What's in a name?

    Subjects

    Passions run high when it comes to job titles. So, what should dually qualified dental hygienists and dental therapists call themselves – and why? Here, we poll the BADT council

    Name-calling – it's a tricky one, isn't it? Many may argue that a name is an arbitrary label – surely, all we need to know is what something is, not necessarily what it is called. And, why must we assign so much importance to a simple job title? As a dually qualified dental hygienist and dental therapist, you know what you are and what you do, you are fully aware what you qualified as and understand what treatments you are entitled to carry out within your Scope of Practice on qualifying. But, how many patients appreciate the role? Come to think of it, how many other members of the dental team are fully up to speed with what dentistry a dental therapist may deliver within the workplace? Additionally, does every dental therapist carry out his or her full Scope of Practice on a day-to-day basis? And, if not – and a lot of the work is hygiene based – then is it sometimes far simpler to stick with the ‘hygienist’ handle than call yourself a ‘therapist’? Interestingly, the General Dental Council (GDC) does not recognise the term ‘hygienist/therapist’ – if a patient wishes to search its registers, the options are in the singular: you are either a dental hygienist or a dental therapist. But the debate over job title continues to rage – a look at any of the social media dental forums bear testimony to this, with dental therapists (and other members of the dental team) debating it ad infinitum; strong views aired on either side of the fence with heartfelt passion and reasoned argument well matched.

    Credit: ©Tuadesk/iStockphoto/Thinkstock

    Simple act

    Here, we hear from British Association of Dental Therapists about what they think a dental therapist should be named, and consider how the very simple act of what you call yourself may, in fact, change not only the mind set of our patients but could shape the future of the delivery of dentistry.

    Q&A

    The full Scope of Practice for a dental therapist can be found here – https://www.gdc-uk.org/Newsandpublications/Publications/Publications/Scope%20of%20Practice%20September%202013.pdf.

    We asked dental therapists the following three questions and their answers follow…

    1. 1

      If you have dual qualification, what do you refer to yourself as and why?

    2. 2

      Do you think it matters to a patient what you are?

    3. 3

      Do you think the title, ‘dental therapist’ could supersede ‘dental hygiene/therapist’ if you have dual qualification or does this remain an acceptable title?

    President Fiona Sandom – ‘It is important to have clarity

    I initially trained as a dental nurse, then a dental hygienist and then a dental therapist. I call myself a dental therapist because that describes what I can do. I don't need to call myself a hygienist and a therapist because, as a therapist, my Scope of Practice includes the skills of a hygienist. A dentist would not call him- or herself a dental hygienist/therapist/technician/dentist, would they?

    I believe this term ‘hygienist/therapist’ stems from the dental schools and is incorrect; the GDC does not recognise this term. It is also confusing for patients to have this inconsistency. If you refer to the medical model, there are practice nurses and nurse practitioners and patients have come to recognise and accept the difference. Why has this not transferred to dentistry? It is important for there to be clarity, so that patients are aware about who they are seeing and are able to determine the dental hygienist's or dental therapist's Scope of Practice – especially in light of direct access. It is really important for patients to be able to make an informed choice about the DCP they are seeing. How can they find out from the GDC about a hygienist/therapist when, in reality, one doesn't exist?

    Secretary Mel Prebble – ‘The profession overestimates what patients might think

    From a marketing point of view, I use the term ‘hygienist’ in my title to attract patients but, although I tell patients I'm a hygienist, I occasionally try to explain what a therapist is, too. Professionally, I refer to myself as a therapist. I don't think patients care what we are so long as we are professional and communicate well and I think the profession overestimates what patients might think. It would make life simpler if the term ‘therapist’ was all encompassing of our skills and we didn't have to try to use both all of the time.

    That said I'm not a fan of the word ‘therapist’ as, for some patients, it implies something else. I once treated an elderly patient who thought she had been sent to a beauty therapist for a filling! I also think people think we fix scared people's heads so they can visit a dentist.

    Amanda Gallie – ‘Too confusing

    I call myself a dental therapist now as it's less of a mouthful and as it's my latest qualification. Perhaps we need a fresh, new title such as ‘oral health therapist’ – or something of the ilk. A hygienist/therapist just sounds too confusing. Patients continue not to be aware of dental therapists and that's what we need to change.

    Jacky Hart – ‘Promote the name

    I refer to myself as a dental therapist and, where patients are concerned, I usually briefly explain the remit of a dental therapist, including being able to do all aspects of hygiene work. I strongly feel the job title of dental therapist needs to be promoted at every opportunity – both to the general public and the dental profession.

    Katrina Matthews – ‘The title “therapist” suggests empathy

    I have a single qualification as a therapist and always explain to my patients and to the general public what I am trained to do and promote my profession.

    People like the title ‘therapist’ as it suggests the empathetic skills we have.

    Therapist/hygienist is not a registered professional name by the GDC and so I understand the confusion by the public. With dual qualification, I think therapist is the best title for the future.

    Victoria Wilson – ‘Enlighten the general public

    I call myself a dental hygiene therapist, as I still feel the public are not fully aware of the role of the therapist. I'm often asked the question: ‘What is a therapist?’ and I guess this is a call to action to raise awareness and fully educate patients of our role. I think it is extremely important for our future that the title of ‘dental therapist’ supersedes ‘dental hygiene therapist’. But we need to enlighten the general public first.

    Debbie McGovern – ‘Reminds our employers we have additional skills

    If therapists call themselves hygienists they will only be treated as so and only get hygienist-related patients. If we use the title ‘dental therapist’, it reminds our employers we have additional skills. I intend to drill this into all final-year students!

    Julie Ellis – ‘Actively discourage the use of this title

    My qualification is as a dental therapist and I think it does matter that the patients know us by our correct title. We need to do away with this notion of being ‘dually qualified’ All recent graduates are dental therapists whose training has covered the full remit. The only way you can get the title of hygienist now is if you fail final therapy exams and exit early, which I believe happens in a few universities. Or train specifically for that role, which I think is only available in one training school now. The title hygiene/therapist does not officially exist and I think we need to actively discourage the use of this title. We need to use the title of ‘therapist’ as much as possible and, if more people referred to themselves as therapists, even if they are employed carrying out hygiene duties only, they are more likely to be referred therapy work.

    Debbie Hemington – ‘We need to target the profession so they gain an understanding of what therapists can do

    I qualified as a therapist first in 1983 at New Cross, which as you will know was the only training school in the UK from 1960-83. We did not qualify as hygienists, as they were two completely separate qualifications at that time. Therapists were restricted to working in community or hospitals at that time and treating mainly children and we were not trained in periodontal disease or treatment to the same level as a hygienist. We could not work in practice as a hygienist unless we had done a separate hygiene qualification. It is here where the distinction and separation between ‘hygienist’ and ‘therapist’ originated.

    After having worked for several years in community, I trained as a hygienist (a full course, not a shortened course) in order to open up my employment opportunities. Dually qualified practitioners were rare in those days and we had to call ourselves ‘hygienist and therapist’ as they were different jobs in those days, and had separate GDC registers, too. I could not work in practice at that time if I used the title ‘therapist’, even if I was providing hygiene treatments, and I could not do any restorative treatment in community or hospital if I used the title ‘hygienist’. This changed when the restriction on therapists' employment was lifted. There are still many singly qualified therapists still working and, although many have brushed up on their perio knowledge by way of CPD courses etc, they do not have a formal hygiene qualification.

    This is the true origin of the double-barrelled title, along with the term ‘dually qualified’. The dental schools often had – and, indeed, still do have – schools of dental hygiene and dental therapy, as students sat both exams and both qualifications were awarded. The term ‘hygiene therapist’ doesn't exist as a title, and has been an attempt by the profession to show there is a difference in some therapist qualifications. So, what do I call myself? It all depends who I am talking to! Socially, I will say I am a dental hygienist and therapist, as Joe Public only really understands the term ‘hygienist’, although I will always explain what a therapist does. If I am in professional company, I will say I am a hygienist and therapist. Many fellow dental professionals still separate the two skills, and there are still singly qualified hygienists being trained, although they are in a minority.

    But there is a need to target the profession so they gain an understanding of what therapists can do, that their training includes perio and, just as important, they should be aware of the level to which we study. There is no difference in the curriculum if it is a BSc course or Diploma course, but dentists often think it is a very basic education. This is illustrated in some of the editorials that have appeared over recent years, especially when discussing direct access.

    Anne Marie Yarwood – ‘Dual name is misleading

    I qualified at New Cross in 1979 and then had a 21-year gap, only to return to dental therapy in 2005, working in a general dental practice for 10 years.

    Dental therapists were trained by the NHS and fully funded and were intended to work for the NHS in a community or hospital setting. Telling therapists they could not be employed as hygienists may have been a ploy to prevent trained therapists draining away for more lucrative work. I for one had a lot of dental hygiene work, with patients who had a wide variety of needs, referred to me in community. Having done the three months of additional training required to gain a hygienist title, some therapists believed they had not gained any more knowledge. When jobs were scarce in the 1980s, it made sense to attend a hygiene short course to obtain a ‘licence’, allowing therapists to widen their scope for employment. The dual name is misleading. If the therapist job role were more widely understood by the public (and other members of the dental team) there would be no need to expand the title into sections in an effort to explain what we do. Dental therapy is a professional qualification just as dentist is a dentist and not a dentist-therapist-hygienist. Orthodontists don't call themselves orthodontist-dentist-therapist-hygienist, do they? In fact I would take it one step further and make it a rule that those therapists who are employed in a hygienist job should actually still call themselves a dental therapist. The general public, I believe, may be better pleased to learn that a more qualified member of the dental profession is attending to their oral hygiene needs. In my workplace, I always insist the dentist refers patients to the therapists and does not call us hygienists. It is inaccurate and also only perpetuates the confusion when patients are unable to find their DCP on the GDC registered ‘hygienist’ list.

    Madalyne Tucker – ‘So long as my patients are happy

    This is an interesting question which causes lots of discussion especially between the dually and singular qualified. As a dually qualified I used to call myself ‘hygienist/therapist’ or ‘DHT’ for short as this is what we were referred to as at dental school. I have two separate qualifications so never had a problem using both in my title and I still don't! I have had many discussions with other therapists, some quite heated. The argument that we should call ourselves ‘therapists’ is a valid one, as we need to promote ourselves as part of the dental team; we are still an ‘unknown’ as far as the general public is concerned.

    I work with practice owner and dental hygienist, Christina Chatfield, who still refers to me as a hygienist/therapist on her website and when talking to her patients. I asked to be called a therapist and we had quite a debate. Her answer was purely from both a marketing and business perspective because patients do not know what a therapist is but they all know a hygienist and feel comfortable with that. I also understand this viewpoint.

    I personally do not like the term ‘therapist’ it's a very misleading title as is DCP.

    To be honest, I am not really too concerned what I'm called – ‘therapist’, ‘hygienist’, ‘DHT’ – so long as my patients are happy!

    Diane Lockhart – ‘Caution must be taken to ensure others do not feel less valued

    When working as a hygienist (as required by my contract), I call myself a hygienist. When utilising both roles, I call myself a hygienist therapist and this is more for ease. On occasions, when I have called myself a therapist, patients have been known to question why they were not seeing a hygienist. This usually takes up valuable appointment time to explain that I am qualified in both roles. I really do think it matters to most patients and always introduce myself. Technically, with the current training, ‘therapist’ does need to supersede ‘hygienist’ as our job title (or therapist only with no hygiene qualification) but this may be a very emotive issue to all those with one qualification. It is very important to raise awareness of dental therapists, but caution must be taken to ensure others do not feel less valued within the team.

    Can you handle it?

    Seemingly, views are varied but what do you think? The BADT would love to hear the thoughts of other members of the dental profession on the importance of a professional name. Email secretary.badt@gmail.com or post on the BADT's Facebook page or tweet @BADT1963.

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    What's in a name?. BDJ Team 2, 15149 (2015). https://doi.org/10.1038/bdjteam.2015.149

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