RESUMEN
Introduction The scope of practice of qualified dental hygienists and therapists allows them to undertake non-surgical periodontal screening, treatment and preventive care, and to diagnose and treatment plan. Therapists are also qualified to restore primary and secondary teeth, and to extract primary teeth. Both professions may see patients directly without needing a dentist's referral. In Scotland, they operate in a context of relatively poor but improving child oral health.Aim To investigate provision of dental care to children, including challenges encountered, by dental hygienists and therapists in the Scottish General Dental Service (GDS).Method An online survey of Scotland-based, GDC-registered dental hygienists and therapists in the GDS.Results Of 426 potential respondents, 194 (46%) responded, including 113 hygienists. Thirty hygienists and six therapists did not currently see child patients. Lack of referrals from dentists/specialisation by other team members, financial/contract reasons and lack of demand were the reasons given. Of those who did see children, most were therapists. Responsibility for preventive paediatric care was evenly split, with 71 (46%) citing the hygienist or therapist and 69 (45%) the dentist. Sixty-five (43%) reported barriers, most commonly relating to parents and children themselves. Time pressures, cost implications for practice and parents, and a number of practice and regulatory barriers were also mentioned.Discussion The response rate is considered to be very good. Limiting factors regarding provision of paediatric dental care include lack of referrals from GDPs and financial or contractual issues.Conclusion There appears to be considerable underuse of hygienists and therapists in respect to paediatric dental care.
RESUMEN
Objectives To explore the level and nature of dental care provided by dental hygienists and therapists to older adults (65 and over) and to identify barriers to such care.Methods An online survey of all GDC-registered hygienists and therapists in Scotland.Results Thirty-two percent (196 of 609) responded. Seventy-five percent worked in general dental practice. Nearly two-thirds of the workload of those in general dental practice was with older patients. Most reported that numbers of such patients were increasing. Fifty-seven percent worked to inflexible appointment slots of 15 or 30 minutes. Time pressure, consent to treatment and power of attorney were the worst administrative problems in the workplace.Only one in four, mainly Public Dental Service (PDS) employees, provided domiciliary care or treated patients in care homes. Common problems in these settings were: poor hygiene, communicating with patients, capacity to consent, power of attorney, insufficient training and time, poor staff liaison, lack of support staff, space and equipment, poor denture storage/maintenance, co-morbidity and NHS charges exemption.Hygienist-therapists, who have a much wider clinical remit than hygienists, often felt their work with older people did not fully utilise their training. There was considerable demand for further training related to the care of older people, with dementia-related training being the most often specified. There was also support for greater professional autonomy through working on a direct access basis and having an NHS list number.Conclusion Respondents working in general practice saw a large proportion of older patients in the practice, while domiciliary and care home visits were largely undertaken by PDS workers. Findings support the conclusion that hygienist-therapists in particular, given their increasing numbers in the UK dental workforce, may be currently under-used in meeting the demand for prevention and treatment of older patients. The combination of demographic and clinical pressure may be met more effectively and economically by developing such 'mid-level' clinical roles in new models of dental care.