Published to coincide with Standards for the Dental Team on 30 September 2013, the revised Scope of Practice outlines what each member of the dental team can do and the additional skills they might go on to acquire throughout their career. It follows an extensive review and consultation process which began in late 2010.
We recommend that you read the latest Scope of Practice for yourself but we would like to draw your attention to the following points.
The GDC says that all members of the dental team should "keep full, accurate and contemporaneous patient records". All dental professionals should be "trained in dealing with medical emergencies, including resuscitation, and possess up to date evidence of capability".
Dental hygienists and therapists
Since 1 May, dental hygienists and therapists have been able to see patients directly, without a prescription from a dentist. The new Scope of Practice reflects this change by increasing the list of tasks that they can carry out, provided they are trained, competent and indemnified. These now include:
- carry out a clinical examination within their competence (not just a periodontal examination)
- diagnose and plan treatment within their competence
- prescribe radiographs
- plan the delivery of care for patients (not just in relation to their periodontal health)
- give appropriate patient advice
- take intra and extra-oral photographs
- care of implants and treatment of peri-implant tissues
- if working on prescription, vary the detail but not the direction of the prescription.
While they can now diagnose disease, there is no change to the GDC's restrictions which prevent dental hygienists restoring teeth, carrying out pulp treatments, extractions or adjusting unrestored surfaces.
Prescribing radiographs and IR(ME)R
The GDC now says that hygienists and therapists can prescribe radiographs and it has updated its Guidance on Direct Access. However, the GDC’s Direct Access Q and As still state this is not permitted because hygienists and therapists are only recognised as operators under the Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER).
The unconfirmed minutes of the GDC Council meeting of 26 September, refer to an update from the GDC's Head of Standards: "Further advice was received in regard to IRMER which govern radiography – which permitted registered healthcare professionals who met certain criteria, to prescribe; therefore, DCPs who met those criteria could be radiography prescribers. It therefore remained in the Scope of Practice."
The DDU is continuing to liaise with the GDC about this aspect of their guidance. Our opinion is that under the Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R) dental hygienists and therapists are not permitted to report on a radiograph, because the regulations require a report on the whole film and a dentist is the only member of the dental team who has the necessary training to report on all aspects of a dental radiograph.
To reflect the change introduced under direct access, the scope of practice for orthodontic therapists now includes carrying out Index of Orthodontic Treatment Need (IOTN) screening, either under the direction of a dentist or direct to patients.
The GDC has also been more prescriptive about the tasks that orthodontic therapists can carry out on archwires, stating that they can only "prepare, insert, adjust and remove archwires previously prescribed or, where necessary, activated by a dentist and they do not modify prescribed archwires".
In addition, orthodontic therapists can now "identify, select, prepare and place auxiliaries", take intra- and extra-oral photographs and keep full, accurate and contemporaneous patient records.
Under direct access changes, the new Scope of Practice document states dental nurses can apply fluoride varnish directly, as part of a structured dental health programme as well as on prescription from a dentist.
Dental nurses can develop their skills in assisting in the treatment of orthodontic patients and carry out extra- as well as intra-oral photography
However, the following additional skills, which were previously listed as "additional skills nurses could develop", should now only be "undertaken on prescription from, or under the direction of, another registrant":
- placing a rubber dam
- measuring and recording plaque indices
- constructing occlusal registration rims and special trays
- repairing the acrylic component of removable appliances.
Dental technicians and clinical dental technicians
There is no significant change in the scope of practice for dental technicians but clinical dental technicians (CDTs) can:
- prescribe and provide complete dentures direct to patients
- provide and fit other dental devices on prescription from a dentist
- vary the detail but not the direction of a prescription according to patient needs.
New additional skills which CDTs could develop include:
- prescribing radiographs
- replacing implant abutments for removable dental appliances on prescription from a dentist
- providing tooth whitening treatments on prescription from a dentist.
As you would expect, there is no significant change to the tasks that dentists can carry out. However, the GDC does now list "providing non-surgical cosmetic injectables" (such as dermal fillers and botulinum toxin injections) as an additional skill they could develop.
This guidance was correct at publication 25/11/2013. It 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.