Evolution of dental therapist 

During WWI, women were trained  as 'dental dressers' to perform dental tasks under dental supervision due to the shortage of dentists and high rates of  dental caries among children in UK.  By 1923, dental dressers were employed in several areas, but by 1942, they were abolished as their role was  strongly opposed  by the dental professionals.

 Following WWII, the UK government recognized widespread oral disease and the decline of the School Dental Service, as many school dentists transitioned to general practice. The UK  drew inspiration from New Zealand's dental nurse model, who performed various dental duties, including dental disease diagnosis  and treatment planning for primary dentition.

Despite dentists' opposition to the concept of introducing dental auxillaries, the Dentists Bill was passed in 1957. The newly formed General Dental Council (GDC) established the conditions for the new dental auxiliaries  who worked under strict supervision only in public services. The first training school for dental auxiliaries opened in 1959 at New Cross Hospital. By the 1980s, changes in dental education and increased training opportunities were recommended to expand the role of dental therapists.

(Rowbotham( 2009).

 

Scope of Practice 

General Dental Council (GDC)'s  Scope of Practice (General Dental Council, 2013) allows the  dental therapist  to carry out range of treatments  such as

  • Periodontal assessment and therapy 
  • Prevention- Standard and Enhanced 
  • Intra/Extra Oral findings
  • taking Radiographs 
  • taking impressions 
  • Restorative treatments on permanent and decidious dentition
  • Oral cancer screenings 
  • Administer Local Anaesthetic
  • Pulpotomies  and extractions on primary teeth
  • Placement of  temporary dressings and re-cement crowns with temporary cement

Dental therapists can perform the full scope of practice under direct access and prescription from a dentist (introduced in 2013) . The only exception is tooth whitening, which requires a dentist's prescription.(General Dental Council (2019) 

 

The roles of dental therapist in: 

Primary Care 

Primary dental care includes General Dental Practices (GDPs) and Public Dental Services (PDS), which are the initial points of contact for patients seeking dental help. Their primary goal is to diagnose and prevent dental disease through initial care (Scotland, 2024).

The GDPs are the primary point of access for NHS dental care, where patients are eligible to receive the complete range of dental treatments provided under GDS(Smith, 2024).

The PDS provides dental care for individuals who can't access independent dentists, including those with special care needs, residents in long-term care, and those referred for specific treatment.

Under this setting, the  dental therapist can provide preventive treatments  such as standard and enhanced prevention,  tailored oral health education, fluoride varnishing,  fissure sealants and nonsurgical periodontal treatment.  They can also provide restorative treatment  for both children and adults, extraction and pulpotomy for children.

 

Secondary Care 

Secondary dental care includes more specialized services like Hospital Dental Services (HDS) or specialists. Patients are referred for more serious or complex dental issues that cannot be treated in primary care settings. The HDS allows patients to be treated in outpatient clinics or, if necessary, admitted as inpatients or day cases.

The services provided under this care are surgical extractions of impacted teeth or complex cases, treatment of advanced periodontal disease, orthodontics, prosthodontics, and oral surgery. They are also involved in management of dental trauma, cleft palate, or oral cancers.

Under this setting, the dental therapists can  support the management of severe cases by performing routine procedures, aiding post-operative care, and assisting in orthodontic and prosthetic treatments. They also contribute to specialized clinics, helping with periodontal care and dental trauma management by performing tasks that complement specialized clinicians.

 

''Dental therapists  roles are essential in both primary and secondary care settings, often assisting with routine procedures, reducing waiting times, and ensuring comprehensive care.''

 

'A  2007 study was conducted to determine what proportion of primary dental care tasks could be delegated to hygienists and therapists. Data from 850 patients at 17 dental practices revealed that diagnostic examinations accounted for 34.2% of visits, with restorative and other complex interventions accounting for the remainder. Dental therapists could provide simple and intermediate restorative interventions, potentially accounting for 35.3% of visits and 43% of clinical time. If therapists were given diagnostic and treatment planning responsibilities, they could perform 69.5% of visits and 58.3% of clinical time. According to the study, hygienists and therapists could take on a significant portion of the work in UK dental practices.' Evans, (2007)

Multidisciplinary Dentistry 

Multidisciplinary Approach 

A multidisciplinary approach to dental care involves collaboration among dental professionals to holistically address a patient's oral health needs. They are essential in preventive dentistry because they enable the early detection and treatment of oral health issues. Working together, dental professionals can detect and treat problems early on, preventing them from worsening and reducing the need for extensive future treatments 

The multidisciplinary team includes:

  • General dentist 
  • Dental Nurses 
  • Dental Hygienist
  • Dental Therapist
  • Orthodontists
  • Endodontist 
  • Oral  & Maxilliofacial surgeon
  • General Practitioner

Dental therapists play an important role in multidisciplinary care. They may work with dietitians and doctors to manage periodontal disease, especially in diabetics. In oral cancer screening, they can identify unusual lesions and refer patients for further evaluation while keeping their emotional well-being in mind. In pediatric care, dental therapists collaborate with pediatricians to monitor children's growth and ensure that oral health is integrated with overall health, such as diet and vaccinations.

Nationwide Health Improvement Projects 

Childsmile 

Childsmile is a nationwide initiative in Scotland aimed at improving children's oral health and tackling disparities in dental health and access to services. It adopts a multi-disciplinary approach, involving both the health service and local authorities. Its success has largely been driven by the dedication of nursery and primary school staff, who provide daily supervised tooth brushing, along with dietary and oral hygiene guidance. In disadvantaged areas, children also receive two fluoride varnish applications.

 

Caring for Smiles 

 

Caring for Smiles is NHS Scotland's oral health promotion, training, and support program for dependent older people, particularly those living in care homes. It provides care staff with the necessary skills and knowledge to assist with the oral care of those under their care. This program is being implemented by Oral Health Improvement teams across Scotland in collaboration with partners such as care homes and other services..

 

Smile 4 life 

 

 

Smile4Life is NHS Scotland’s oral health improvement initiative aimed at people experiencing homelessness. The program includes resources such as a co-designed, evidence-based oral health promotion training guide, which helps health professionals, third-sector staff, and social care workers address the unique oral health needs of this group.

 

Career pathway for dental therapist 

  • Further Education to qualify as a dentist 

  •  Specialization such as orthodontic therapy, pediatric dentistry, or periodontics. 

  • Operate your own practice 

  • Becoming a Lead Therapist

  • Clinical Trainer or Educator

  • Expanding Scope of Practice

  • Management and Administration

  • Pursue opportunities in dental research and development: