The scene
A dental therapist was a few months into their first post as part of a large dental team when a dentist colleague asked them to provide a filling for an elderly patient who had an appointment that afternoon.
The therapist wanted to help but they were worried about giving the patient a local anaesthetic without a prescription.
DDU advice
The therapist was right that the local anaesthetic was a prescription only medicine (POM) but it was now possible for them to go ahead with the procedure without a dentist’s prescription, after completing the necessary training.
An amendment to the Human Medicines Regulations 2012, allows dental therapists and hygienists to supply or administer specific prescription-only medicines under exemptions, including lidocaine and articaine (the full list can be found in Schedule 17, Part 2, para 13).
As the therapist has recently qualified, they would need to check with their dental school whether their training complied with the curriculum and learning outcomes (Annex A) jointly set by NHS England, the DHSC, and hygienist and therapist professional bodies. They must also be confident that they have the skills and knowledge to assess the patient, obtain consent, safely administer the local anaesthetic on their own, and record the relevant information in the clinical notes.
If this wasn’t the case, the therapist would instead need to administer the local anaesthetic for the filling under a patient specific direction (PSD) which is a written instruction from a dentist to administer a specific medicine to the individual patient. It wouldn’t be possible to use a patient group direction (PGD) because these are being phased out.
If the therapist decided to complete the required training to work under exemptions in the future, they would be indemnified to do this as a benefit of their DDU membership.
What happened next
After speaking to the DDU, the dental therapist contacted their dental school who explained that it was in the process of integrating the training into the curriculum, but this would not be in place until the next academic year.
Once they’d explained the situation to the dentist, she agreed to write a PSD for the local anaesthetic so they could go ahead with the filling. The practice then arranged for the therapist to complete appropriate training so she could start working under exemptions with support.
This is a fictionalised case compiled from actual DDU case files.
Need help? Contact us
Student members can contact our dento-legal advisers for support or call us on 0800 374 626 between 8am and 6pm Monday to Friday
This page was correct at publication on 15/07/2025. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Leo Briggs BDS, MSc Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service, including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. Since 1995, he has provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005.
Between 2007 and 2009 he worked part-time at the DDU and part-time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009, Leo went full time with the DDU and became deputy head in January 2016. He continues to work clinically as a specialist periodontist in a general practice on Saturdays.