An important first step is to make sure you understand their scope of practice and respect their experience. Here we have provided a summary of the background information, which will help you in managing both clinical and non-clinical staff.
Dental Care Practitioners
Dental Care Practitioners (DCPs) have significant influence on the way the practice functions. You should strive to make the most of their knowledge and skills.
Clinical DCPs’ duties are regulated through ethical guidance and curricula, rather than through prescriptive lists of permitted duties. The generic term DCP is used to refer to all registered members of the dental team (apart from dentists) with each group operating under a protected title.
The scope of practice of each dental team member is outlined in the GDC’s publication of the same name.
You should know that:
- DCPs play a major role in the success of a practice
- DCPs must be properly trained and competent to fulfil their roles
- Dental hygienists, dental therapists and clinical dental technicians (CDTs) can undertake clinical procedures which are in their scope of practice on prescription of a dentist or direct to the public, depending on practice arrangements.
- DCPs can work without a dentist on the premises
- Dentists may be responsible for the acts, omissions and safety of their team members
- Registered Dental Care Professionals (DCPs) are also responsible for their own acts and omissions through their GDC registration.
Responsibility for the acts and omissions of DCPs is shared between the DCP and the referring or supervising dentist. Under extreme circumstances, as a registered dentist, you may have to answer a complaint before the GDC resulting from the actions of a DCP who is working under your direction. Dental hygienists, dental therapists and the other DCP groups are also responsible to the GDC for their professional conduct.
Have a look at the practice where you work:
- Are all the staff properly trained and capable of the work they are required to do?
- Do they understand the professional standards to which you all have to work?
If you have any concerns, talk to the practice owner or contact our team of expert advisers for advice at firstname.lastname@example.org.
In the past, many dental nurses learned the necessary practical skills and theoretical knowledge on the job, under instruction from a dentist or senior dental nurse. Others studied for a qualification by working in practice and attending an evening or day class at a local college or undertaking a distance learning training programme. Smaller numbers have undertaken a one or two-year course in a dental hospital or the Armed Forces.
The current standard qualifications for all dental nurses are now either the National Diploma in Dental Nursing, or the NVQ (SVQ in Scotland) Level 3 (Dental Nursing).
Training can be undertaken in the workplace (possibly using distance learning materials) and at training centres (accredited local colleges or private training providers). Dental training providers must be accredited by one of the bodies accepted by the GDC for that purpose.
Since the introduction of statutory registration of dental nurses in July 2008, dental nurses must be qualified to be registered. Non-qualified nurses must be enrolled on or on the waiting list of a recognised training course.
Qualified dental nurses may take further certificates in oral health education, sedation, general anaesthesia, radiography and special care dentistry.
Managing a dental nurse
Most associates will not have direct line management of the dental nurses who work for them. Dental nurses tend to be employees of the practice owner. Whilst it is essential for dentists to have a good relationship with their dental nurse, associates should raise employment problems with the practice owners rather than deal with them themselves.
Associates, nevertheless, will often be responsible for the day-to-day supervision of their dental nurse and must establish an effective working relationship by:
- Communicating clearly the tasks for which the dental nurse is responsible and the standards of performance expected
- Praising when tasks are performed well and pointing out in a constructive way when they have not been achieved
- Making sure that the job contains elements that will develop skills
- Motivating the dental nurse by making the work as interesting as possible, recognising their contribution and providing positive feedback on performance.
Even in the best-run practices, personnel problems can occur and not every dental nurse/dentist relationship is a happy one. If you are having a problem that you cannot resolve, talk to the practice owner.
Sometimes practice owners must take disciplinary action against members of staff for poor performance, poor timekeeping or misconduct.
If you are employed by the practice, so a member of staff yourself, you would not normally be involved in a disciplinary case except perhaps to prepare a statement that factually records an incident in which you were involved or which you witnessed. You should not be given responsibility for conducting a disciplinary interview or issuing warnings to a dental nurse.
Dental hygienists and therapists
Dental hygienists are usually qualified dental nurses who have taken a two-year full-time Diploma in Dental Hygiene or a three-year bachelor’s degree at a school of dental hygiene, university dental school, or the Armed Forces. Nowadays, most courses dually train hygienists and therapists.
In most practices, dentists will provide the hygienist with a written prescription of the treatment to be carried out, preferably on the patient’s record. Abbreviations can be used in the prescription so long as the hygienist is absolutely clear what is required. If the practice has introduced direct access arrangements (the hygienist or therapist working with patients without a dentist’s prescription), make sure you are familiar with the practice policy on this.
Provided that the hygienist has been appropriately trained and is competent, they may undertake local infiltration analgesia without the direct personal supervision of a dentist, and ID block anaesthesia. A hygienist can treat patients under conscious sedation, but it is preferable that a dentist remains in the room throughout the treatment.
Dental therapists are trained in all the skills a hygienist usually has, plus a number of additional skills, such as extracting primary teeth or carrying out restorations on primary and secondary teeth.
Orthodontic therapists are usually trained dental nurses who have received additional training to carry out certain parts of orthodontic treatment under prescription from a dentist. They are also permitted to carry Index of Orthodontic Treatment Need (IOTN) screening directly to patients.
Dental technicians train to receive a BTEC First and Higher Certificates in Dental Technology, SCOTVEC modules and City and Guilds Certificates in specialised areas. Most technicians are employed by commercial dental laboratories but some (an estimated 500) work in laboratories attached to dental practices. They are not allowed to work in the mouth.
Clinical dental technicians
Clinical dental technicians are technicians who have received further training to undertake some clinical procedures. They can take impressions, make and fit dentures. They can provide full dentures to edentulous patients, but all other clinical treatments must be made to the prescription of a dentist.
Receptionists and practice managers
Dental receptionists are responsible for looking after patients, appointment scheduling, collecting money, dealing with files and general practice administration.
Practice managers manage a range of organisational areas and are often responsible for recruiting DCPs and dentists, staff management and ensuring the practice complies with the legislation and rules that apply to GDPs. Some managers are also involved with practice financial management including budgets, paying associates and purchasing. These members of the dental team are not GDC-registered, unless they also perform clinical duties as dental nurses.