By Catherine Cutler, a Year 2 Dental Therapy & Hygiene student at King's College London
A great team is built upon respect and recognition of one another's roles. The success of the England football team reaching the Euro 2020 Championship final shows what can be achieved when individuals work to each other's strengths. The dental team is like any other and to work to each other's strengths, all members need to be well versed in each other's scope of practice. Those who lead the dental team are responsible for team structure and delegation, and so need to be especially aware of what each team player can do.
This summer I completed my first year of dental therapy training. My cohort was taught alongside the Bachelor of Dental Surgery (BDS) students, a great initiative that encouraged interprofessional communication and integration. However, as the year progressed, I became aware of a lack of familiarity within the dental department surrounding the role and identity of dental therapists. Given it had been the first year that the two student cohorts had been taught together, perhaps this was to be expected.
My experience of interprofessional education has been the catalyst behind this article, which explores my current understanding of the dental team's perceptions of dental therapists, and how clarifying the role of dental therapists early in education could help ensure their optimal use in practice.
What treatments can a dental therapist provide?
A dental therapist can perform the full scope of practice of a dental hygienist, and in addition, can carry out direct restorations on primary and secondary teeth, carry out pulpotomies on primary teeth, extract primary teeth and place pre-formed crowns on primary teeth.1
BDS students' perception of dental therapists
A UK based study of dental students' perceptions towards the role of dental hygiene and therapy students2 showed that final year dental students considered dental hygiene and therapy students to have a supportive role to dentists, whereas dental hygiene and therapy students considered themselves to have a collaborative rather than supportive role within the dental team.
Co-teaching of dental and dental therapy and hygiene students will hopefully lead to building an effective and cohesive dental team.
A survey published by Satter et al. in 20203considered the impact of intraprofessional education (IPE) between dental hygiene students and dental students in the USA. Attitudes towards teamwork, roles and responsibilities were compared between dentists who took part in IPE, and dentists who had not experienced formal training with hygienists (non-IPE). There was a statistically significant difference between the views of IPE and non-IPE dentists on whether hygienists can solve clinical problems. IPE dentists viewed hygienists as more capable. One IPE dental student reported that their experience with hygienists had helped them understand the knowledge base of hygienists, which was more extensive than they expected. However, another student reported that joint learning had no impact as 'neither dental nor hygiene students knew enough about anything to really value the (IPE) experience'.
The studies described above were both based on the experiences of dental students from single institutions, in 2010-112 and 2012-17,3 respectively. It would be interesting to understand if dental students' perceptions have changed in the last ten years towards the role of dental hygiene and therapy students, and how perceptions vary at other institutions.
Dental faculty perceptions of dental therapists
The University of Minnesota began training therapists in 2009, and a paper by Lopez et al. in 20124 assessed the attitudes and perceptions of the dental school faculty members during the first year of the dental therapy programme. The paper concluded that the majority of the faculty understood their responsibility and commitment to educate future therapists. However, only 58% of respondents claimed to have a good understanding of the role of therapists in practice, and 69% said they had sufficient knowledge to answer the survey. Of the 151 responses, 3% of faculty said they would employ dental therapists in their practice, whilst 35% said they would not employ therapists and 10% didn't know. Male and part-time faculty members and those in private practice and those over 40 years of age disagreed more about employing therapists in their practice.
The role of the dental therapist has been established longer in the UK than in the state of Minnesota and so perceptions in the USA may be different to teaching staff in the UK. However, it is vital that those tasked with training the future dental team understand their students' future professional roles. There are currently some barriers to utilising therapists fully in practice, including regulatory barriers on prescribing and opening a course of treatment in the NHS. Nevertheless, new training programmes should identify ways to support all staff and stakeholders in understanding their new roles and responsibilities - perhaps through education on the scope of practice4 of new students and their career pathways. Only then can it be ensured that therapists are supported to succeed in their careers, reducing some of the barriers to therapists contributing fully to the profession and society.
Public perceptions of dental therapists
A telephone survey by Dyer et al. in 20105 looked at public awareness and social acceptability of dental therapists. One thousand UK adults were surveyed, and 90% hadn't heard of therapists. Despite this, 61% would be willing to accept simple restorative treatment from a therapist, having received an explanation of their role and training.This suggests public acceptance of a broader dental team, especially when education is provided on the role of the wider team.
Co-teaching of dental and dental therapy and hygiene students will hopefully lead to building an effective and cohesive dental team. However, this will only occur if time is spent educating faculty and the future workforce on all scopes of practice, and experience is gained in working together as early as possible. Further research into dental students' awareness and perceptions of dental therapy would be useful to understand if more can be done to unify the future dental team whilst still in education and clarify the role of dental therapists.
Read more about Catherine in her first article for BDJ Team:
'An untraditional start to my degree' https://www.nature.com/articles/s41407-020-0463-1.
General Dental Council. Scope of practice. 2013. Available at: https://www.gdc-uk.org/docs/default-source/scope-of-practice/scope-of-practice.pdf (accessed July 2021).
Colonio Salazar F B, Andiappan M, Radford D R, Gallagher J E. Attitudes of the first cohort of student groups trained together at the University of Portsmouth Dental Academy towards dental interprofessional education. Eur J Dent Educ 2017; 21: 91-100.
Satter K E G, Jackson S C, DiMarco A C, Nagasawa P R. Intraprofessional education with dental hygienists: The post training impact on dentists. J Dent Educ 2020; 84: 991-998.
Lopez N, Blue C M, Self K D. Dental school faculty perceptions of and attitudes toward the new dental therapy model. J Dent Educ 2012; 76: 383-394.
Dyer T, Humphris G, Robinson P. Public awareness and social acceptability of dental therapists. Br Dent J 2010; 208: E2.
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Cutler, C. Perceptions of dental therapists within dental schools: a brief exploration. BDJ Team 8, 22–23 (2021). https://doi.org/10.1038/s41407-021-0706-9