As we started 2025, a realisation dawned on me. This year marks twenty years of seeing patients (I still had to double check this because I am sure I didn’t hit 30, and if I did I cannot remember…). However, incredibly, it is true.
It’s hard to believe that two decades have passed since I treated my very first patient – a towering, broad-shouldered gentleman who, to my nineteen-year-old eyes, seemed terrifying. It was Valentine’s Day, a day traditionally associated with love, and I often muse: was it love at first sight?
In many ways, it was. That first appointment, sat on floor three in the Denmark Hill site of King’s College Hospital, marked the beginning of a profound and enduring passion for dental therapy.
Even more profound is that if you had asked me twenty years ago if I truly thought I would be doing the therapy work that I am now… I actually really would have! However, it has taken huge leaps within the profession, changes to legislation, a quiet, enduring personal fight and a period of eleven years working solely as a hygienist, to get me here.
Highs and lows
Over the past 20 years, the field of dental hygiene and therapy has experienced significant highs and lows. One of the most transformative changes has been the advent of direct access. In 2013, the General Dental Council (GDC) announced that patients could see dental hygienists and therapists without a prior examination by a dentist. This shift empowered us to utilise our full scope of practice, enhancing patient care and streamlining services.
Dental Directives, a company co-owned by Benji Blum, flew into action and provided a patient group directive (PGD) service to support dental therapists working without a prescription to be able to give local anaesthetic and fluoride. Without this, my clinical work – and that of hundreds of other dental therapists – would have been seriously limited regardless of the direct access mandate.
By working in a direct access model, I was able to take charge of my dental hygiene diary, plan appropriate treatments for my patients and provide a complete service for the early intervention of periodontal diseases. This was the start of the therapy-led model that I now work within and advocate for, and the start of my personal journey to put therapy into practice.
I embarked on a catalogue of additional training to support me, and ultimately many others, in picking up the fast handpiece again. Without being able to prove that therapist-led care works in private practice, I don’t believe the profession would have been so open to the transition into therapy-led care in the NHS.
The introduction of NHS personal numbers for dental therapists has been another milestone. This change has facilitated our integration into the NHS system, allowing for better recognition and utilisation of our skills within multidisciplinary teams. However, as PGDs were unavailable on the NHS, it was not without further concern and consideration.
The tireless work of a few notable members of our profession helped lead to legislative changes which have further expanded our capabilities. In June 2024, amendments to the Human Medicines Regulations 2012 came into effect, enabling dental hygienists and therapists to supply and administer specific prescription-only medicines without the need for a dentist’s prescription or a PGD. This development has improved our efficiency and autonomy in patient care, especially within the NHS.
Changing perceptions
However, there is, of course, much further change to be made – namely better integrative training for teams, updates to a now much outdated scope of practice, and pension and maternity rights for dental therapists working within the UDA system.
Our scope of practice has evolved: we now undertake a broader range of procedures, including prescribing and reporting on radiographs, which was once the sole domain of dentists. This expansion not only enhances our professional growth but also improves patient outcomes by providing more comprehensive care.
The perception of dental therapists within the wider dental team has shifted positively. Initially, there was quite some resistance and a lack of understanding of our role. However, collectively the dental therapy profession and its supporting associations have demonstrated our value and competence, and we have grown to become even more integral members of the dental team, contributing significantly to patient care and practice efficiency.
Throughout this journey, I have been committed to continuous learning and professional development. Establishing my own training brand, The Modern Therapist, has been a highlight, allowing me to share knowledge and advocate for the effective integration of dental therapists into practice.
The past two decades have been a testament to the resilience and adaptability of dental therapists. We have navigated legislative changes, expanded our scope of practice, and enhanced our standing within the dental community. As I look back on that Valentine’s Day 20 years ago, I am filled with gratitude for the journey and excitement for the future of our profession – it truly was love at first bite.
