer removal to a dentist, despite their competency to manage these cases safely. Expanding the scope to include this task would simplify workflows and improve patient care without compromising safety.
6. Performing partial or full pulpotomies in the permanent dentition
Partial or full pulpotomies are vital in saving teeth with exposed or compromised pulp. Expanding the scope to include this procedure would empower therapists to manage cases that currently require unnecessary referrals, especially in general practice or emergency care settings.
This change aligns with their advanced restorative training and supports conservative dentistry principles. With advancements in materials available and dental therapists already trained in deciduous pulpotomies and pulpectomies, this would be a welcome step toward better integrating dental therapists into the team.
Modern dental therapy
GDC representatives often revert back to advising registrants that ‘the scope of practice document is not an exhaustive list of what individual dental care professional groups can or cannot do’. However, indemnity companies have the final say on indemnifying registrants and they often refer to the scope of practice document as a hard list of tasks.
This disconnect is holding the profession back from staying current with advancements in dentistry. A more descriptive scope of practice that formally embraces further and additional training is more likely to resolve this disconnect.
The proposed changes to the scope of practice for dental therapists are more than just a list of additional tasks – they represent an evolution in how we view collaboration and efficiency in dental care.
One of the biggest frustrations therapists face is encountering a straightforward clinical situation they are more than capable of addressing, yet being constrained by outdated or confusing regulations.
Tasks like suturing after deciduous extractions or removing mobile root fragments often require unnecessary handovers to a dentist, which wastes time for both the patient and the practice. By expanding the scope to include these tasks, therapists could work more autonomously, easing the workload for dentists and enhancing patient flow.
Modernising the scope also recognises the incredible technological advances in dentistry. The use of digital tools, such as guided preparation for lab-made composite veneers, allows for precision in treatments that therapists can already deliver with their restorative training.
Pivotal moment
The anticipated GDC scope of practice review represents a pivotal moment for the profession. Modernising the scope for dental therapists is not just about expanding their duties – it’s about aligning the profession with the realities of 21st-century dentistry.
These proposed changes would address practical challenges therapists face, improve patient care, and ensure that therapists remain integral and effective members of the dental team.
As we approach 2025, the dental profession has a unique opportunity to advocate for a scope of practice that reflects modern skills, training, and patient needs. By embracing these changes, we can build a more effective, efficient and inclusive dental care model of the future.
Catch up with Cat’s previous columns:
- Building partnerships between practice owners and therapists
- Are dental therapists going to save the NHS?
- How to make dental therapy a success in practice
- What can dental therapists do now? – an update
- What I’ve learned about dental therapy since speaking about it
- What do dental therapists want?
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