Tag: Dental Team

Dental Therapist Sarah Murray MBE, Associate Member, Board member of the College’s Faculty of Dental Hygiene and Dental Therapy, and Senior Lecturer in Dental Public Health at Queen Mary University of London, discusses the role of dental practices in delivering preventative oral care advice.

As dental professionals, we are all aware of the challenges individuals are currently experiencing in accessing dental services. We are also very aware that tooth decay has a significant impact on children, their families and the wider society, with children experiencing pain, infections and difficulty in eating, the need to take time out of school to attend dental appointments, parents taking time off work to bring their children to the dental practices, and the high costs of general anaesthetic for extractions when preventive measures have not been adopted or failed. The latest guidance from Public Health England (2017) Health Matters: Child Dental Health, identified a staggering £7.8 million was spent on tooth extractions in 2015 to 2016 amongst children under the age of five, with the majority being a result of tooth decay.

As dental professionals we need to review whether we are utilising every opportunity to promote healthy oral health behaviours from early in a child’s life and through an individual’s life course, and it is the responsibility of all members of the dental team to provide this support. Utilising extended duties dental nurses who are appropriately trained and competent in oral health education and the application of fluoride varnish, dental hygienists, dental therapists and orthodontic therapists, in addition to dentists, is fundamental to this.  

We have all experienced that getting our patients to change their unhealthy behaviours is a challenge, so we should be promoting this at every appointment and see it as a long-term commitment from the dental team. The advice we provide needs to be tailored and individualised, and to regularly reinforce key messages in line with contemporary evidence.

Foundation Dentists’ experiences

A recent article by Rutter et al (2023) made me consider whether we need to review what messages we are providing to our patients and how we are delivering these. The authors explored the challenges that newly qualified dentists experienced in delivering oral health advice to parents and caregivers of young children in the Yorkshire and Humber region; one of the five themes was around motivation for behaviour change and this linked well to another theme around parental receptivity to the messages being provided.

The study identified two aspects to motivation: the parents’ motivation to change, and the practitioners’ motivation to engage in a behaviour change conversation. As many experienced  clinicians will have found, there are no surprises to the findings: the Foundation Dentists discovered that in general, parents did not return diet diaries and, if they were returned, there were questions about whether they were accurate. The lack of embracing positive oral health behaviours by patients created despondency in the practitioners; this is a sad outcome considering how Foundation Dentists are at the start of their career journeys and experiences such as these could hinder them in promoting behaviour change through the rest of their careers.  

Supporting patients to take the next step

We remind ourselves that changing behaviour is part of a cycle; every time we promote healthy habits we are enabling patients to think about making a change (precontemplation and contemplation), and one day, they inform you that they are planning on making that change and have set a date for the change (planning for change) – how wonderful is that! We should be there to support them when they are ready to make that change (action) and guide them if, and when, they relapse.

Reviewing our practices

So, what are dental practices or clinics actively doing to encourage positive oral health behaviours particularly in children? These could include:

• embracing Dental Check by One in our clinics, by using the British Society of Paediatric Dentistry posters as a promotion tool; this could encourage parents to book an appointment and begin considering healthy habits for their babies which may result in a change for their other children and themselves. BSPD has other useful resources on its website so is worth checking out further
• utilising extended duty dental nurses to provide health promotion in dental practices, and in outreach, such as schools and the community
• ensuring children have a toothbrush and are using the correct toothpaste for their needs, and reinforcing the ‘spit, don’t rinse’ message
• considering undertaking clinical audits of patient records to establish whether the advice being provided is highlighting any gaps; look to see if the messaging is clear and consistent and explore ways this can be improved 
• reviewing the literature to ensure our skill set is maximised and for us to be open to making change and sharing new information with the whole of the dental team

How we work with the population who are experiencing common oral diseases and difficulties with access, and how we move to a future population free from dental caries, and other preventable oral diseases, is certainly food for thought.

References used in the compilation of this blog:

British Society of Paediatric Dentistry (2017). Dental Check By One. (2017). Available at https://dentalcheckbyone.co.uk/

Public Health England (2017) Health Matters: Child Dental Health. London: Department of Health Publications. Available at https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health

Rutter L, Duara R, Vinall-Collier KA, Owen J, Haley I, Gray-Burrows KA, Hearnshaw S, Marshman Z and Day PF (2023). Experiences of newly qualified dentists in delivering oral health advice to parents/caregivers of young children —challenges and solutions. Front. Oral. Health 4. Available at https://eprints.whiterose.ac.uk/199925/1/froh-04-1079584.pdf

Join us for a webinar, in partnership with Haleon, to discover how we’re working together to enhance oral healthcare across the UK and to discuss the findings of our upcoming ‘Dental Health Barometer’ campaign. Join us on Thursday 30 November at 2pm (GMT) – more information and register.

Can you help us in the next phase of our research? We would like to hear from practices around the UK who are interested in hosting an evening focus group to explore preventative oral care advice given within practice – find out more.

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Clinical Dental Technicians Emily Pittard MCGDent and Carmel Vickers-Wall, an Associate Member of the College, examine the role of a CDT and how they can work efficiently and effectively within the dental team.

What are Clinical Dental Technicians?  

Firstly, what actually is a Clinical Dental Technician (CDT)? Well, they are a registered dental care professional who can provide complete dentures direct to the public. They can also provide partial dentures and other dental devices on prescription from a registered dentist.  

What can we do?  

A CDT  is able to oversee the patient’s whole denture journey. They can treatment plan (complete dentures), take the impressions, do a bite registration and then manufacture the denture from start to finish. This results in the patient receiving a high-quality denture, and changes can be made instantly rather than trying to communicate through prescriptions where information can be missed.   Many times, we’ve heard “A CDT is a Dental Technician who just takes impressions”, which isn’t true. A CDT has a large scope of practice and takes on a variety of responsibilities within the dental team:

• taking impressions
• taking a detailed medical history
• carrying out clinical examinations
• taking and processing radiographs
• recognising abnormal mucosa and referring to the appropriate healthcare professionals
• giving appropriate oral health advice

Many edentulous patients won’t see a general dentist as they believe they don’t need to if they don’t have any remaining teeth. This means that they might only see a CDT if their denture breaks, or they feel they need a replacement. Therefore, it is crucial that CDTs have a full understanding of a patient’s mucosa and are able to identify any abnormalities as well as understanding medications in detail and their interactions.  

Clinical Dental Technicians have an extensive knowledge of anatomy, pharmacology, cross infection and health promotion. A CDT can also further enhance their scope of practice by gaining relevant training so that they can re-cement crowns, provide anti-snoring devices, replace implant abutments and provide tooth whitening treatment on prescription.  

How can we be beneficial to your dental team?  

Dentistry is currently in a crisis with some patients unable to see a dentist for up to four years. CDTs can help to alleviate this strain by seeing all denture treatment; allowing dentists to focus on other treatment. Dentures are very time-consuming as they require adjustments and reviews to help the patient acclimatise; CDT’s can take over this entire journey.  

They can also take impressions, see whitening patients, mouthguards and sports guards appointments and, on prescription from a dentist, they can temporarily fit crowns, bridgework and implant work. So how would this work in practice? Let’s take a look at three examples of how a CDT could help to significantly improve a workflow:  

1. A patient who needs an upper denture but has teeth in their lower arch. Typically, this would take a dentist up to five appointments to get the patient to final fit, and then multiple review appointments. Instead, the dentist could see them for the initial examination and then hand over all the other appointments to a CDT.
   
2. A patient who needs a dental implant. A dentist could see the patient up to their uncover and then the CDT could take over, take the impression / scan and temporarily fit the implant crown. The patient would then see the dentist for a review a few weeks later. This requires great communication within the team and a CDT who has knowledge of implants, but it would mean that in the time frame a dentist would have seen one patient for one implant placement, they could have seen two.
   
3. A patient who wants a denture on locators. Again, the dentist can place the implants and uncover and then hand over to the CDT who can then complete the treatment for the patient.

These are just a few examples but there are many more. As with any dental professional, to incorporate them into the team workflow will take great communication between clinicians and excellent records, but as that is something that we all intend to maintain as part of our general standards anyway, it shouldn’t take much to adapt to incorporate a CDT.  

A CDT is also the only dental professional who bridges the gap between the dental practice and the laboratory. They have an intimate understanding of dental prosthesis and can help to manage patient expectations; take shades; quickly repair some things; provide teeth in a day and help to treatment plan complex cases.

Q&A

Emily Pittard is on the Board of the College’s Faculty of Clinical Dental Technology and Dental Technology.

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