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Print Role of the Dental Therapist

Role of the Dental Therapist
Date Added: 12/08/2008
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The Role of the Dental Therapist A guest article:

"I have been a dental therapist and hygienist for more than 25 years. Long before the training was combined I thought that the roles went hand in hand and the range of skills would enable me to provide quality dental care to a wide range of patients. Now back in the 70's this was not the done thing - you were either a hygienist or therapist - you definitely weren't both. I even did both full courses - at that time 2 years for therapy one year for hygiene - again a bit strange - the majority of therapists who went on to do hygiene opted to do a shortened 3 month course. I can honestly say I was well trained - and those in the days before extended duties! Now you can do the combined course in 27 months!

Since qualification I have worked in a wide variety of settings as both a therapist and hygienist where those I came into contact with benefited from the extensive training. I have worked in practice both in the UK and abroad, health authority and hospital including ten years training hygienists and I can honestly say I have a great career. Along the way I have gained a masters degree in health promotion - at one point I thought that was a realistic option when no one knew what to do with dental therapists - a post grad certificate in further and higher education and a couple of diplomas in health education.

Someone recently described me as a chameleon - I think that a reasonable description when I consider how I have evolved to fit in with the various working environments I have found myself. I presently work in general practice as part of some really great teams of professionals providing quality oral health care. It has been worth the exceptionally long wait to have the freedom to choose where to practice. It is unfortunate that many dental professionals do not know enough about therapists and how they can work.

Some perceive the therapist as a 'children's' clinician, others understand that they can do hygienist cleaning and 'simple fillings' and yet others consider them as an alternative to an associate. None of these do justice to the skills and knowledge of the dental therapist. Having a quality clinician with great communication skills and a real preventive approach frees up time to do all the complicated stuff that only a dentist can do. The dentist remains the diagnostician and refers the patient for appropriate care from the appropriate team member.

This is what a dental therapist can do (more information is available on the BADT website)

A dental therapist works to the extent of their training and competence.

  • This includes Treatment of adults and children
  • Intra oral and extra oral assessment
  • Recording indices and monitor disease
  • Routine restorations from Class l -V in permanent and deciduous teeth
  • Use of all materials except pre cast or pinned placements
  • Pulp therapy treatment of deciduous teeth
  • Placement of preformed metal crowns on deciduous teeth
  • Extraction of deciduous teeth under local analgesia
  • Administration of ID block and infiltration analgesia - no supervision required
  • Emergency placement of crowns and fillings if removed during treatment
  • Taking impressions for study models
  • Treating patients under conscious sedation
  • Scaling and polishing teeth
  • Root surface debridement
  • Application of medicaments e.g. fissure sealants, fluoride, antimicrobials etc
  • Dental radiography
  • Oral health education
  • Dietary analysis and counselling
At present I work in practice the way I always wanted to when I was a teenager - using all my knowledge and skills to treat all ages. I love it! Working with children is a great challenge but I believe it is worth investing the extra effort to gain their confidence and leave having had a positive experience - these are the future and if you can get a solid preventive foundation laid you will be making life so much easier in the long term - for all concerned. My day spans from one end of the age spectrum to the other, cons, perio, prevention, smoking cessation etc.

In all successful teams each member works to their strengths and this is no different in dentistry. These days the public are more aware of a team approach to health care and whilst therapists and hygienists have a limited range of dental skills, they do them to an extremely high standard.

Over the years I have found the need to be versatile in my practice and prepared to move with the times. Like all enthusiastic people I try to constantly challenge myself to achieve the best in any given circumstances, underpinning all treatment with a preventive programme based on individual needs. And its not just about treating patients. I am involved in continuing professional development for all members of the dental team, designing practice literature and policies and developing a real team approach to patient care and promoting the practice. Getting involved in practice development adds variety and opportunity to extend and enhance your role as an integral team member.

Like all things new there is a learning curve for all involved in maximising the potential of any and all team members. I have found that effective communication with both dentists referring and other members of the team has been crucial to the happy teams I now work with. Dentists must have confidence in your ability to care and treat patients they refer and conversely I am happy when I know that the dentist is holding up their end of the patient's care programme. We are all working to the same end and it is important that everyone knows the extent and the limitations of each others role. Looking at the curricula followed during training (available on the GDC website) gives a good basis to what can be expected in the way of knowledge and skills.

Many years ago when I was working abroad as a hygienist my directing dentist asked me to cut a cavity in a lower six and was not a happy bunny when I said no! He quite rightly pointed out that I had been trained to do so (as a therapist) and felt I should be good to get on with it. Completely intimidated I (stubbornly) stuck to my guns pointing out that I could not practice therapy either in general practice never mind in the country I was in!! This then set a tone where the dentist took the opportunity to belittle my skills and knowledge. We did move on eventually to a reasonable working relationship but this could so easily have been avoided. Maybe I should have excluded my qualifications on my application form; maybe the dentist could have done a little more homework on the legal and ethical issues surrounding the work involved! Many hygienists and therapists report similar experiences of being pressed to work outside their remit (possibly through ignorance) and the consequences of such experiences which may put a strain on working relationships.

Dental therapists and hygienists are professional people who should be treated as such. No doubt some are better than others. We all have our preferences in practice. Some dentists love doing endo - others do it but prefer to do crown preps or perio etc. Therapists are no different - my advice to anyone considering a therapist for their team is to think how they can benefit your practice. Then look for the therapist who fills this profile. Think of a medical practice which provides care for a large student population near a college specialising in sports. If they want to add a physio to their team they would probably look for one interested in sports injuries - maybe not the best analogy but you get the gist.

I learnt a lot from the issue abroad about perceptions and expectations and the importance of two way communications and sharing information. Thankfully that was one of the very rare difficulties I have run into over the past 25 years. Getting the skill mix right is crucial to any teams success but just because someone has the right qualifications does not necessarily make them right for your team. There are good bad and indifferent in all work environments - dentistry is no different.

The driving force - usually the dentist - sets the scene and drives the practice in the direction they want to go. I have been enthused and motivated by dentists who have a clear philosophy for their practice which everyone shares and becomes engaged with. Others have almost bled me dry with lack of direction and management. Granted most dental students are not taught how to build businesses and teams, some are lucky enough to have it come naturally, others seek assistance (cb) to help and yet others muddle through. The muddlers, in my experience, tend to have ostrich tendencies, ignoring the general malaise that sets in, turnover of staff and loss of goodwill and drive. They put all their energy into the clinical stuff and hope for the best with the rest. Dealing with the worst in shock and amazement when things go pear shaped. Team members often get disillusioned when left to tread water aimlessly.

Therapists and hygienists are trained to be team players - they thrive in proactive, enthusiastic teams and bring a lot of skills that can benefit a practice, setting it apart from the one down the street. They bring more than just the financial benefits. Like most things in life you get out what you put in. If you are considering a therapist - do the homework, have a clear idea why and what you want this team member to bring that will set you apart from the rest, then advertise and select accordingly."

Leigh Hunter

This is a re-print of an article by Leigh (with her permission)

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