Commentary

Inequitable or limited access to oral health services is seen in a wide range of countries whether they are considered to be high-, middle-, or low-income economies. Task shifting or labour substitution where typically the focus is on moving work from a more expensive worker to a less expensive alternative is often advocated to; compensate for shortages or reduce demand; reduce cost or improve efficiency.1 A number of countries use dental auxiliaries who are permitted to work in patients' mouths and there is a wide variation in their training and permitted duties. This review uses the term ‘operating dental auxiliaries which includes dental therapists, dental hygienists, extended-duty dental nurses, oral health therapists, orthodontic auxiliaries, clinical dental technicians, maxillofacial technicians and denturists. The aim of this review was to assess the effectiveness, costs and cost-effectiveness of dental auxiliaries in providing care traditionally provided by dentists.

This review was undertaken using the methodological approaches of the Cochrane Effective Practice and Organisation of Care (EPOC). This Cochrane Group has a focus on interventions designed to improve the delivery, practice and organisation of health care services. Because of the topic areas that they cover this group utilises a broader range of study designs in their reviews and this can been seen by the consideration of non-randomised controlled trials (NRCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) to address the review's question. However despite a wide search of a large number of databases no NRCTs, CBAs or ITSs study designs met the review's inclusion criteria.

Only five studies were included in the review; all were considered to be at high risk of bias, and the majority of those were more than 20 years old. The quality of the available evidence was considered to be very low, as it was in the 2012 review by Wright et al.2 and the 2002 review by Galloway et al.3 One of the main recommendations of the Galloway review was that more high-quality studies be undertaken into the effectiveness and cost-effectiveness of dental auxiliaries, and it is disappointing that this new review of the topic could find little or no new research since that review had been published. Here in the UK where there has been an expansion of both the numbers of operating dental auxiliaries being trained and the range of treatments they are able to provide, this lack of available evidence to help ensure their most effective use is likely to have a negative effect on the development of effective dental teams.

Corrections and clarifications

This article was originally published in the Sept 2014 issue of EBD. Owing to a problem in the production process an incorrect commentary section was paired with the abstract of the paper. The Editor would like to thank a number of readers who highlighted this error. The corrected article is reprinted here in full.