The rise of the NHS dental therapist: life at the coalface

Dave Martin reflects on the decades-long journey of dental therapists in the NHS and the barriers they continue to face today.

It was 1963 when campaigning first started for the dental therapy profession. Progression has been made from that time, with the first positive step in 1964 when it was decided that a dentist did not need to be on the premises whilst a therapist was working.

Dental therapists at that time were restricted by remit (not scope as it is today) and could only work in a hospital or community dental setting. They were restricted clinically and not permitted to administer inferior dental nerve blocks or treat the pulp in the deciduous dentition.

The General Dental Council (GDC) rejected the addition of ID blocks to the remit as far back as 1979 – it took a whopping twenty years for this to change.

Fast forward to 2001, dental therapists were permitted to treat patients in a general dental practice setting, or rather those practices that were contracted as a personal dental service. One year later, dental therapists were allowed to work in any general dental practice – whether private or NHS.

Dental therapy in general practice

Dental therapists did not rush to work in general practice, with most staying put in a hospital or community dental setting, presumably fearful that they could not work to the demands of the NHS system, but also secure in the fact they had a fixed salary without the pressures of a fee per item system.

The migration of dental therapists into general practice took years, with the addition of a dental therapist into teams being plagued with misconceptions. A prominent misconception at that time was that dental therapists could only treat children and that they were not trained to provide periodontal care. In fact, many had undertaken additional training to allow them to treat periodontal diseases and they had always been allowed to treat both adults and children.

My NHS journey started at the very in beginning in 2001. I had been working for the NHS as a dental hygienist for four years with a contract that was fee per item. I was really fortunate to graduate as a therapist when we were first permitted to work in general practice, so I took the bull by the horns and started using my restorative and exodontia skills.

Sadly, very few restorations were referred as the dentists I worked alongside had no real clue how to utilise my new skills, and there was also a reluctancy to refer. Money was undoubtedly a factor, and I was told, ‘You will be taking away my bread and butter’.

This was coupled with the belief that a dental therapist could not provide treatment to the same standard because ‘you don’t have a degree’. Ignorance was rife around the profession, but it improved – albeit at a snail’s pace.

Pressure, progress and pushback

Fast forward 24 years, I’d take a guesstimate that I have restored over fifty thousand teeth. I have joined many dental teams in that time, some excellent, but many questionable. I am left with an overwhelming sense that financial gain is the motivation for most practice owners, and that mixing health care with a target driven system is questionable on many levels. I have, however, always placed my sole attention to the care I provide and not the money I make.

The workload is most definitely intense and very much dependent on the dentist referring. I could certainly write a chapter of a book on how not to refer to a dental therapist. Financial and contractual pressures recently seemed to have magnified, and it definitely feels more about delivering a contract. Dentists, however, are under increasing pressures to deliver, with therapists working tirelessly alongside them to help achieve the targets.

Now restrictions have been lifted even further, allowing therapists to open an NHS course of treatment and to supply and administer certain medicines, though it will take some time for all training providers to catch up with equipping new graduates to be able to work more independently. The many years of working to a dentist’s treatment plan have undoubtedly had a negative effect on some therapists’ confidence in their skillset.

Twelve years on from ‘direct access’ and I am still working on those skills.

Shaping the future

The future of NHS care could be positive, but it really requires a full appreciation of the skills each team member brings to the table. It would also be great to see dental therapists having the opportunity to upskill and provide services with an extended scope of practice. This could be similar to the scope of dental therapists in different countries where they are extracting permanent teeth, providing partial dentures and having a greater role in pain management.

Dental therapists now hold doctorates, they lead university dental programmes and are influential in research. They are highly skilled in restorative treatments, experts in treating periodontal diseases, and now have the freedom to work independently to their full scope.

The vision of therapists being integrated into most dental teams is fast becoming a reality… but the battle for equal rights continues.

The BADT (British Association of Dental Therapists) is run by working dental therapists to represent all dental therapists and hygienists. It continues to lead for the rights of dental therapists and represent them at all levels, including parliamentary to raise awareness of their skills and assets and to continue fighting to expand the scope of practice and develop their skills. Find out more at badt.org.uk.

Read more from the National Dental Hygienist and Dental Therapist Day campaign:

• Military to community dentistry: a journey of adventure and resilience
• Why patient awareness is more important than ever
• Unlocking the power of therapy-led care
• From prevention to policy: the power of dental hygienists and therapists.

With thanks to our sponsor, NSK.

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