The dental team and skill mix

Question 1

Nuffield Foundation 1993 definition of dental team and team work (1)

Answer 1

“An interchangeable mix of skills provided by those best suited to exercise them by virtue of their training and experience”

Question 2

Drivers for change (4)

Answer 2

The Nuffield Report (1993)
Political Influences (1998, 2003)
A workforce shortage
The pattern of oral disease

Question 3

The Nuffield Report 1993 (2)

Answer 3

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.

Question 4

Political influences (4)

Answer 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.

Question 5

The pattern for oral disease (3)

Answer 5

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.

Question 6

A workforce shortage (3)

Answer 6

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.

Question 7

Centre for Workforce Intelligence, 2014 (3)

Answer 7

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.

Question 8

What is a DCP? (3)

Answer 8

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’

Question 9

GDC registration: all members of the dental team (3)

Answer 9

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

Question 10

DCPs include (7)

Answer 10

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)

Question 11

Dental Nurses - number registered and registerable qualifications (4)

Answer 11

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

Question 12

Scope of Practice for Dental Nurses (10)

Answer 12

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.

Question 13

Scope of Practice for Dental Nurses: additional skills (a lot)

Answer 13

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

Question 14

Dental Nurses: post qualification courses include (6)

Answer 14

Dental Radiography
Oral Health Education
Dental Sedation Nursing
Orthodontic Nursing
Special Care Dental Nursing
Dental Implant Nursing

Question 15

Dental hygienists: number registered and training (5)

Answer 15

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

Question 16

Scope of Practice for dental hygienists (15)

Answer 16

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

Question 17

Dental hygienists: additional skills (3)

Answer 17

tooth whitening to the prescription of a dentist
administering inhalational sedation
removing sutures after the wound has been checked by a dentist

Question 18

Dental therapist: registered and training (5)

Answer 18

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

Question 19

Dental Therapist: Scope of Practice (2)

Answer 19

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.

Question 20

Ortho therapists: what do they do (6)

Answer 20

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

Question 21

Dental Technicians: how many registered and qualifications (4)

Answer 21

Approx 6000
Qualifications
-BTEC National Diploma in Dental Technology
-Bachelors Degree in Dental Technology
Many people are employed as ‘process workers’

Question 22

Dental technicians: Scope of Practice

Answer 22

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

Question 23

Dental technicians: additional skills (6)

Answer 23

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

Question 24

Clinical Dental Technicians: numbered registered and training (5)

Answer 24

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

Question 25

Clinical Dental Technicians: Scope of Practice (8)

Answer 25

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

Question 26

Clinical Dental Technicians: Scope of Practice: additioanl skills (6)

Answer 26

Re-cementing crowns
Anti-snoring devices
Removing sutures
Prescribing radiographs 
Placing implant abutments
Tooth whitening

Question 27

Ortho therapist: number registered and training (4)

Answer 27

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

Question 28

Ortho therapist: additional skills (4)

Answer 28

Applying fluoride varnish
Repairing removable appliances
Measuring plaque scores
Removing sutures

Question 29

Maxillofacial prosthetist (2)

Answer 29

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

Question 30

Dentist: number registered and role (5)

Answer 30

42,009 registered with the GDC (Oct18) 
Strategic role
Diagnose
Long-term responsibility for treatment
Scope of practice

Question 31

Direct Access (3)

Answer 31

Introduced 1st May 2013
Patients have direct access to DCPs
No necessity to see a dentist first.

Question 32

Benefits for Dental Workforce (5)

Answer 32

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

Question 33

Benefits for patients (3)

Answer 33

Responsive and patient sensitive service
Cost effective service
The development of comprehensive healthcare plans which meet the needs of individual patients and communities

Question 34

Developments and the future (3)

Answer 34

Dental contract
Removal of training bursaries in NHS
Dental training reform