The dental team and skill mix Flashcards
Nuffield Foundation 1993 definition of dental team and team work (1)
“An interchangeable mix of skills provided by those best suited to exercise them by virtue of their training and experience”
Drivers for change (4)
The Nuffield Report (1993)
Political Influences (1998, 2003)
A workforce shortage
The pattern of oral disease
The Nuffield Report 1993 (2)
Highlighted the potential of using DCPs to provide a more effective service.
The report recommended that clinical procedures could be divided between the dental team.
Political influences (4)
After a series of scandals in the NHS, the government were keen to ensure that there were mechanisms in place so professionals were held accountable for their actions.
In 1998 the Dental Auxiliaries Review Group (DARG) made a series of recommendations to the GDC which has paved the way for today’s DCPs.
In 2001 the PM pledged that everyone who needed NHS dental care would be able to access it.
DCPs were to be a large part of this.
The pattern for oral disease (3)
The prevalence of caries is falling in the young.
The older population are maintaining their own teeth. (Adult Dental Health Survey)
In time these patients will need care which could be provided by DCPs.
A workforce shortage (3)
The majority of dentistry is provided through the NHS but move towards private care.
This in combination with shortage of dentists causes a problem with service provision.
DCP’s cheaper to train and have an expanded Scope of Practice.
Centre for Workforce Intelligence, 2014 (3)
Demand for DHs and DTs expected to rise.
40-50% of dental care could be undertaken by DCPs by 2025.
Train dentists in effective use of DCPs.
What is a DCP? (3)
A DCP is a person who provides dental care for patients as a member of a team usually directed by a dentist.
There are different classes of DCP.
All duties are outlined in GDC’s ‘Scope of Practice’
GDC registration: all members of the dental team (3)
Need to be appropriately trained and registered with the GDC.
Are professionally accountable for their actions.
Are required to undertake eCPD and have a PDP:
-from January 2018 Dentists – 100 hours per 5 years
-from August 2018 DCPs – 75 hours per 5 years for DH, DT, CDT, OT. 50 hours per 5 years for DN and DTech
DCPs include (7)
Dental Nurses Dental Hygienists Dental Therapists Orthodontic Therapists Dental Technicians Clinical Dental Technicians Maxillofacial Prosthetist (not registered with the GDC if they just do this role)
Dental Nurses - number registered and registerable qualifications (4)
56,790 registered (Oct18)
Registerable Qualifications
-National Examining Board (NEBDN)
-National Diploma in Dental Nursing, National Vocational Qualification (NVQ)
-Advanced Apprenticeship in Dental Nursing (level 3) and Certificate of HE in Dental Nursing
Scope of Practice for Dental Nurses (10)
Prepare and maintain clinical environment and equipment
Infection control
Record dental charting
Prepare mix and handle dental bio-materials
Provide chairside support to the operator.
Keep patient records
Prepare equipment, materials and patients for dental radiograph.
Process radiographs
Give appropriate patient advice
Medical emergencies
Make appropriate referrals.
Scope of Practice for Dental Nurses: additional skills (a lot)
Oral health education & promotion
Treatment of patients under conscious sedation
Treatment of patients with special needs
Treatment of orthodontic patients
Photography, shade taking and tracing cephalographs
Pouring, casting and trimming study models
Taking radiographs, placing rubber dam
Measuring and recording plaque indices
Removing sutures, applying fluoride varnish
Making occlusal registration rims, trays, mouth guards, retainers and bleaching trays.
Taking impressions, repairing the acrylic component of removal appliances
Applying topical anaesthetic
Dental Nurses: post qualification courses include (6)
Dental Radiography Oral Health Education Dental Sedation Nursing Orthodontic Nursing Special Care Dental Nursing Dental Implant Nursing
Dental hygienists: number registered and training (5)
7230 registered (Oct18)
-diploma or Certificate in Dental Hygiene or BSc in Oral Health Sciences
Training programmes in USA since 1913
Training in UK since 1943 (RAF programme)
Mainstream since 1959 in Dental Schools
Sheffield began training dental hygienists in 1984
Scope of Practice for dental hygienists (15)
Treatment direct to patients or under prescription from a dentist
Clinical examination, Oral health screening, diagnose, treatment plan and give appropriate advice
Periodontal examination, screen and monitor periodontal disease
Dental hygiene care
Dental history and evaluate medical history
Prescribe, take, process and interpret radiographs
Provide preventive oral care
Supra and subgingival scaling and root debridement
Anti-microbial therapy: manage plaque related diseases
Adjust restored surfaces in relation to perio treatment
Infiltration and inferior dental block analgesia
Temporary dressings and re-cement crowns with temporary cement
Take impressions and place rubber dam
Care of implants and treatment of peri-implant tissues
Refer patients to other healthcare professionals
Vary the detail but not the direction of the prescription according to patient needs
Dental hygienists: additional skills (3)
tooth whitening to the prescription of a dentist
administering inhalational sedation
removing sutures after the wound has been checked by a dentist
Dental therapist: registered and training (5)
3294 registered with the GDC (Oct18)
Were known as ‘dental dressers’ and ‘dental auxiliaries’
Training in the UK since 1960
Initially worked in Community dental services, Hospital settings and the armed forces
Legislation changed in 2002 to extend to general practice
Dental Therapist: Scope of Practice (2)
Hygienists scope of practice plus:
-direct restorations on primary and secondary teeth
-pulpotomies on primary teeth
-extract primary teeth
-pre-formed crowns on primary teeth
Vary the detail but not the direction of the prescription according to patient needs.
-e.g. the number of surfaces to be restored or the material to be used.
Ortho therapists: what do they do (6)
Ortho tx under prescription
Prepare tooth surfaces, bond brackets and bands, and place archwires, headgear, fit and bond retainers
Take imps, registrations, facebows and take models
Insert removable appliances, remove fixed appliances.
Carry out IOTH screening
Make appropriate referrals
Give patient advice
Dental Technicians: how many registered and qualifications (4)
Approx 6000
Qualifications
-BTEC National Diploma in Dental Technology
-Bachelors Degree in Dental Technology
Many people are employed as ‘process workers’
Dental technicians: Scope of Practice
Dental technicians work to the prescription to make Dental Devices:
- crowns, Bridges, Dentures, Orthodontic appliances
- review cases, treatment plan with a dentist or CDT
- give appropriate patient advice
- design plan and make dental devices
- shade taking
- cross infection control
- verify safety of devices*
- make appropriate referrals
Dental technicians: additional skills (6)
Working with a dentist or CDT to: Fit attachments Taking impressions Recording facebows, occlusal registration and GAT Implant frame assessment Tracing cephalographs Intra-oral scanning
Clinical Dental Technicians: numbered registered and training (5)
400 registered with the GDC (Oct18)
Dental technicians who have undertake a diploma in Clinical Dental Technology
Now A-level entry three year degree programme
Previously refereed to as ‘Denturist’ and in other countries as ‘Dental Prosthetists’
CDTs initially trained in Canada
Two current centres in the UK since 2011
Clinical Dental Technicians: Scope of Practice (8)
Complete dentures directly to patients
Removable appliances under prescription
-clinical examination, Oral health screening, Dental and -medical History
-clinical and technical stages of providing dental devices
-take and process radiographs & other images
-refer to other healthcare professionals
-fit appliances
-vary the detail but not direction of a prescription
Clinical Dental Technicians: Scope of Practice: additioanl skills (6)
Re-cementing crowns Anti-snoring devices Removing sutures Prescribing radiographs Placing implant abutments Tooth whitening
Ortho therapist: number registered and training (4)
623 registered with the GDC (Oct18)
Diploma in Orthodontic Therapy
Core training completed in hospital/dental school then will work under the supervision of a specialist trainer in practice
Take impressions, fit orthodontic bands and place and remove brackets and wires
Ortho therapist: additional skills (4)
Applying fluoride varnish
Repairing removable appliances
Measuring plaque scores
Removing sutures
Maxillofacial prosthetist (2)
Work in hospital oral surgery, ophthalmic, cancer and burns units. They are involved in the reconstruction of faces of patients that have been damaged by accident or disease
Usually qualified and experienced dental technicians with Diploma or MSc in Maxillofacial Technology
Dentist: number registered and role (5)
42,009 registered with the GDC (Oct18) Strategic role Diagnose Long-term responsibility for treatment Scope of practice
Direct Access (3)
Introduced 1st May 2013
Patients have direct access to DCPs
No necessity to see a dentist first.
Benefits for Dental Workforce (5)
Distribute patient care and workload
Efficiency
Specialise or focus in certain areas of dentistry
Job satisfaction and career paths for primary dental healthcare workers
Avoidance of fragmentation and working in isolation
Benefits for patients (3)
Responsive and patient sensitive service
Cost effective service
The development of comprehensive healthcare plans which meet the needs of individual patients and communities
Developments and the future (3)
Dental contract
Removal of training bursaries in NHS
Dental training reform
