The viability of a diagnostic role for dental hygienists and dental therapists in the UK: a review of the literature
Main Article Content
Abstract
Dental therapists (DTs) and dental hygienists (DHs) are registered in the UK by the General Dental Council. They have a defined scope of practice and this allows them to see patients by direct assess, undertake clinical examinations and tests to formulate a diagnosis and care plan. This review will focus on the viability of a diagnostic role for these highly trained health care professions within the UK, with reference to national and international literature.
Several key themes consistently appear in the literature; acceptability, examination & diagnostic skills, financial impact, clinical knowledge and safeguarding. These themes, act either as barriers or facilitators or both in this defined role of direct access.
This review concludes patient’s acceptance of DHs and DTs and that they have significant examination and diagnostic skills. Despite the potential cost saving for either, the patient, insurer or the UK National Health Service when they are utilised in this role of undertaking oral health assessments, dentist’s acceptance of DH and DTs continues to serve as a barrier.
More primary research in the UK and internationally is required to provide a stronger foundation for support and enhancement for this front-line role.
Article Details
How to Cite
QUACH, Josh D.D.; RADFORD, David R; LOUCA, Chris.
The viability of a diagnostic role for dental hygienists and dental therapists in the UK: a review of the literature.
Medical Research Archives, [S.l.], v. 8, n. 7, july 2020.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2182>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v8i7.2182.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. General Dental Council. (2013a). Scope of Practice. General Dental Council
2. General Dental Council. (2013b). Guidance on Direct Access. London: General Dental Council Retrieved from https://www.gdc-uk.org/professionals/standards/direct-access
3. Ohrn, K., Hakeberg, M., & Abrahamsson, K. H. (2008). Dental beliefs, patients' specific attitudes towards dentists and dental hygienists: a comparative study. Int J Dent Hyg, 6(3), 205-213. doi:10.1111/j.1601-5037.2008.00300.x
4. Dyer, T. A., Humphris, G., & Robinson, P. G. (2010). Public awareness and social acceptability of dental therapists. Br Dent J,, 208(1), E2-E2. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=47376648&site=eds-live. doi:10.1038/sj.bdj.2010.1
5. Dyer, T. A., Owens, J., & Robinson, P. G. (2013). What matters to patients when their care is delegated to dental therapists? Br Dent J, 214(6), E17. doi:10.1038/sj.bdj.2013.275
6. Dyer, T. A., & Robinson, P. G. (2016). The acceptability of care provided by dental auxiliaries: A systematic review. J Am Dent Assoc, 147(4), 244-254. doi:10.1016/j.adaj.2015.09.018
7. Macey, R., Glenny, A. M., & Brocklehurst, P. (2016). Feasibility study: assessing the efficacy and social acceptability of using dental hygienist-therapists as front-line clinicians. Br Dent J, 221, 717. Retrieved from https://doi.org/10.1038/sj.bdj.2016.913Retrieved from 10.1038/sj.bdj.2016.913.
8. Phillips, E., Shaefer, H. L., Aksu, M. N., & Lapidos, A. (2016). Is a mid-level dental provider model acceptable to potential patients? Community Dent Oral Epidemiol, 44(5), 426-434. doi:10.1111/cdoe.12230
9. Nash, D. A., Friedman, J. W., Kardos, T. B., Kardos, R. L., Schwarz, E., Satur, J., . . . Nagel, R. (2008). Dental therapists: a global perspective. Int Dent J, 58(2), 61-70.
10. Jones, G., Devalia, R., & Hunter, L. (2007). Attitudes of general dental practitioners in Wales towards employing dental hygienist-therapists. Br Dent J, 203(9), E19; discussion 524-525. doi:10.1038/bdj.2007.89
11. Turner, S., Tripathee, S., & MacGillivray, S. (2013). Direct access to DCPs: what are the potential risks and benefits? Br Dent J, 215(11), 577-582. doi:10.1038/sj.bdj.2013.1145
12. Ross, M. K., Ibbetson, R. J., & Turner, S. (2007). The acceptability of dually-qualified dental hygienist-therapists to general dental practitioners in South-East Scotland. Br Dent J, 202(3), E8; discussion 146-147. doi:10.1038/bdj.2007.45
13. Blue, C. M., Funkhouser, D. E., Riggs, S., Rindal, D. B., Worley, D., Pihlstrom, D. J., . . . Gilbert, G. H. (2013). Utilization of nondentist providers and attitudes toward new provider models: findings from the National Dental Practice-Based Research Network. J Public Health Dent, 73(3), 237-244. doi:10.1111/jphd.12020
14. Ross, M., & Turner, S. (2015). Direct access in the UK: what do dentists really think? Br Dent J, 218(11), 641-647. doi:10.1038/sj.bdj.2015.504
15. Blue, C., Phillips, R., Born, D., & Lopez, N. (2011). Beginning the socialization to a new workforce model: dental students' preliminary knowledge of and attitudes about the role of the dental therapist. J Dent Educ, 75(11), 1465-1475.
16. Barnes, E, Bullock, A, Chestnutt, IG, Cowpe, J, Moons, K, Warren, W. Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances. Eur J Dent Educ, 2019; 24: 109– 120. https://doi.org/10.1111/eje.12474 doi:10.1038/sj.bdj.2009.666
17. Reinders, J. J., Krijnen, W. P., Onclin, P., van der Schans, C. P., & Stegenga, B. (2017). Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists. Int Dent J, 67(1), 46-58. doi:10.1111/idj.12254
18. Nash, D. A., Mathu-Muju, K. R., & Friedman, J. W. (2018). The dental therapist movement in the United States: A critique of current trends. J Public Health Dent, 78(2), 127-133. doi:10.1111/jphd.12252
19. Turner, S., Ross, M. K., & Ibbetson, R. J. (2011). Dental hygienists and therapists: how much professional autonomy do they have? How much do they want? Results from a UK survey. Br Dent J, 210(10), E16. doi:10.1038/sj.bdj.2011.387
20. Hopcraft, M. S., Morgan, M. V., Satur, J. G., & Wright, F. A. (2011). Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities. Community Dent Oral Epidemiol, 39(4), 378-384. doi:10.1111/j.1600-0528.2010.00605.x
21. Leisnert, L., Axtelius, B., Johansson, V., & Wennerberg, A. (2015). Diagnoses and treatment proposals in periodontal treatment. A comparison between dentists, dental hygienists and undergraduate students. Swed Dent J, 39(2), 87-97.
22. Kwan, S. Y. L., & Prendergast, M. J. (1998). The use of clinical dental auxiliaries as examiners in caries prevalence surveys in the United Kingdom: a feasibility study. Community Den Oral Epidemiol, 26(3), 194-200. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=12014360&site=eds-live.
23. Brocklehurst, P., Ashley, J., Walsh, T., & Tickle, M. (2012). Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol, 40(3), 239-246. doi:10.1111/j.1600-0528.2012.00671.x
24. Macey, R., Glenny, A., Walsh, T., Tickle, M., Worthington, H., Ashley, J., & Brocklehurst, P. (2015). The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res, 94(3 Suppl), 70S-78S. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=25604256&site=eds-live. doi:10.1177/0022034514567335
25. O'Keefe, E. J., McMahon, A. D., Jones, C. M., Curnow, M. M., & Macpherson, L. M. D. (2016). Evaluation of undertaking dental examinations in a school setting in Scotland. Community Dent Oral Epidemiol, 44(6), 515-522. Retrieved from; https://doi.org/10.1111/cdoe.12244. doi:10.1111/cdoe.12244
26. Daniel, S. J., & Kumar, S. (2017). Comparison of dental hygienists and dentists: clinical and teledentistry identification of dental caries in children. Int J Dent Hyg, 15(4), e143-e148. doi:10.1111/idh.12232
27. Brocklehurst, P., Pemberton, M. N., Macey, R., Cotton, C., Walsh, T., & Lewis, M. (2015). Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions. Br Dent J, 218(9), 525-529. doi:10.1038/sj.bdj.2015.344
28. Evans, C., Chestnutt, I. G., & Chadwick, B. L. (2007). The potential for delegation of clinical care in general dental practice. Br Dent J, 203(12), 695-699. doi:10.1038/bdj.2007.1111
29. Gallagher, J. E., Lim, Z., & Harper, P. R. (2013). Workforce skill mix: modelling the potential for dental therapists in state-funded primary dental care. Int Dent J, 63(2), 57-64. doi:10.1111/idj.12006
30. Wanyonyi, K. L., Radford, D. R., Harper, P. R., & Gallagher, J. E. (2015). Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operation research. Hum Resour Health 13(1), 78. https://doi.org/10.1186/s12960-015-0072-9.
31. Hill, H., Macey, R., & Brocklehurst, P. (2017). A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent, 77(4), 334-343. doi:10.1111/jphd.12212
32. Office for National Statistics. (2018). Living longer - how our population is changing and why it matters. Retrieved from United Kingdom: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13
33. Leisnert, L., Hallstrom, H., & Knutsson, K. (2008). What findings do clinicians use to diagnose chronic periodontitis? Swed Dent J, 32(3), 115-123.
34. Santella, A. J., Krishnamachari, B., Davide, S. H., Cortell, M., Furnari, W., Watts, B., & Haden, S. C. (2013). Dental hygienists' knowledge of HIV, attitudes towards people with HIV and willingness to conduct rapid HIV testing. Int J Dent Hyg, 11(4), 287-292. doi:10.1111/idh.12022
35. Taichman, L. S., Gomez, G., & Inglehart, M. R. (2014). Oral health-related complications of breast cancer treatment: assessing dental hygienists' knowledge and professional practice. J Dent Hyg, 88(2), 100-113.
36. Singla, A., Patthi, B., Singh, K., Jain, S., Vashishtha, V., Kundu, H., . . . Pandita, V. (2014). Tobacco cessation counselling practices and attitude among the dentist and the dental auxiliaries of urban and rural areas of Modinagar, India. J Clin Diagn Res, 8(9), Zc15-18. doi:10.7860/jcdr/2014/9250.4799
37. DeBate, R. D., Tedesco, L. A., & Kerschbaum, W. E. (2005). Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists. J Dent Educ, 69(3), 346-354.
38. General Dental Council. (2015). Preparing for Practice: Dental team learning outcomes for registration (2015 revised edition). London UK Retrieved from https://www.gdc-uk.org/professionals/education
39. Chadwick, B. L., Davies, J., Bhatia, S. K., Rooney, C., & McCusker, N. (2009). Child protection: training and experiences of dental therapists. Br Dent J, 207(3), E6; discussion 130-131.
2. General Dental Council. (2013b). Guidance on Direct Access. London: General Dental Council Retrieved from https://www.gdc-uk.org/professionals/standards/direct-access
3. Ohrn, K., Hakeberg, M., & Abrahamsson, K. H. (2008). Dental beliefs, patients' specific attitudes towards dentists and dental hygienists: a comparative study. Int J Dent Hyg, 6(3), 205-213. doi:10.1111/j.1601-5037.2008.00300.x
4. Dyer, T. A., Humphris, G., & Robinson, P. G. (2010). Public awareness and social acceptability of dental therapists. Br Dent J,, 208(1), E2-E2. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=47376648&site=eds-live. doi:10.1038/sj.bdj.2010.1
5. Dyer, T. A., Owens, J., & Robinson, P. G. (2013). What matters to patients when their care is delegated to dental therapists? Br Dent J, 214(6), E17. doi:10.1038/sj.bdj.2013.275
6. Dyer, T. A., & Robinson, P. G. (2016). The acceptability of care provided by dental auxiliaries: A systematic review. J Am Dent Assoc, 147(4), 244-254. doi:10.1016/j.adaj.2015.09.018
7. Macey, R., Glenny, A. M., & Brocklehurst, P. (2016). Feasibility study: assessing the efficacy and social acceptability of using dental hygienist-therapists as front-line clinicians. Br Dent J, 221, 717. Retrieved from https://doi.org/10.1038/sj.bdj.2016.913Retrieved from 10.1038/sj.bdj.2016.913.
8. Phillips, E., Shaefer, H. L., Aksu, M. N., & Lapidos, A. (2016). Is a mid-level dental provider model acceptable to potential patients? Community Dent Oral Epidemiol, 44(5), 426-434. doi:10.1111/cdoe.12230
9. Nash, D. A., Friedman, J. W., Kardos, T. B., Kardos, R. L., Schwarz, E., Satur, J., . . . Nagel, R. (2008). Dental therapists: a global perspective. Int Dent J, 58(2), 61-70.
10. Jones, G., Devalia, R., & Hunter, L. (2007). Attitudes of general dental practitioners in Wales towards employing dental hygienist-therapists. Br Dent J, 203(9), E19; discussion 524-525. doi:10.1038/bdj.2007.89
11. Turner, S., Tripathee, S., & MacGillivray, S. (2013). Direct access to DCPs: what are the potential risks and benefits? Br Dent J, 215(11), 577-582. doi:10.1038/sj.bdj.2013.1145
12. Ross, M. K., Ibbetson, R. J., & Turner, S. (2007). The acceptability of dually-qualified dental hygienist-therapists to general dental practitioners in South-East Scotland. Br Dent J, 202(3), E8; discussion 146-147. doi:10.1038/bdj.2007.45
13. Blue, C. M., Funkhouser, D. E., Riggs, S., Rindal, D. B., Worley, D., Pihlstrom, D. J., . . . Gilbert, G. H. (2013). Utilization of nondentist providers and attitudes toward new provider models: findings from the National Dental Practice-Based Research Network. J Public Health Dent, 73(3), 237-244. doi:10.1111/jphd.12020
14. Ross, M., & Turner, S. (2015). Direct access in the UK: what do dentists really think? Br Dent J, 218(11), 641-647. doi:10.1038/sj.bdj.2015.504
15. Blue, C., Phillips, R., Born, D., & Lopez, N. (2011). Beginning the socialization to a new workforce model: dental students' preliminary knowledge of and attitudes about the role of the dental therapist. J Dent Educ, 75(11), 1465-1475.
16. Barnes, E, Bullock, A, Chestnutt, IG, Cowpe, J, Moons, K, Warren, W. Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances. Eur J Dent Educ, 2019; 24: 109– 120. https://doi.org/10.1111/eje.12474 doi:10.1038/sj.bdj.2009.666
17. Reinders, J. J., Krijnen, W. P., Onclin, P., van der Schans, C. P., & Stegenga, B. (2017). Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists. Int Dent J, 67(1), 46-58. doi:10.1111/idj.12254
18. Nash, D. A., Mathu-Muju, K. R., & Friedman, J. W. (2018). The dental therapist movement in the United States: A critique of current trends. J Public Health Dent, 78(2), 127-133. doi:10.1111/jphd.12252
19. Turner, S., Ross, M. K., & Ibbetson, R. J. (2011). Dental hygienists and therapists: how much professional autonomy do they have? How much do they want? Results from a UK survey. Br Dent J, 210(10), E16. doi:10.1038/sj.bdj.2011.387
20. Hopcraft, M. S., Morgan, M. V., Satur, J. G., & Wright, F. A. (2011). Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities. Community Dent Oral Epidemiol, 39(4), 378-384. doi:10.1111/j.1600-0528.2010.00605.x
21. Leisnert, L., Axtelius, B., Johansson, V., & Wennerberg, A. (2015). Diagnoses and treatment proposals in periodontal treatment. A comparison between dentists, dental hygienists and undergraduate students. Swed Dent J, 39(2), 87-97.
22. Kwan, S. Y. L., & Prendergast, M. J. (1998). The use of clinical dental auxiliaries as examiners in caries prevalence surveys in the United Kingdom: a feasibility study. Community Den Oral Epidemiol, 26(3), 194-200. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=12014360&site=eds-live.
23. Brocklehurst, P., Ashley, J., Walsh, T., & Tickle, M. (2012). Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol, 40(3), 239-246. doi:10.1111/j.1600-0528.2012.00671.x
24. Macey, R., Glenny, A., Walsh, T., Tickle, M., Worthington, H., Ashley, J., & Brocklehurst, P. (2015). The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res, 94(3 Suppl), 70S-78S. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=25604256&site=eds-live. doi:10.1177/0022034514567335
25. O'Keefe, E. J., McMahon, A. D., Jones, C. M., Curnow, M. M., & Macpherson, L. M. D. (2016). Evaluation of undertaking dental examinations in a school setting in Scotland. Community Dent Oral Epidemiol, 44(6), 515-522. Retrieved from; https://doi.org/10.1111/cdoe.12244. doi:10.1111/cdoe.12244
26. Daniel, S. J., & Kumar, S. (2017). Comparison of dental hygienists and dentists: clinical and teledentistry identification of dental caries in children. Int J Dent Hyg, 15(4), e143-e148. doi:10.1111/idh.12232
27. Brocklehurst, P., Pemberton, M. N., Macey, R., Cotton, C., Walsh, T., & Lewis, M. (2015). Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions. Br Dent J, 218(9), 525-529. doi:10.1038/sj.bdj.2015.344
28. Evans, C., Chestnutt, I. G., & Chadwick, B. L. (2007). The potential for delegation of clinical care in general dental practice. Br Dent J, 203(12), 695-699. doi:10.1038/bdj.2007.1111
29. Gallagher, J. E., Lim, Z., & Harper, P. R. (2013). Workforce skill mix: modelling the potential for dental therapists in state-funded primary dental care. Int Dent J, 63(2), 57-64. doi:10.1111/idj.12006
30. Wanyonyi, K. L., Radford, D. R., Harper, P. R., & Gallagher, J. E. (2015). Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operation research. Hum Resour Health 13(1), 78. https://doi.org/10.1186/s12960-015-0072-9.
31. Hill, H., Macey, R., & Brocklehurst, P. (2017). A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent, 77(4), 334-343. doi:10.1111/jphd.12212
32. Office for National Statistics. (2018). Living longer - how our population is changing and why it matters. Retrieved from United Kingdom: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13
33. Leisnert, L., Hallstrom, H., & Knutsson, K. (2008). What findings do clinicians use to diagnose chronic periodontitis? Swed Dent J, 32(3), 115-123.
34. Santella, A. J., Krishnamachari, B., Davide, S. H., Cortell, M., Furnari, W., Watts, B., & Haden, S. C. (2013). Dental hygienists' knowledge of HIV, attitudes towards people with HIV and willingness to conduct rapid HIV testing. Int J Dent Hyg, 11(4), 287-292. doi:10.1111/idh.12022
35. Taichman, L. S., Gomez, G., & Inglehart, M. R. (2014). Oral health-related complications of breast cancer treatment: assessing dental hygienists' knowledge and professional practice. J Dent Hyg, 88(2), 100-113.
36. Singla, A., Patthi, B., Singh, K., Jain, S., Vashishtha, V., Kundu, H., . . . Pandita, V. (2014). Tobacco cessation counselling practices and attitude among the dentist and the dental auxiliaries of urban and rural areas of Modinagar, India. J Clin Diagn Res, 8(9), Zc15-18. doi:10.7860/jcdr/2014/9250.4799
37. DeBate, R. D., Tedesco, L. A., & Kerschbaum, W. E. (2005). Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists. J Dent Educ, 69(3), 346-354.
38. General Dental Council. (2015). Preparing for Practice: Dental team learning outcomes for registration (2015 revised edition). London UK Retrieved from https://www.gdc-uk.org/professionals/education
39. Chadwick, B. L., Davies, J., Bhatia, S. K., Rooney, C., & McCusker, N. (2009). Child protection: training and experiences of dental therapists. Br Dent J, 207(3), E6; discussion 130-131.