Progress and headwinds for dental therapists

Imogen Fox outlines the milestone journey of dental therapists and the remaining challenges preventing them from fully reaching their potential.

In 2011, I embarked on my journey into dentistry with both excitement and apprehension. As a new graduate, I was keen to practice my new skills but found myself navigating the uncertainty of clinical decision-making, treatment planning and meeting patient expectations.

With practice, my confidence in my ability to make good decisions and deliver high-standard patient care grew, but sadly my frustration in the role grew alongside this. Restricting legislation and outdated or uninformed views of patients and colleagues hindered me from delivering the dentistry I was trained to provide.

I have been repeatedly frustrated by the feeling of always working with one hand behind my back (metaphorically). In more recent years, each legislative change has felt like a bind being cut, another step toward opening the true potential of dental therapists. These changes sit hand-in-hand with a gentle shift in the way the profession is viewed by both dental colleagues and patients alike.

With the recent introduction of the amendments to the Human Medicines Regulations 2012 (HMR 2012), further freeing dental therapists to deliver local anaesthetic for treatment plans they can write alone due to the introduction of direct access in 2013.

Here, I reflect on the progress we’ve made and the obstacles still in our path, while looking ahead to the very bright future of dental therapy in the UK.

A milestone journey

The General Dental Council (GDC) has progressively expanded the scope of practice for dental therapists over the years. Below are some of the key developments.

1960s: introduction of dental auxiliaries

Training began at the School of Dental Auxiliaries in South London, marking the inception of the formal training for dental auxiliaries, the predecessors to dental therapists.

1979: rebranding to dental therapists

The role of dental auxiliaries was officially changed to dental therapists.

2003: extended duties

This was a pivotal point for dental therapists. The scope was extended to include the delivery of ID blocks as well as pulpotomies and preformed metal crowns on deciduous teeth. It was at this point dental therapists also gained the power to set up their own dental practice.

However, many restrictions continued to hold therapists back from utilising their skill set, including the need for a treatment plan created by a dentist, prescriptions, and the requirement to have a dentist on-site for the delivery of ID blocks and whitening procedures.

2006: delivering inhalation sedation

In 2006, the delivery of inhalation sedation (nitrous oxide) was added to the expanded clinical role of dental therapists. Since dental therapists are often involved in the delivery of paediatric dentistry and hold many posts within the community and special care dentistry settings, this was a significant step in enhancing the treatment experience for patients.

It is important to note that dental therapists must complete further and ongoing training to deliver inhalation sedation.

2013: direct access and expanded autonomy

A major turning point for dental therapists came on 1 May 2013, with the introduction of direct access legislation. This allowed dental therapists to see patients without the requirement of a dentist’s prescription and treatment plan, marking a significant step toward greater independence in clinical practice.

Direct access legislation expanded dental therapists’ ability to diagnose and treatment plan within their scope of practice and, most importantly, it also gave them the ability to prescribe X-rays independently. This reform empowered dental therapists to work as independent clinicians.

It has opened many doors for therapists, including the ability to offer patients dental examinations and deliver periodontal and restorative treatments without the involvement of a dentist. By the same means, this change in legislation meant that dental therapists were more able to open their dental practices and have their own patient base. This meant that patients could access care more readily.

2022: changes to the FP17 claim forms

In October 2022, another momentous change took place for dental hygienists and therapists working within the NHS. From this date, DCPs in the UK could open and close an NHS course of treatment (CoT) by recording their General Dental Council (GDC) number and role on the FP17 claim form.

A nominated performer number must still be included. The absence of this option on previous FP17s hindered direct access and shared care being used effectively in the NHS general practice setting.

2024: supply and administration of medicines

The legislative amendments introduced on 26 June 2024 have significantly enhanced the scope of practice for dental therapists in the UK. This most recent, crucial change to legislation permits dental therapists to supply and administer specific prescription-only medicines, including local anaesthetics and fluoride varnish, without a dentist’s prescription, patient-specific direction (PSD), or patient group direction (PGD).

To operate under these exemptions, dental therapists must complete appropriate training to ensure they are competent in the use of these medicines. Once completed, dental therapists can independently supply and administer prescription-only medicines, such as local anaesthetics and fluoride varnish, streamlining patient care by reducing delays associated with obtaining prescriptions from dentists and further enabling dental therapists to work effectively as independent clinicians.

Challenges remain: trust and pay structure

Despite these significant advances, challenges remain that continue to prevent dental therapists from fully reaching their potential. Two critical limitations that still affect the role of dental therapists are the lack of trust from some dental colleagues and issues surrounding pay structures, particularly within the NHS.

While legislative changes have expanded the role of dental therapists, trust and recognition from dental colleagues remain key barriers.

Many dental therapists encounter resistance in practices where they are perceived as less qualified or capable compared to dentists in procedures they are equally qualified to deliver, such as direct restorations. This lack of trust can hinder the scope of practice for dental therapists and limit their autonomy.

It creates a vicious circle whereby dental therapists are not given ample opportunity to practice and are therefore not developing their skills at the same rate newly qualified dentists are. This in-tail leads to a drop in clinical confidence and the negative cycle continues. To address this, continued professional development, evidence of clinical competence, and a shift in mindset toward a more integrated approach to patient care is needed.

Improving the shared-care mindset from the outset is a key agenda across many current teaching settings with a growing number of dental schools blending their BDS and therapy students in both theoretical and clinical teaching areas. I believe this will bring the changes we hope to see.

Nursing support needed

Many registered hygienists and dental therapists continue to work without full nursing support despite the GDC guidelines advising ‘you must be appropriately supported when treating patients’ outside of exceptional circumstances. This seems to be especially common in the south of the UK.

To work as a dental therapist, a dental nurse is essential. Therapists currently working solo but hoping to expand to utilise their full scope within their practice will need the support of their practice owner to provide them with nursing support, and I strongly believe this should not be at the cost to the clinician.

Another significant issue affecting dental therapists is the pay structure within the NHS. In many instances, dental therapists’ salaries still do not reflect the complexity of the procedures they are now authorized to perform.

NHS pay structures tend to be rigid, with dental therapists often receiving lower remuneration than dentists, despite performing similar procedures, and a hard cap on their income within hospital-employed NHS banded roles. It continues to be almost unheard of for dental therapists to be paid band 7 pay, even with extended responsibilities such as delivering care for medically compromised patients or delivering sedation.

To resolve this issue, it will be necessary to adjust the NHS pay structures to reflect the growing responsibilities and skills of dental therapists. Fair compensation will not only help retain talented dental therapists, but also attract more individuals to the profession, ultimately benefiting the overall healthcare system.

Looking ahead: unlocking the full potential of dental therapists

Despite the headwinds we still face, the progress made in expanding the role of dental therapists in the UK is remarkable. It is down to the dedication of our unions that we have more opportunity and clinical freedom than ever before.

To unlock the full potential of dental therapists, there are still areas that require attention. Building trust and recognition among dental colleagues, addressing pay disparities, and ensuring that dental therapists have the resources and support to operate at the full extent of their scope are critical for the continued success of the profession.

With the changes we have seen in recent years, there has been a titanic shift in the opportunities for dental therapists to be utilised in both general and private practice. I hope that dental practices will also recognise the opportunity to ride this wave of change, and many more job opportunities will open for dental therapists.

My vision is a future in which dental therapists play the leading role in the examination and treatment of paediatric patients; delivering care from examination and treatment planning right through to restorative and preventative treatment, setting recalls without the need for a dentist. Alongside this, we should continue to deliver high-standard periodontal and restorative treatment to patients with an integrated, shared care approach through building effective, trusted and mutually respectful relationships with dental colleagues.

I believe that this is now just over the horizon, and I feel a buzz of excitement for the future of the profession. For our visions to become a reality, we must all continue to push our limits by building our clinical confidence, supporting our colleagues to grow and flourish, and building better relationships with our teams. Individually, we must showcase our skillsets. Together, we can make waves.

NSK Ikigai is a vibrant community of dental hygienists and dental therapists, running courses, webinars and other events throughout the year. For more info visit mynsk.co.uk/ikigai/

The Regeneration Course 27 September 2025: Professor Luigi Nibali and Dr Varkha Rattu will present a lecture and workshop combo, featuring MINST (minimally invasive non-surgical therapy) techniques for hygienists and therapists. Click here to reserve your place!

Tides of change: progress and headwinds for dental therapists