Decisions, decisions, decisions...
 

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Decisions, decisions, decisions...

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Decisions, decisions, decisions...

 

Decisions, decisions, decisions...

Sometimes it is really difficult working in a busy NHS practice as a Dental Therapist. There are time constraints, UDA pressures, low quality materials, products and instruments all to cope with. It is all too easy for the busy referring practitioner to delegate treatments that are not within our scope of practice, to lighten their load.

In 2006 a new document was published by the BSDHT that put the onus of clinical skill responsibility on the Dental Therapist. The way the document was worded made it appear that so long as the Therapist felt confident in completing a task, they were entitled to undertake it; however this is not the case.

An interesting opportunity presented itself when one of my referring dentists suggested I learnt to provide Cerec inlays to our patients. Cerec is a ceramic inlay designed by using CAD (computer-aided design) technology. The ceramic restorations are completed in the surgery in one visit. After tooth preparation an optical impression is taken, and then the 3D software takes a digital picture and converts into a 3-dimensional virtual model on a computer which is then manipulated by the operator, finished in a milling machine and then cemented in place by the clinician. So in effect there is no laboratory involvement, which makes it a direct restoration (something Dental Therapists are allowed to perform), as opposed to an indirect restoration.

Excited but nervous about learning such a wonderful skill I contacted my indemnity provider to confirm the legality and insurance implications of undertaking such procedures. My provider confirmed two very important issues:

  1. Although the company was more than happy for me to attend their one-day training course, it was not specifically designed for Dental Therapists.
  2. The Dental Therapist training courses at university do not teach students on the principles of cavity preparation for indirect restorations.

The published guidelines state that if the Dental Therapist has undergone enough professional training designed specifically for a Dental Therapist on a particular skill and had proved competency to some official, and then felt personally competent they would then be qualified to perform that skill.

Although it is surely the future that Dental Therapists will be taught and given additional clinical skills, at present there are no official courses available that give Dental Therapists additional clinical skills. If your referring dentist asks you to do anything you feel is not within your competency or remit always confirm any concerns with your indemnity provider, after all, that's what you pay your money for and as a professional clinician you have a duty to always act in your patient's best interest and a moral ethical responsibility to yourself and our profession.

 Posted on : Thu 6th - Aug - 2009

 

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