Sir, the UK has invested heavily in the education and training of dental hygienists and dental therapists but has never established appropriate conditions to allow them to exercise their skills fully.
Oral healthcare professionals with qualifications in both dental hygiene and dental therapy are able to undertake approximately 70% of primary care dentistry. In the UK, almost all education in this field is offered as a three- or four-year Bachelor of Science (BSc) programme in Oral Health Sciences. The standard of education is robust, comprehensive and quality-assured by the General Dental Council (GDC). The learning outcomes contained within the GDC document Preparing for practice are almost identical for undergraduate dentists and dental hygienists and therapists, other than those skills which are outwith the scope of practice of the latter group. Much education in dental schools is shared between BDS and BSc undergraduates, and the expectation is that levels of knowledge will be largely the same in the common subject areas. It could be argued that given the narrower curriculum for BSc undergraduates, they may have a greater experience of primary care dentistry by the end of their training.
Direct access for patients to these professionals was granted by the GDC in 2013, meaning that a prescription from a dentist was no longer required to allow them to undertake the clinical treatment for which they had been trained. However, the full potential of these individuals has been shackled by regulations and indeed by some in the dental profession itself. One wonders why this group of highly skilled individuals has been forgotten or overlooked? Is it intentional, an oversight or perhaps driven by those who consider that they may endanger the monopoly of dentists in the provision of routine dental care?
The lack of recognition of the skills of dually qualified dental hygienists and therapists has led to their de-skilling and demoralisation. It is a waste of a workforce which could make a substantial contribution to addressing the unacceptable levels of disease in the population. If permitted NHS List (Provider) numbers and prescribing rights for simple procedures such as the administration of local analgesia and the application of fluoride therapies, they could work in partnership with GDPs and others to reduce these constantly escalating problems.
Whilst these observations may not solve the lack of dental care in the UK, they may serve as a reminder of the contribution that an extended, willing and able workforce is able to make. The question remains: are these professionals forgotten, ignored or a threat to those who do not wish to recognise teamworking, and the skills of non-dentists in the health and wellbeing of our population? The silence of governing bodies and governments is deafening.
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Ross OBE, M. A forgotten workforce?. Br Dent J 233, 440–441 (2022). https://doi.org/10.1038/s41415-022-5041-9