Matt Everatt explains why he believes the GDC is ‘heavy-handed’ and ‘overly punitive’ in its regulation of dental technicians – and the GDC responds.
The General Dental Council (GDC) plays an important role in safeguarding patients and maintaining trust in dental services. However, when it comes to its approach to regulating dental technicians, the GDC often uses a ‘sledgehammer to crack a nut’ – applying heavy-handed and overly punitive measures for issues that may not warrant such severity.
Dental technicians, working behind the scenes of the dental profession, are a vital part of the team. Our work directly impacts the comfort, function and aesthetics of patients’ oral health, even though we have limited interaction with them.
While regulation is necessary to ensure the quality and safety of these devices, the GDC’s methods of regulation do not take into account the nature of our work or the nuanced differences between technicians and other dental professionals like dentists and hygienists.
To be clear, there are cases where the GDC should act if dental technicians have flagrantly gone beyond their scope of practice and provided direct patient services with total disregard for patient safety. Equally, there are services supplied by beauticians and other high street outlets where non-dental professionals blatantly provide the likes of tooth whitening, or like the US company Smile Direct Club, direct-to-consumer orthodontics – yet these are unchallenged by the GDC.
Guilty until proven innocent
A current fitness to practise (FtP) case I have been following is a scary example of how the GDC has gone in ‘all guns blazing’. Following two complaints, it is alleged that the dental technician in question had been asked by the dentist to adjust a bite on a dental appliance and to make adjustments on articulated models as a diagnostic process so the dentist could make the adjustment in the mouth.
The technician, with over 30 years of experience, had been trained in taking impressions and bite registrations, but now faces sanctions for allegedly working beyond his scope of practice (SOP), despite achieving a positive outcome for the patient, who experienced relief from previous discomfort. The two complaints from 2014 and 2019 have been consolidated against him, and he is still awaiting a full FtP hearing,
Meanwhile he has been prevented from working as a dental technician due to the interim sanctions applied. Most dentists would admit that a dental technician has a much better knowledge of materials used in dental appliances and can adjust them far more effectively than they can. Yet, despite the positive outcome, the technician has had interim sanctions applied and awaits the full FtP hearing because he worked beyond his SOP.
Drawn out cases
The very strict interim sanctions placed on him prevent him from practising as a dental technician until the cases have been heard, meaning he cannot run his lab or sign off on any cases– ultimately, he is guilty until proven innocent. The case has been drawn out over months, and the hearing is not due to be heard until October 2025.
Let’s put this into context: the registrant was asked by a dentist to adjust a dental splint by trimming a dental appliance. He didn’t trim the appliance, but took a bite record using the appliance to be used for articulation of plaster models. The patient wasn’t harmed by this procedure. In fact, it is quoted in the body of the complaint that the appliance felt much better at the time.
Did the dental technician work beyond his SOP? He suggests he was appropriately trained and experienced. Even if he did work beyond his SOP, there should be corrective actions – a learning process, an opportunity to improve and, in the long term, improved patient care. It could be argued that the SOP is too restrictive, and that there is an opportunity to extend the scope and introduce further learning opportunities for professionals…
Heavy-handed tactics
Another example of these heavy-handed tactics used by the GDC starts when a dental technician rang the dentist to explain that the design of the bridge was flawed and ‘bound to fail’. The practice manager (a non-registered professional) told him that the dentist wanted him to proceed.
The technician failed to document this on the prescription and proceeded with the construction of the bridge, supplying it to the treating dentist with an invoice containing the following MDD (medical devices directive) statement: ‘This device conforms to the relevant essential requirements as set out within annex 1 of the Medical Devices Directive (93/42/EEC). Any relevant essential requirements not met and reasons why are listed overleaf.’
No defect or other issue with the bridge was listed. The bridge subsequently failed, and following a complaint by the patient and lengthy discussion with the dentist, the technician faced a FtP because of the administrative error. He had essentially deemed the bridge fit for purpose by not recording his recommendation or conversation.
Disproportionate disciplinary actions
As we have experienced, the GDC’s FtP hearings, which are designed to protect the public from unsafe professionals, can be triggered for relatively minor infractions involving dental technicians. Even minor errors or administrative oversights can lead to investigations and potential sanctions.
In many cases, these infractions could be dealt with more appropriately through retraining or professional guidance rather than resorting to full disciplinary proceedings.
These proceedings often take months, sometimes years, impose restrictive interim sanctions that severely affect livelihoods and, in many cases, harm the mental health and wellbeing of those being investigated, occasionally leading to tragic outcomes like suicide.
Over-regulation for low-risk work
Dental technicians primarily have very limited patient contact. In my opinion, there is a lack of tailored oversight, with more of a ‘one-size-fits-all’ approach. The GDC’s regulatory framework does not differentiate adequately between the different professionals under its umbrella.
This ‘one-size-fits-all’ approach ignores the unique role dental technicians play, treating as though they pose the same level of risk to patients as dentists who perform more invasive procedures.
The heavy-handed nature of GDC regulation is having several negative consequences for the dental technician profession. The perception that the GDC is over-regulating has led to frustration among dental technicians, who feel they are unfairly targeted and undervalued, which is eroding morale and pushing some skilled technicians out of the profession entirely.
Some have claimed to have left the profession to attract similar salaries working in unskilled roles without worries of imperious regulation.
The GDC’s broad and often unnecessary investigations into dental technicians strain both the resources of the regulator and the professionals themselves. Instead of focusing on truly harmful or negligent practices, the GDC can become bogged down with minor issues that do not pose a significant threat to patient safety.
New approach needed
To address these issues, the GDC must rethink its approach to regulating dental technicians. A more proportionate regulatory system should be developed, recognising the lower risks posed by dental technicians in comparison to other dental professionals. This is not to say we should ignore those individuals who flagrantly disregard the rules; they, of course, should be dealt with appropriately.
The GDC’s current approach to regulating dental technicians is overly punitive and disproportionate to the risks involved in their work. The use of heavy-handed regulation not only demoralises the workforce but also undermines the efficiency of the regulatory system itself.
It is time for the GDC to recalibrate its regulatory practices, taking a more nuanced and measured approach that ensures patient safety without unnecessarily burdening the professionals who help keep the UK’s dental services running smoothly.
The GDC’s response
‘As the UK regulator of all members of the dental team, our primary purpose is to protect patient safety and maintain public confidence in the dental professions. We acknowledge the concerns raised regarding our regulatory approach to dental technicians.
‘The GDC is not able to comment on ongoing cases; this is to preserve the integrity of matters yet to be determined by the Dental Professionals Hearings Service. The hearings service administers cases that are decided upon by panels, which include at least one registrant member, and make independent decisions. As a general point, the GDC does not adopt a ‘one-size-fits-all’ approach to cases. Each case is considered carefully at each stage of the process, based on its own facts.
‘We are working to improve the speed at which cases are dealt with, particularly through the fitness to practise investigation stage, without compromising the quality of outcomes. For example, in the last 18 months, adopting a new and streamlined approach to certain cases through ‘initial inquiries’, we have halved the average time taken to deal with single patient clinical cases, from an average of 30 weeks to 15 weeks.
‘We recognise the challenges of regulating direct-to-consumer orthodontics, but the GDC’s powers are limited to regulating regulated professionals, rather than businesses. Only people who are registered with us can legally practise dentistry in the UK. If people who are not registered dental professionals are practising dentistry, they are breaking the law. There is a separate and distinct process that we follow when we receive a referral for alleged illegal practice, and we do take action as necessary and appropriate.
‘We know fitness to practise investigations can be intrusive and we recognise that stress can be caused not just by the experience but also by the information publicly available. We announced a change last year to what will be published following decisions by the Interim Orders Committee after a review of our policy. The change is part of our ongoing commitment to reduce the negative impacts of the fitness to practise process on dental professionals’ health and wellbeing. All previously published Interim Orders Committee determinations have been removed from the Dental Professionals Hearings Service website and replaced with the outcome of any hearing or review.
‘We value the essential contribution dental technicians make to oral healthcare and are committed to engaging with the profession to ensure our regulatory approach supports high-quality care while being proportionate and fair.’
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