1.
HandbookThe perfectly informed companion for dental hygenists and therapists
2015-2016
2015-2016Handbook

2.
3
Introduction
Foreword
by BADT
President
Fiona
Sandom
Fiona Sandom says be
inspired to raise your voice to
the benefit of all
I suspect the answer lies in a multitude of topics
and new developments, not least of which is the drive
by NHS England to harness a skill mix to deliver
dentistry within an environment of preventive care.
The NHS contract places pressure on all NHS
practices to offer care within a primary dental
fter being invited to write a foreword for this
handbook generously sponsored by Dental
Protection, I considered what were the key
oral health developments in 2015 that will make this
handbook current and an essential read for dental
hygienists and therapists.
A
www.dentistry.co.uk
Introduction

3.
4
Introduction
Fiona Sandom qualified as a dental
hygienist from Manchester Dental
Hospital in 1993 and as a dental therapist
in 1999 from Liverpool University Dental
Hospital and in 2013 gained her MSc
in medical education from Cardiff
University. She currently works three
days clinically, one day teaching dental
nurses for the North Wales Community
Dental Service, and one day for Cardiff
University as a postgraduate tutor for
dental hygienists and dental therapists.
She is also a quality assurance inspector
for the GDC and an examiner for the RCS
Edinburgh and president of the British
Association of Dental Therapists.
healthcare setting that is accessible to all – whilst
maintaining financial viability. As we are all acutely
aware, the business of dentistry is not immune to
the current economic turmoil and it is, therefore, a
tricky balance to strike. The debate that the skills of
a dental therapist are, therefore, a cheaper route to
care for many – and so more financially viable for
government – is only part of the story.
Improving the current dental
health statistics
Despite the naysayers, I truly believe that allowing
dental therapists to use their whole scope of practice
in general dental practice can empower dental
phobics and other reluctant patients to engage
actively in preventive oral healthcare, and this will
ultimately lead to improving the current dental
health statistics.
As healthcare workers, surely we all need to be
singing from the same song sheet if we are to raise
public awareness of the importance of good habits,
whether we are GPs, nurses or fellow members of the
dental team. How care is delivered and who delivers
it is inevitably a region-specific conundrum – with
care in the valleys of Wales (my particular patient
base) differing greatly from my London colleagues,
for example.
Access remains a challenge in places, and I do
see a future that welcomes with open arms the skills
of dental hygienists and therapists – especially in
remote and rural areas of the UK.
The media focus on the nation’s health, what they
put in their mouths and how this
affects their overall well being
does not look set to disappear
– and I feel it is here where we
need to seize an opportunity
caused by ‘hooking’ our home
care hygiene instruction on the
much-publicised demise of the
western world’s health status.
When I took over the presidency of the BADT
last year, I vowed that my main aim was to raise the
profile of dental therapy. It’s been a tough enough call
amongst fellow dental professionals, but the rest of
council and I have cast our net further afield – to the
general public.
A two-pronged attack
My modus operandi is a two-pronged attack. I have
reached out to other dental associations, secured
two chief dental officers of England to speak at our
annual conference last month (September) and am
currently in ongoing conversations with the BDA
about how best to get the UK dentally fit. I have also
pledged to work towards changing the ‘unfair’ status
quo on prescribing rights for dental therapists and
hygienists.
Alongside this, our council is heavily committed
to media exposure – not the unpleasant experience
that dentistry usually gets, but of a more informative
variety. Via blogs on national health websites and in
local newspapers and online forums, we are trying
to raise the profile of dental therapy in the hope that
patients will wake up to their own health risks as well
an alternative route to care.
As a dental therapist in North Wales Community
Dental Services, I am acutely aware of what needs
to be done and how it can best be achieved. As a
postgraduate tutor at Cardiff University, I am equally
passionate about how the next generation must help
to raise the profile of this profession.
I see education as a key to driving forward the
role of hygienists and therapists – within dentistry,
amongst newly qualifieds and, especially, with our
patients.
With change comes opportunity, and this DH&T
Handbook offers perspectives and evidence on both.
So, read on and be inspired to raise your voice to the

4.
6
Introduction
ContentsIntroduction
3 Foreword - Fiona Sandom
8 Acknowledgements
10 How this handbook works - Julian English
New beginnings
14 Career checklist
16 First tasks
18 Registration and standards
19 Scope of practice
22 Reflective learning
24 CPD
26 Direct access
28 Foundation Traning
Career options
32 CV and interview techniques
34 Extended duties
36 Career pathways
40 Salaried services
42 Remuneration and charging
Organisations and associations
44 BSDHT update
46 BADT update
50 Key associations
Clinical protocols
56 BPE scoring
58 Periodontal disease
61 Tooth notation
62 Periodontal disease and systemic health
64 Implant maintenance
66 Developing dentition
68 Xerostomia - Charlotte Wake
70 Xerostomia - Bal Chana
72 Tooth whitening
75 BADT minimally invasive dentistry
76 Treating endodontically-exposed implant threads
78 Minimally invasive dentistry
80 Dentine hypersensitivity

5.
7
Introduction
General practice
83 Referral letter template
84 Caries risk from sports drinks
86 Prescription-only medicines
87 Caring for the orthodontic patient
88 Avoiding needlestick injuries
90 Bruxism
91 Recall interval guidelines
92 Radiography and radiation protection
96 Medical emergencies: resuscitation
100 Oral cancer - early detection
102 Working with the elderly
104 Photography
106 Eating less sugar
108 Educating patients on sugar consumption
110 Increasing access
112 Social inequalities
Indemnity and governance
116 Indemnity partnerships
118 Handling complaints
122 Social media usage
124 Good communication practices
Glossary
126 Abbreviations
www.dentistry.co.uk

6.
6
Introduction
Acknowledgements
November 2015
FMC, Hertford House, Farm Close, Shenley, Hertfordshire WD7 9AB
Tel: 01923 851777 Fax: 01923 851778
Website: www.dentistry.co.uk/oral-health-dental-hygiene-news/
Editorial: Julian English, julian.english@fmc.co.uk
Editorial: Charlotte Lloyd, charlotte.lloyd@fmc.co.uk
Editorial: Sophie Bracken, sophie.bracken@fmc.co.uk
Designer: Brendan Morrell, brendan.morrell@fmc.co.uk
Designer: Corin Skeggs, corin.skeggs@fmc.co.uk
Head of production: Laurent Cabache, laurent.cabache@fmc.co.uk
Production manager: K-Marcelyne McCalla, k-marcelyne.mccalla@fmc.co.uk
Advertising manager: Tim Molony, tim.molony@fmc.co.uk
Authors and advisers
Scott Froum, New York dentist
Graham Hart, radiography and IRMER regulations expert
Debbie McGovern, chair of the BADT
Baldeesh Chana, past president of BADT
Heather Richardson, Browns Locumlink
Pat Popat, dental hygienist and winner of DH&T’s Best Treatment of Nervous Patients 2014
Christina Chatfield, Brighton hygienist and owner of Dental Health Spa and winner of DH&T’s Dental
Hygienist of the Year 2012
Charlotte Wake, dental hygienist and therapist
Leon Bassi, dental hygienist at Bridge Dental, London
Leanne Barwick, winner of DH&T’s Best Young Hygienist 2014
Julie Rosse, president of BSDHT
Melanie Joyce, dental therapist
Gareth Grimes, sales development manager, Astek Innovations
Amanda Gallie, dental therapist, president-elect of the BADT
Robiha Nazir, dental hygienist
Damien Walmsley, specialist in prosthodontics
Leigh Hunter, dental therapist and hygienist
Fiona Sandom, dental therapist, president of the BADT
Juliette Reeves, an expanded-duties hygienist and nutritionist
Diane Rochford, dental hygienist and clinical coach for Jameson Management
Mhari Coxon, registered dental hygienist and dental and senior professional marketing and relations
manager for Philips Oral Healthcare, UK & Ireland
Sheila Scott, consultant for dental business and dental practice management
Henry Clover, former general dental practitioner and deputy chief dental officer for Denplan
Kirstie Thwaites, dental hygienist and therapist
Joe Ingham, Dental Protection
Katrina Matthews, primary care dental therapist and manager

7.
7
Introduction
dentalhygienetherapy.co.uk
Email subscriptions@fmc.co.uk to request a copy: £20 each.
Printed by: Headley Bros, Kent
ISSN: 2044-1436
The DH&T Handbook is an annual publication available to a controlled circulation of subscribers to
Dental Hygiene & Therapy magazine.
The publisher’s written consent must be obtained before any part of this publication may be
reproduced in any form, including photocopies and information retrieval systems.
The DH&T Handbook makes every effort to report clinical information and manufacturer’s product
news accurately but cannot assume responsibility for the validity of product claims or for typographical
errors. The publishers also do not assume responsibility for product names, claims or statements made
by advertisers. Opinions expressed by authors are their own and may not reflect those of the DH&T
Handbook.
Without the support of our sponsor, we could not have produced this publication. The DH&T
Handbook would like to thank the team at Dental Protection and, in particular, communications
manager David Croser, for an ongoing commitment to excellence in dental hygiene
and therapy.
We would also like to thank:
Dental Hygiene & Therapy magazine
British Society of Periodontology
British Society for Dental Hygiene & Therapy
British Association of Dental Therapy
Ivoclar Vivadent
Tepe
Information contained in this handbook is believed to be correct at the time of going to press. The
publishers also do not assume responsibility for product names, claims or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect those of the DH&T Handbook or
Dental Protection.

8.
10
Introduction
A guiding
handJulian English welcomes you to the DH&T Handbook 2015
– an essential reference guide designed to help you with all
aspects of dental therapy and dental hygiene
reading, covering all aspects of dental hygiene and
therapy. A quick scan of the handbook’s contents
and sections should confirm its intentions. It is our
aim and genuine belief that a dental therapist and
hygienist can read this publication and find useful
information within, and have genuine cause to
retain it as an essential reference guide.
The handbook contains the most up-to-date
guidance, rules, regulations and best practice for
dental therapists and dental hygienists.
Enthusiasm, hard work and dedication have
been poured into the production of the DH&T
Handbook from the editorial team at FMC and all
the contributors and sponsor Dental Protection.
Nothing less than 100% dedication is required to
produce a publication like this. I hope you enjoy it
and find it of benefit and use.
H&T magazine welcomes you to its guide
to professional life.
The intention of this guide is
to produce a concise and entirely relevant
handbook of practical information and advice
to assist undergraduates, new graduates, and
even the experienced dental therapist and
dental hygienist practising in this professional
landscape.
This handbook has been compiled by the
editorial team of DH&T magazine, with input
from some of the opinion leaders in the profession.
This includes the significant input from the
dentolegal experts at Dental Protection, one of
the leading UK defence organisations supporting
therapists and hygienists throughout their career.
There are more than 100 pages of essential
D

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13
Newbeginnings
New
Beginnings

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14
Newbeginnings
Set sailBal Chana’s
top tips on
cruising into the
uncharted waters
of dentistry
ndergraduate training provides the basic skills required to gain qualification. Through experience
and continuing professional development one develops and enhances one’s skills. Dentistry is
a career that involves lifelong learning. The first stage of the journey is to identify needs, define
goals and have a basic route towards a successful career in dentistry that will lead to great opportunities.
U

11.
15
Newbeginnings
Career checklist
1
Work within a team environment and communicate. Look through your
patient list and plan how you wish to work through the day. Do not
struggle – ask for help if required. Have aide memoires (crib sheets) to help
with treatment protocols, eg, history taking, treatment planning, etc.
Use the skills of your dental nurse; an experienced dental nurse will literally hold
your hand and guide you through the day.
2
Have a professional development plan (PDP). A PDP is defined as ‘a
structured and supported process undertaken by an individual to reflect
upon their own learning, performance and/or achievement and to plan for their
personal, educational and career development’.
• What would you like to achieve in the next five years, where do you see yourself
in five years? A PDP will give you greater confidence in the skills, qualities and
attributes that are required.
3
Work within your scope of practice and competency. If you feel treatment is
beyond your competency, liaise with the prescribing dentist and either
refer back, ideally if within your scope of practice, then get the dentist to
guide you through the treatment. This will help you gain confidence and
enhance your skills.
4
Join your professional associations. The benefits are:
• An association supports members in all matters relative to their chosen
profession, ranging from education, clinical techniques, employment and
personal development
• Members receive a professional journal and newsletters throughout the year
• Reduced fees at national conferences and regional study days
• Dedicated phone line and email address for advice and help from an
experienced team
• Forums for advice and discussion on the website
• Networking opportunities with fellow professional
• Tax relief on membership fees.
5
Continual professional development (CPD) – Patient safety is paramount. As
a registrant of the GDC, one has to meet certain standards. The GDC
expects professionals to:
• Uphold and follow the required standards and any additional guidance
(the standards guidance is a code of behaviour that registrants are required to
abide by in order to safeguard the patient)
• Maintain CPD – it is vital to keep your skills and knowledge up-to-date. 150 hours
of CPD must be completed over a five-year cycle, with a minimum of 50 hours
must be verifiable. You are also recommended to complete three core subjects
which are: medical emergencies, infection control and decontamination and
radiography and radiation protection
• You are also expected to keep up to date in areas such as legal and ethical issues
and handling complaints. Only CPD carried out within your cycle can be counted.
www.dentistry.co.uk
Bal Chana is a DCP inspector with the General Dental Council. She is immediate past
president of the BADT. Bal was recipient of The Dental Therapist of the Year award in
2006.

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16
Newbeginnings
Plain
sailing:
first
tasks
You’re qualified and now raring to meet your first patients.
There are some essential steps you need to take
o, you’re now qualified and ready to jump
headfirst into the exciting world of dentistry,
but there are a few crucial steps you need to
take first.
They might seem like boring admin issues that
you can push to one side, but it’s worth doing them
straight away because, of course, it’s all just plain
sailing after that…
General Dental Council
The General Dental Council (GDC) regulates
dental professionals in the UK. By law, you must
register with the council in order to legally practise
in this country.
The GDC protects patients and the profession
S
alike, dealing with standards of care, complaints,
fitness to practise hearings and quality assurance
through continuing professional development.
Indemnity/defence
organisations
Dental Protection looks after the interests of dental
hygienists and therapists in the UK. Its services
You’re now qualified and
ready to jump headfirst
into the exciting world of
dentistry...

13.
17
Newbeginnings
Essential steps
1
Register with the General Dental
Council
2
Sickness insurance is optional, but
recommended
3
Joining the BSDHT or the BADT is
recommended
4
Joining the British Dental Health
Foundation is recommended
5
Plan your career right now and take
action.
www.dentistry.co.uk
include:
• Access to defence and indemnity against claims
for clinical negligence
• Safeguarding professional reputation
• Assisting in complaints and replying to them
• Representing the clinician in court and at
committees of investigation
• Advising in matters affecting the DCP’s
professional career
• Representing the dental team’s interests in
matters affecting the profession in general.
Sickness insurance
Sickness insurance providers to the UK’s dental
profession include Dentists & General. Dentists
& General is a friendly society and, as such, is a
non-profit making organisation that enables a
lump sum to be paid on retirement. The fund for
this sum grows yearly by appointment of company
profit and interest.
The BSDHT
The British Society of Dental Hygiene and Therapy
welcomes members who are dental hygienists,
dental hygienist-therapists and students. The
BSDHT is a major organisation within dentistry
that exists to represent your interests.
The BADT
The British Association of Dental Therapists
promotes the advancement of dental therapy
within the dental profession. Membership is
available to all qualified dental therapists (newly
qualified therapists receive a 50% discount for their
first year of membership).
The BDHF
The British Dental Health Foundation is a charity
aimed at promoting oral health to the public. It
provides a range of resources including leaflets,
posters, stickers, books, DVDs and dental
motivators to help educate and motivate patients.

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18
Newbeginnings
Registration
and standardsJulian English presents the nine standards expected of a
dental professional
Registration with the GDC depends upon certain
criteria – namely those with a recognised UK
qualification. If you do not have a recognised UK
qualification, please check the following points to see
if you can have your qualification and/or experience
assessed. If the assessment is successful, your name
will be entered onto the DCP’s register. Assessment
is available for those with a formal qualification from
an EEA Member State or overseas.
Those that are unsure should fill out the ‘route
to registration’ questionnaire. You can find out
if you are able to apply for registration, if your
qualifications may need to be assessed, or if you
need to pass the overseas registration exam before
you can register.
Standards
The GDC, which holds the register of hygienists,
also provides guidance to its registrants on a
number of topics, including advertising, indemnity,
prescribing medicines, using social media, child
protection and GDC standards. The document sets
out the standards of conduct, performance and
ethics that govern you as a dental professional. It
With more than 20 years’ experience
at the helm of multi-award-winning
Dentistry magazine and numerous other
dental journals, editorial director of
FMC, Julian, is a well-known face in the
dental publishing industry. He is also a
member of the editorial committee of
the British Dental Industry Association.
Julian attends many events at home and
overseas throughout the year.
specifies the principles, standards and guidance
that apply to dental hygienists and therapists.
There are nine standards, which set out what is
expected and what patients expect. The principles
must be kept at all times. They are:
1. Put patients’ interests first
2. Communicate effectively with patients
3. Obtain valid consent
4. Maintain and protect patients’ information
5. Have a clear and effective complaints procedure
6. Work with colleagues in a way that is in patients’
best interests
7. Maintain, develop and work within your
professional knowledge and skills
8. Raise concerns if patients are at risk
9. Make sure your personal behaviour maintains
patients’ confidence in you and the profession.
You have an individual responsibility to behave
professionally and follow these principles at all times.
Reference
www.gdc-uk.org/Dentalprofessionals/
Applyforregistration/Pages/default.aspx
retrieved 13/10/15

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19
Newbeginnings
Scope of
Practice
he scope of your practice is a way of
describing what you are trained and
competent to do. It describes the areas
in which you have the knowledge, skills and
experience to practise safely and effectively in the
best interests of patients.
Orthodontic therapists
Orthodontic therapists are registered dental
professionals who carry out certain aspects
of orthodontic treatment under prescription
from a dentist. As an orthodontic therapist, you
can undertake the following if you are trained,
competent and indemnified:
• Clean and prepare tooth surfaces ready for
orthodontic treatment
• Identify, select, use and maintain appropriate
instruments
• Insert passive removable orthodontic appliances
• Insert removable appliances activated or adjusted
by a dentist
• Remove fixed appliances, orthodontic adhesives
and cement
• Identify, select, prepare and place auxiliaries
• Take impressions
• Pour, cast and trim study models
• Make a patient’s orthodontic appliance safe in the
www.dentistry.co.uk
T
absence of a dentist
• Fit orthodontic headgear
• Fit orthodontic facebows that have been adjusted
by a dentist
• Take occlusal records including orthognathic
facebow readings
• Take intraoral and extraoral photographs
• Place brackets and bands
• Prepare, insert, adjust and remove archwires
previously prescribed or, where necessary,
activated by a dentist
• Give advice on appliance care and oral health
instruction
• Fit tooth separators and bonded retainers
• Carry out Index of Orthodontic Treatment
Need (IOTN) screening either under the direction
of a dentist or direct to patients
• Make appropriate referrals to other healthcare
professionals
• Keep full, accurate and contemporaneous patient
records
• Give appropriate patient advice.
Additional skills that orthodontic therapists could
develop include:
With more than 20 years’ experience at
the helm of multi-award-winning
Dentistry magazine and numerous other
dental journals, editorial director of FMC,
Julian, is a well-known face in the dental
publishing industry. He is also a member
of the editorial committee of the British
Dental Industry Association. Julian
attends many events at home and
overseas throughout the year.
Julian English discusses
the scope of practice for
orthodontic therapists,
dental hygienitsts and
dental therapists

16.
20
Newbeginnings
• Applying fluoride varnish to the prescription of
a dentist
• Repairing the acrylic component part of
orthodontic appliances
• Measuring and recording plaque indices
• Removing sutures after the wound has been
checked by a dentist.
Orthodontic therapists do not:
• Modify prescribed archwires
• Give local analgesia
• Remove sub-gingival deposits
• Re-cement crowns
• Place temporary dressings
• Diagnose disease
• Treatment plan as these tasks are reserved to
dental hygienists, dental therapists or dentists.
Orthodontic therapists do not carry out lab work
other than that listed above as that is reserved to
dental technicians and clinical dental technicians.
Dental hygienists
Dental hygienists are registered dental
professionals who help patients maintain their
oral health by preventing and treating periodontal
disease and promoting good oral health practices.
They carry out treatment direct to patients (direct
access) or under prescription from a dentist. As a
hygienist, you can undertake the following if you
are trained, competent and indemnified:
• Provide dental hygiene care to a range of patients
• Obtain a detailed dental history from patients
and evaluate their medical history
• Carry out a clinical examination within their
competence
• Complete periodontal examination and
charting and use indices to screen and monitor
periodontal disease
• Diagnose and treatment plan within their
competence
• Prescribe radiographs
• Take, process and interpret various film views
used in general dental practice
• Plan the delivery of care for patients
• Give appropriate patient advice
• Provide preventive oral care to patients and
liaise with dentists over the treatment of caries,
periodontal disease and tooth wear
• Undertake supragingival and subgingival scaling
and root surface debridement using manual and
powered instruments
• Use appropriate antimicrobial therapy to manage
plaque-related diseases
• Adjust restored surfaces in relation to periodontal
treatment
• Apply topical treatments and fissure sealants
• Give patients advice on how to stop smoking
• Take intraoral and extraoral photographs
• Give infiltration and inferior dental block analgesia
• Place temporary dressings and re-cement crowns
with temporary cement
• Place rubber dam and take impressions
• Care of implants and treatment of peri-implant

17.
21
Newbeginnings
www.dentistry.co.uk
tissues
• Identify anatomical features, recognise
abnormalities and interpret common pathology
• Carry out oral cancer screening
• If necessary, refer patients to other healthcare
professionals
• Keep full, accurate and contemporaneous patient
records
• If working on prescription, vary the detail but
not the direction of the prescription according to
patient needs.
Additional skills that dental hygienists might
develop include:
• Tooth whitening to the prescription of a dentist
• Administering inhalation sedation
• Removing sutures after the wound has been
checked by a dentist.
Dental hygienists do not:
• Restore or extract teeth
• Carry out pulp treatments
• Adjust unrestored surfaces.
Other skills are reserved to orthodontic
therapists, dental technicians, clinical dental
technicians or dentists.
Dental therapists
Dental therapists are registered dental
professionals who carry out certain items of
dental treatment direct to patients or under
prescription from a dentist. As a dental therapist,
you can undertake the following if you are trained,
competent and indemnified:
• Obtain a detailed dental history from patients
and evaluate their medical history
• Carry out a clinical examination within their
competence
• Complete periodontal examination and
charting and use indices to screen and monitor
periodontal disease
• Diagnose and treatment plan within their
competence
• Prescribe radiographs
• Take, process and interpret various film views
used in general denal practice
• Plan the delivery of care for patients
• Give appropriate patient advice
• Provide preventive oral care to patients and
liaise with dentists over the treatment of caries,
periodontal disease and tooth wear
• Undertake supragingival and subgingival scaling
and root surface debridement using manual and
powered instruments
• Use appropriate antimicrobial therapy to manage
plaque-related diseases
• Adjust restored surfaces in relation to periodontal
treatment
• Apply topical treatments and fissure sealants
• Give patients advice on how to stop smoking
• Take intraoral and extraoral photographs
• Give infiltration and inferior dental block
analgesia
• Place temporary dressings and re-cement crowns
with temporary cement
• Place rubber dam and take impressions
• Care of implants and treatment of
peri-implant tissues
• Carry out direct restorations on primary and
secondary teeth
• Carry out pulpotomies on, and extract, primary
teeth
• Place pre-formed crowns on primary teeth
• Identify anatomical features, recognise
abnormalities and interpret common pathology
• Carry out oral cancer screening
• If necessary, refer patients to other healthcare
professionals
• Keep full, accurate and contemporaneous patient
records
• If working on prescription, vary the detail but
not the direction of the prescription according
to patient needs. Additional skills that dental
therapists could develop include:
• Carrying out tooth whitening to the prescription
of a dentist
• Administering inhalation sedation
• Removing sutures after the wound has been
checked by a dentist
All other skills are reserved to orthodontic
therapists, dental technicians, clinical dental
technicians or dentists.

18.
22
Newbeginnings
Back to
basicsThroughout your professional career, it is important to
have a structured approach to your learning. Here, BADT
president Fiona Sandom reflects on how best to shape
your future safely and successfully
uring your time as a student, your
education is supported by lecturers within
a carefully monitored environment. They
provide feedback and guidance in order that you
develop clinically. On qualification, there is then
an expectation upon you to continue this process
using different platforms, and a requirement to
formulate and demonstrate by the GDC. Keeping
abreast of new skills and knowledge is at the heart
of dentistry and a commitment to the regulatory
continuing professional development (CPD) is
only a part of this.
Keep a log
A reflective log is a way of thinking in a critical
D
and analytical way about your work in progress.
Self-evaluation is a key part of learning and
keeping written reflective logs each time you take
a new step is an essential part of your personal
development activity. There is no standard format
for a reflective log – but there are many templates
available. Genuinely identifying areas for
development means a clinician needs:
• Focus – to pinpoint key areas for improvement
• Courage – to recognise when something is
wrong, however uncomfortable this may be
• Honesty – to address the problem and, if
needs be, share this with a mentor or trusted
colleague and find a solution together.
Reflective learning is an ongoing process, but

19.
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Newbeginnings
www.dentistry.co.uk
there are key moments when this may prove
fruitful.
• In times of innovation. Before offering new
treatments, ask yourself why you should do so,
what this will achieve for you and your patient
and whether it is realistically achievable. So, if
you are considering offering tooth whitening,
for example, fully consider the skills you
need to do so safely, which courses you will
attend (and when and why) and how you will
implement them in practice
• When with colleagues. Making time to
reflect with others on what you have learned,
what you will do the same or differently as a
result and whether your learning needs have
changed, is essential. As well as developing your
performance, it also fosters a confident, safe
and competent dental team
• When considering your next step. There is
a propensity by many of us to learn what we
already know and sit tight in our comfort zone.
A reflective log is useful in identifying strengths
and weaknesses and highlights the clinical skills
with which we are less familiar or use less often.
Seeking courses in these latent skills will only
serve to develop you as a clinician
• During research. The internet has opened
up our access to knowledge – not always for
the good. Auditing what you have read is an
important part of the learning process and a
reflective log aids in our assimilation of clinical
information. Just like information accessed
in books and journals, be sure to dispense
with anything found online that does not have
its roots in current scientific thinking as is
therefore not evidence based.
Increasingly, regulators are expecting the dental
team to use a personal development plan (PDP).
A PDP can identify goals for the forthcoming year
and methods for achieving these goals and can
work in tandem with a reflective log. Although
not currently a requirement of the GDC (unless
the registrant has had conditions placed upon
them following a GDC inquiry), it is nevertheless
a recommendation.
The GDC maintains: ‘You are highly
recommended to use a personal development plan
(PDP), to help you make good CPD decisions,
and review it regularly, ideally with an appropriate
colleague.
‘Holding and maintaining a PDP will also
enable you to identify your learning needs and
consider them in a structured way.’
Confidence
It’s the aim of the dental team to provide high
quality oral healthcare to patients who are
confident in their standards and are acting in their
best interests at all times.
A programme of CPD – together with
comprehensive reflective practice and a well-
considered (but flexible) PDP – supports this.
Aims
1. To identify strengths and weaknesses
2. To improve and/or learn new skills
3. To consolidate these skills
4. To encourage a self-awareness
5. To improve performance and knowledge
6. To reflect on pathways
7. To offer respite from – and an outlet for –
the stresses of a demanding workplace
8. To share with others in order to build a
culture of openness and improvement.
Fiona Sandom qualified as a dental
hygienist from Manchester Dental Hospital
in 1993 and as a dental therapist in 1999
from Liverpool University Dental Hospital
and in 2013 gained her MSc in medical
education from Cardiff University. She
currently works three days clinically,
one day teaching dental nurses for the
North Wales Community Dental Service,
and one day for Cardiff University as a
postgraduate tutor for dental hygienists
and dental therapists. She is also a quality
assurance inspector for the GDC and
an examiner for the RCS Edinburgh and
president of the British Association of
Dental Therapists.

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Newbeginnings
Love to learn
As a registered dental care professional, you have a
duty to keep your skills and knowledge up to date in
order to give patients the best possible treatment and
care. CPD is compulsory, but it should simply set out a
formal framework for what you are already doing.
What is CPD?
CPD is an activity that contributes to your
professional development. There are two kinds of
CPD – general and verifiable.
What is verifiable CPD?
To count as verifiable CPD, an activity must have:
• Concise educational aims and objectives
• Clear anticipated outcomes
• Quality controls
• Documentary proof.
A look at the many ways you can gain that all-essential CPD
In other words, you should know what the
activity is about and what you will learn, how it’s
going to benefit your patients, whether you can
provide feedback on the activity and that you will be
given documentary proof (such as a certificate) that
you carried out the activity. The certificate should
come from the provider or organiser, and should
show the number of hours you spent on the activity,
your name and registration number, as well as the
subject of the activity.
How much CPD should I do?
You must complete at least 150 hours of CPD over
your five-year cycle. A minimum of 50 of these hours
must be verifiable CPD. You must keep your CPD
records for at least five years after the end of the cycle

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Newbeginnings
www.dentistry.co.uk
in which they were completed.
Which subjects should
CPD cover?
CPD is any activity that could reasonably be said to
have benefitted you professionally, so you should use
your own judgement when choosing subjects and
activities. We recommend that you create a personal
development plan, which will help you to meet your
CPD requirement over your cycle.
As well as your chosen areas there are three core
subjects that we strongly recommend you complete as
part of your verifiable CPD. The suggested minimum
number of hours for dental care professionals in each
subject are:
• Medical emergencies - 10 hours per CPD cycle
• Disinfection and decontamination - five hours per
CPD cycle
• Radiography and radiation protection - five hours
per CPD cycle.
We also recommend that you keep up to date by doing
CPD in the following areas (verifiable or general, no
suggested minimum number of hours):
• Legal and ethical issues
• Complaints handling
• Oral cancer: improving early detection
• Vulnerable children and adults.
When do I start my CPD?
Your CPD cycle is determined by your date of first
registration. Your CPD cycle is always five years long,
and this is the period in which you must complete
your compulsory number of hours. You can break
down your CPD each year in a way that works for
you, but you should spread it out across your cycle as
evenly as possible. Only CPD carried out within your
cycle can be counted. Any activities you do before
your cycle starts, or after it has ended, cannot be
included. As a dental care professional, your first CPD
cycle will start on 1 August after you register.
Activities that count as CPD:
• Courses and lectures
• Distance learning
• Private study
• Journal reading
• Multimedia learning
• Training or study days
• Educational elements of professional
and specialist society meetings
• Peer review and clinical audit
• Background research.
Information provided in this article comes
directly from General Dental Council
literature, by kind permission. If you have
any questions about CPD, call 020 7167
6000, email information@gdc-uk.org or
visit www.gdc-uk.org.

22.
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Newbeginnings
Direct
Access
Charlotte Wake looks
at the barriers and
advantages of
Direct Access
ay 2013 saw a big shift to a new era
in the world of dentistry with the
introduction of Direct Access (DA).
Direct Access is a term that reflects the exact
meaning – it is the time when dental therapists
and dental hygienists are able to work without a
prescription and see a patient ‘directly’ without
having seen the dentist first.
As with any change there were, and are, people
in agreement and disagreement. There were
concerns about how patients would accept this
and concern from within the profession about
competency, workload and indeed whether this
would be compulsory in daily work. The GDC
provided some clarity with this statement:
‘Dental hygienists and dental therapists can
carry out their full scope of practice without
prescription and without the patient having to see
a dentist first. The only exception to this is tooth
whitening, which must still be carried out on
prescription from a dentist.
‘Dental hygienists and dental therapists
must be confident that they have the skills and
competences to treat patients directly. A period
of practice working to a dentist’s prescription is a
good way to assess this.
‘Hygienists and therapists who qualified
since 2002 should have covered the full scope of
practice in their training, while those who trained
before 2002 may not have covered everything.
However, many of these registrants will have
addressed this via top-up training, CPD and
experience.
‘Registrants who are unsure whether there
are any gaps in their training should contact
the dental school where they received their
Charlotte Wake qualified as a dental
therapist and dental hygienist in 2005
from St. Bart’s and the Royal London.
Until recently Charlotte was on the British
Association of Dental Therapists’ council,
and is a regular writer and a public
speaker. Charlotte was winner of Dental
Therapist of the Year 2011. Charlotte
works four days a week in practice.
M
qualification, and check their indemnity
arrangements before undertaking any new duties.’
It has been some time now since this new
pathway was introduced and there are still some
barriers in place that restrict the use of DA.
More difficult to use in an
NHS environment
Currently it is only possible for a dentist who has
a performer number to open and close a course
of treatment. This means it is not possible for
a dental hygienist or therapist to see a patient
directly under the NHS.
Prescription needed for
local anaesthetic
DA does not change the need to have a
prescription to use local anaesthetic. This written
prescription may come as a Patient Group
Directive (PGD) or directly from the dentist.
Tooth whitening and
prescription only
medication (POM)
Again the introduction of DA does not change the
need for a prescription if using any item labelled

23.
27
Newbeginnings
www.dentistry.co.uk
as ‘POM’ or tooth whitening. This includes
antibiotics, Duraphat toothpaste, topical fluoride
and Ledermix. This prescription should be in
writing.
Advantages
Direct Access would not have been introduced if it
did not have advantages:
Optional
This is imperative. Use of Direct Access is
optional. It is for each clinician to decide, if and
when they will use DA. It is not compulsory.
Promotes utilisation of skill mix
DA allows you to undertake what is clinically
necessary within your scope of practice. This
encourages a therapist and hygienist to use all
their skills.
Increased access to dental care
More patients are able to get appointments sooner
as more clinical time is available. The importance
of this must not be under emphasised.
Able to see patient in an event of
staff absence
We have all been there when the dentist is not
able to work, due to holiday or sickness and prior
to DA if a new patient to the practice was booked
then both those appointments would need to be
re-scheduled. Now the patient is able to attend, for
example, their hygiene treatment and return at a
later date for their consultation with the dentist.
Practice builder
Offering DA can help build a practice and
can become a unique selling point, certainly
in situations where a hygiene appointment is
requested prior to a major event such as a wedding.
There are some key points that need to be
acknowledged if you work with DA:
• Make sure the patients know you are not a
dentist and that there is a robust practice
referral procedure in place should it be needed
• Never work outside of your scope of practice or
outside of your competency

24.
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Newbeginnings
Dental
foundation
trainingA dental therapist foundation training programme provides
a safe and secure transition from dental school to dental
practice, highlights the BADT
he purpose of dental foundation training
for dentists is the first phase of continuing
postgraduate education after graduation and
is recognised as a part of career pathways in all
sections of the dental profession. The purpose of
dental therapist foundation training is similar and
provides a structured introduction to working in
dental general practice for dental therapists.
There are two main strands of the programme,
working in a protected environment within an
approved practice that has been selected to provide
training and mentoring. This is backed by a
programme of study days, lectures and conferences
organised by the Dental Postgraduate Education
Department and tutorial/feedback sessions once a
month with the practice trainer.
The dental therapists who complete dental
therapist foundation training are equipped with
the necessary training and education required to
continue to develop and expand the clinical and
personal skills learnt as a student, and to gain the
skills required to work successfully in a general
dental practice environment.
The positions in practice are usually part time
and can be combined with split jobs in other
practices or full time if the training practice
T
has the capacity. The BADT also support the
development of a dental therapist foundation
training programme, which provides a safe and
secure transition from dental school to dental
practice and the additional responsibilities that the
NHS contract reform will give to dental therapists.
Therapist Foundation Training
Thames Valley and Wessex
The Dental Therapist Foundation Training Scheme
(TFT) is primarily aimed at newly qualified
therapists to provide the initial stage of training
and education required to practice in a general
dental practice environment.
Emphasis is placed on continuing professional
development throughout the course. The therapist
is encouraged to develop and expand the clinical
and personal skills learned as a student. The
scheme covers the Thames Valley and Wessex area
(Berkshire, Buckinghamshire, Oxfordshire, Milton
Keynes, Hampshire and the Isle of Wight).
The programme, which will last for an academic
year commences in September and is open to
recently qualified therapists. Therapists will be
employed within training practices, be allocated
an approved trainer and attend the day-release

25.
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Newbeginnings
www.dentistry.co.uk
More information on the Dental Therapist
Foundation Training Thames Valley and
West Sussex scheme can be found at
www.oxforddeanery.nhs.uk/dental_school/
therapist_foundation_training.aspx.
For more information on the Welsh
Dental Therapist Foundation Training
Scheme, contact Kath Liddington at
LiddingtonKE@cardiff.ac.uk, or telephone
02920 687 498.
For further information regaring the West
Midlands Foundation Training Scheme
for Dental Therapists, contact Dr Steve
Clements, programme director for
Foundation Training Dental Therapy, HEWM
Dental Team, St Chad’s Court, Hagley
Road, Edgbaston, Birmingham, B16 9RG, or
phone 0121 695 2587.
For more general information contact
Jane Ford, regional lifelong learning
advisor. Contact via Judith Hunter at
Judith.hunter@ne.hee.nhs.uk, or phone
0191 275 4714.
educational programme organised by Oxford &
Wessex Deaneries’ Dental School.
Training Programme for
Dental Therapists West
Midlands Deanery
The West Midlands Foundation Training Scheme
for Dental Therapists was established in 2009 and
is based on the Foundation Training Scheme for
Dental Graduates. It is a structured introduction to
NHS general dental practice for recently qualified
dental therapists.
The scheme is looking for suitable dentists and
practices to provide a supportive environment
for dental therapists. It is looking for recently
qualified (or soon to be qualified) dental therapists
who wish to pursue a career in NHS dentistry.
Therapists will be based in practices around the
West Midlands and attend monthly study days.
Welsh Dental Therapist
Foundation Training Scheme
This programme provides a structured introduction
to working in general practice for dental therapists.
The two main strands of the programme are
working in a protected environment within an
approved practice that has been selected to provide
training and mentoring. This is backed by a
programme of study days, lectures and conferences
organised by the department and tutorial/feedback
sessions once a month with the practice trainer.
The positions in practice are for two days a week
so they can be combined with split jobs in other
practices, or full time if the training practice has
the capacity.

26.
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Careeroptions
Career
Options

27.
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Careeroptions
The job of
dreams
Need a fresh challenge? Heather Richardson of Browns
Locumlink offers some key tips to those of you seeking
pastures new
f a new challenge is required then what
should you be bearing in mind if you wish to
get the job of your dreams? Let’s start at the
beginning…
Your CV
This may seem an obvious thing to say but it needs
to be said because so many professionals still get
it wrong. Do your best to avoid any gaps in your
employment history. If there are gaps, make sure
you can adequately explain them.
People often tell me that they have taken
information out to shorten the CV to one page –
this is not always best. It is important that we see
all relevant experience and skills, even if this goes
on for a couple of pages. You do not, however, need
to add every single detail.
How far will you travel?
It is wise to be realistic. Enure you have researched
a journey before applying for a position; there is
nothing worse than pulling out at the point you are
asked for an interview, or worse if the job is offered
and you decide the journey is too far to travel on a
regular basis.
DBS checks and
GDC credentials
As you would expect, these all need to be in order
and up to date.
I

28.
33
Careeroptions
Browns Locumlink is one of the UK’s
leading recruitment agencies specialising
in finding locum and permanent work
for dental, pharmacy and most recently
GP professionals. With over 30 years of
experience, the company has worked
with thousands of professionals across
the UK. For those looking for cover,
Browns Locumlink has a database
consisting of hundreds of registered
dental professionals (both clinical and
non-clinical) and pharmacists looking
for work. This means that the team can
find the most suitable candidate for
the position. Whether it is short notice,
a sick day for example, holiday cover,
simply high demand, or something
longer term such as maternity leave, or
permanent such as unexpected staff
shortage, the team will try their hardest
to ensure you are covered. Contact the
team today to put them to the test! Visit
www.brownslocumlink.com for more
information.
www.dentistry.co.uk
References
Do you have good, solid references? A potential
employer will quite frequently wish to see at least
two clinical references before offering a position
to you. Ensure you have more than two referees
that are reliable and that will respond quickly to a
request. Current referees are preferable and it would
always be questionable if you cannot supply these.
Flexibility
What type of role is it that you are looking for? A
degree flexibility is key – always attend an interview
with an open mind. Many opportunities arise at
this point – the more flexible that you can be, the
more posts will be open and available to you.
Remuneration
Quite possibly number one on your list. It is
of course a vital part of the process and one of
the most important reasons for choosing or not
choosing a role. Your expectations need to be
realistic, however. It is tough out there and many
dental professionals can have an overvalued
opinion of what they are worth. Depending on the
role, are you looking for a salaried position or a
day/hourly rate? Have in your mind the minimum
that you will consider and be open and honest
about the numbers with any potential employer.
There is no point in accepting an offer that you feel
is too low; a frank dialogue is in everyone’s best
interests. Discuss periodic pay reviews or bonus/
target incentives.
Conditions and benefits
These can be somewhat overlooked as many push
for the salary above all else. Pension provision,
holidays and flexible working hours can make a
‘maybe’ job become a ‘definitely’. Even if you are on
a paid by day rate, take a step back and look around.
Are the team happy and upbeat? Do the patients
seem comfortable and relaxed? Does the role offer
longevity? Above all, could you be happy here?
Appropriate dress and
appearance for interviews
This may come as somewhat of a surprise in a
recruitment article for dental professionals. In
our experience though, it is not uncommon for
candidates to get it spectacularly wrong when
attending an interview. All we suggest is that you
give this some consideration – no matter the role,
who you are meeting or what level of seniority you
are looking to hold, professional, clean and well
presented applies to all.
Register with agencies you
can trust
It generally doesn’t cost anything to join an agency
but choose with care and ideally a name that has
been associated specifically with the healthcare
profession for some time. Ensure you find out how
the agency takes their fee if you are looking to
take up locum work; could they take a percentage
of your invoice? Browns will not charge you to
receive notifications of work or any fee to arrange
this. It is entirely free to be registered and work
through us, all we ask for in return is loyalty and
some compliance documents.

29.
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Careeroptions
The British Association of Dental
Therapists (BADT) promotes the
advancement of dental therapy within
the dental profession.
Membership is available to:
• All qualified dental therapists
(newly qualified therapists receive
a 50% discount for their first year of
membership).
• Dental therapy students (student
membership is free)
• Associate membership for all members
of the dental team
• Overseas members welcome.
ental hygienists and therapists may develop
additional skills in line with the GDC
Scope of Practice guidance. These extended
duties are:
• Carrying out tooth whitening to the prescription
of a dentist
• Administering inhalation sedation
• Removing sutures after the wound has been
checked by a dentist.
Additional training
Dental hygienists and therapists that qualified
before 2002 may also need to undertake additional
training in the following areas:
• Prescribing radiographs
• Impression taking
• Local anaesthetics.
Dental therapists that qualified before 2002 may
D

30.
35
Careeroptions
Another
string to
your bowFiona Sandom considers your potential
extended duties
Fiona Sandom qualified as a dental
hygienist from Manchester Dental
Hospital in 1993 and as a dental therapist
in 1999 from Liverpool University Dental
Hospital and in 2013 gained her MSc
in medical education from Cardiff
University. She currently works three
days clinically, one day teaching dental
nurses for the North Wales Community
Dental Service, and one day for Cardiff
University as a postgraduate tutor for
dental hygienists and dental therapists.
She is also a quality assurance inspector
for the GDC and an examiner for the RCS
Edinburgh and president of the British
Association of Dental Therapists.
For more about the BADT, visit
badt.org.uk.
www.dentistry.co.uk
also need to undertake additional training in:
• Prescribing radiographs
• Impression taking
• Administering inferior dental block anaesthetic
• Pulpotomies in deciduous teeth
• Stainless steel crowns for deciduous teeth.
It is important to remember that a dental
hygienist or dental therapist should only carry out
a task or treatment about a patient’s care if they
have the necessary skills.

31.
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Careeroptions
Voyage of
discoveryWhat routes to new horizons will you
consider in the future? Kirstie Thwaites offers
a road map to some key destinations
patients and will raise our profile. Here are a few
options you may wish to consider...
Perfect therapy
The pilots currently testing the NHS dental
contract reforms are rooted in the principle that
the skill mix of the whole team is the best way to
e have an important role in promoting
good oral health and, with our GDC
Scope of Practice ever expanding and
NHS dentistry looking towards a team approach to
care, our options are increasing. We should all have
a desire to develop our skill set; it prevents clinical
complacency, offers more treatment options to
W

32.
37
Careeroptions
www.dentistry.co.uk
deliver dentistry – suiting clinical outcomes, the
changing needs of a population and government
purse strings. There have been claims that the
increasing use of dental therapists in NHS general
practice is simply a government ploy to deliver
dentistry on a budget.
But, many forward-thinking practices are
realising that the more holistic approach we offer
is better suited to a patient base that’s living longer
and remaining dentate. Dental therapists can

33.
38
Careeroptions
treat these patients while dentists can focus on
delivering the more complex (and more lucrative)
treatments that are going to be in demand.
There are a number of training options for
hygienists wishing to extend their skill set to
expand their scope of practice as a dental therapist.
The University of Bristol, for example, offers a two-
year part-time course and the University of Essex
offers a one-year full-time course whilst remaining
in practice.
State of independence
There have been many developments in dentistry
over the years and being able to work without the
dentist on the premises has been a massive change
for the hygienist and therapist. To date, very few of
us have monopolised on direct access in this way,
coinciding as it did with a long period of global
economic turmoil.
For those of you who braved it and now practise
independently, I salute you for it will be your
blood, sweat and tears on which other hygiene
practices will be built. The challenges are many –
having the capital to invest, securing support from
dental dealers and ensuring there is a solid referral
arrangement in place are among the few obvious
ones. But, the rewards are many and it offers
patients a different path to care.
Brace yourself
For those wishing to extend their scope of practice
in orthodontic care, the Royal College of Surgeons,
among others, offers a diploma in orthodontic
therapy. An orthodontic therapist can carry out a
limited range of orthodontic procedures such as the
placement of brackets and changing of orthodontic
arch wires. The GDC requires all orthodontic
students to train for a minimum of 45 weeks
full time but training on a part-time basis is also
available. Visit www.gdc-uk.org/dentalprofessionals/
education/pages/orthodontic-therapist-
qualifications.aspx for a full list of course providers.
Periodontally yours
Do you have the enhanced skills in advanced
care needed in the new dental contract? Dental
practices that do are likely to be commissioned
Kirstie Thwaites qualified in 2006
from the University of Leeds as a dental
hygienist and dental therapist. Since
qualifying she has completed a PG
Certificate in Medical & Clinical Education
at the University of Essex and a two year
postgraduate programme in Enhanced
Skills in Clinical Periodontology at King’s
College Hospital. At the 2012 DH&T
Awards Kirstie was the recipient of the
Young Hygienist/Therapist award. She
has previously worked in NHS practice
and as a clinical educator teaching
student dental hygienists from the
University of Essex, she now divides her
working week between private general
& specialist practice and lecturing at the
University of Essex. Kirstie is the Editorial
Council member for BADT.
to provide specialised services. Periodontology
is just one of those specialised services you could
be commissioned to do. The University of Essex
offers a MSc advanced periodontal practice
course that provides an educational route for
you to acquire valuable skills and knowledge
in periodontology. For more information, visit
www.essex.ac.uk/coursefinder/course_details.
aspx?course=MSC+A40136.
Go public!
Public health experts help shape decisions made by
government policy makers and develop national
public health programmes. An understanding
of oral health strategy – based on evidence-
based research – forms a key part of a clinician’s
understanding and should be the foundation on
which we all develop our clinical skills. Equally, a
masters degree in dental public health may also set
you on a more academic pathway.
Research
Branching out into the field of research is an
exciting path to tread. Continuing your education
long after qualification can spark renewed interest
in – and give you a fresh pair of eyes on – the
complexities of our chosen profession. We all
know that preventing and controlling dental
disease requires an evidence-based approach,

34.
39
Careeroptions
www.dentistry.co.uk
but conducting research provides the scientific
understanding of what we offer patients and why.
You also learn new skills when coordinating or
collaborating in clinical trials. Some faculties offer
opportunities, as do dental companies that are
keen to road test new dental products.
University teaching
Inspired by your course tutor? Enjoy the role of
mentor? You may wish to consider academia.
BADT president, Fiona Sandom, says of her role:
‘I have taught dental nurses in north Wales since
1994 and still do as part of my CDS role. I enjoy it
a great deal. Once I qualified as a dental therapist
from Liverpool, I was offered a tutor post. A few
years later, in 2004, the Wales Deanery created
the DCP postgraduate education department,
which at the time was very forward thinking. I
enjoy the variety and opportunities that my tutor’s
role brings me and last year I gained my MSc in
medical education from Cardiff University.’
Hungry for nutrition
Increasingly, the evidence that links nutrition,
dental health and overall wellbeing is taking
dental hygienists and therapists into other areas of
healthcare. Hygienists are now developing skills as
nutritionists in order to understand and educate
patients in the systemic links and treat them with
a ‘whole body’ approach. Teaching patients proper
nutrition and guiding them to an improved quality
of life is a vital part of your role.
Elderly care
A population with a higher number of older people
will require dental care to be provided in different
settings – in their own home or in residential
care homes, for example. We will be required to
collaborate a lot more with other health and social
care professionals. Challenges such as increased
prevalence of dementia within society will also
need to be considered. The ageing population is
one that will need careful nurturing. Their mental
health and dexterity may be compromised but they
may remain dentally fit. Hygiene protocols will
have to be adapted in order to meet their needs
and capabilities and, only with the proper training,
will successful outcomes be achieved.

35.
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Careeroptions
Be
dynamic
Salaried services – have
DH&Ts forgotten about
this vital role? Dental therapist
Leon Bassi reviews this all-
encompassing role
challenging and dynamic. It provides you the
opportunity to use your full skill set. The team is
led by a consultant paediatric dentist. The dental
y dental therapy career started at Bart’s
and the London School of Medicine
and Dentistry. Most graduates are
lured towards the sparkle of private practice but,
just before I graduated, a post of staff therapist
was advertised. The post would be working on
the paediatric department at the London Dental
Institute with Bart’s Health Trust. Working as
a staff therapist, on a children’s department, is
M
Leon Bassi is a dental therapist whose
dental therapy career started at Bart’s
and the London school of medicine
and dentistry.

36.
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Careeroptions
Rewardingly different
I would urge any new graduate to seriously consider a position within salaried services
if there is an opportunity. The salaried service will always struggle to lure new graduates
to the service due to restraints on pay scales, in particular compared to that of private
hygiene or therapy services, but the rewards is being able to use our full scope of
practice. Dental nurses and dentists both have postgraduate qualifications in special care;
dentists have a clear pathway for postgraduate training within paediatric dentistry and
dental therapists should work towards more specialised postgraduate training.
www.dentistry.co.uk
hospital provides you with the chance to work
within a multi-disciplinary team. The patient base
is far reaching and broad.
Paint a picture
To give you an idea of a typical child patient referred
to a dental therapist, imagine a picture of early
childhood rampant caries. Most of the children
we see have high treatment needs with DMFTS 10
and above, will be from a large family with several
siblings, and will speak English as an additional
language. Communication between the patient,
parent and the dental team can be problematic so
we often use health advocates to interpret; learning a
few words of several different languages is extremely
helpful. Acclimatising children into the dental
surgery setting can take time, especially as they have
experienced episodes of pain relating to their teeth;
we have toys and models to help with this and use a
passport system to encourage progress.
With such a high caries rate in young children,
methods such as the Hall’s technique is very useful;
we have found it a successful way of treating carious
second primary molar teeth. Many of these patients
require teeth to be extracted, and this can be done
in a surgery setting using inhalation sedation,
which helps make the experience easier. However,
if the treatment is not suitable or too extensive, a
referral is made for general anaesthetic.
State of transition
Salaried services are currently undergoing dynamic
and far-reaching changes. The NHS is in a state
of transition, which has impacted on community
dental services. There has been a spilt between
commissioners who are funding the services and
Many patients have
complex medical histories:
• Bleeding disorders
• Global developmental delay
• Cleft lip and palate
• Severe learning difficulties
• Heart problems
• Conditions only seen in very rare
circumstances.
providers who are supplying the service. This
means that community dental services can be
tendered for, and bid on, by interested parties. A
contract is then agreed on. Hospital services are
having to deliver services with tighter budgets as
dental hospital services are in increasing demand.
The way healthcare services are being delivered
is changing; hopefully there will be a continued
role for dental therapists working in salaried
service settings, even if this not under the umbrella
of the NHS. As clinicians, we represent good
economic value for providing patient care. Because
of the way NHS dentistry is funded, it is very
hard to conduct cost-benefit analysis as all UDAs
generated by dental therapists are submitted under
a dentist’s performance number. Hospital services
are paid differently to that of the CDS, but we still
need recognition of the role the therapist plays in
reducing waiting lists and having a positive affect
on a child’s dental health.
As salaried services are increasingly being target
driven, I hope dental therapists continue to be
used to provide care for patients and, as a group,
we should push for greater recognition of our role
among the commissioners who are funding the
service and hospital boards.

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Careeroptions
Fee setting
and pay scales
Julian English presents
a guide to the highs and
lows in fees charging and
remuneration
there are four basic payment methods. A hygienist’s
salary is paid as either:
1. A fixed annual salary
2. Straight commission
3. A combination of salary and commission
4. Daily/hourly rates.
Each method has advantages and disadvantages.
With a straight salary, paid vacations and sick leave
usually are included. This can provide financial
security. However, it may not be as rewarding. There
may be less incentive to fill broken appointments
and to maintain a good patient-return rate. Straight
commission is usually paid at 30-40% of a hygienist’s
daily production. Some dentists pay more.
References
Boyer EM (1990) Methods of charging and the fees
charged for dental hygiene services in traditional and
non-traditional settings. J Dent Hyg 64(3):144-9
www.payscale.com/research/uk/Job=Dental_
Hygienist/Hourly_Rate Retrieved 13/10/15
everal studies have been conducted regarding
fee setting, such as that by Boyer (1990). This
survey found that the methods of charging for
services and the fees charged were similar. Although
most hygienists provided many services, only one fee
for those services was changed in most settings.
The most recent data has been collected by
publisher FMC, but not yet released at the time of
going to press. However, the survey of dental fees
suggests that the average hygienist’s hourly fee charged
in the UK is £105, ranging from £70-£240 per hour
for hygienist services.
Salary setting
Salary is one of the most important questions to think
about. After all, would you work for free? Would you
leave a job you love for more money? How much
money would it take to get you to stay at a job you
hate?
Market demand ultimately determines the going
hygienist pay rate. Cities have more dentists, which
means that more hygienists will be needed, and,
therefore, the dentists in big cities are going to pay far
more to get the hygienists into the cities.
To be compensated for your productivity, the
dentist must see you as a great asset to the practice.
And thinking is definitely changing, but even in
countries like the US, still a whopping 40% of dentists
do not employ a hygienist.
There are two ways a dental hygienist can be
classified: independent contractor or employee. And
S
Julian English is the editorial director at
FMC.

38.
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Organisationsand
associations
Organisations
& Associations

39.
44
Organisationsand
associations
Introducing
the BSDHT
British Society of Dental Hygiene and Therapy
The main organisation for
dental hygienists in a nutshell
the interests of their profession.
The mission of the BSDHT is to represent the
interests of members and to provide a consultative
body for public and private organisations on all
matters relating to dental hygiene and therapy.
It aims to work with other professional and
regulatory groups to provide the highest level
of information to its members as well as to the
ith over 3,600 members, the British
Society of Dental Hygiene and
Therapy (BSDHT) is the primary UK
organisation for hygienists and dental therapists.
The BSDHT (formerly British Dental Hygienists’
Association, BDHA) was set up in 1949 by a group
of 12 dental hygienists who felt the time was right
to organise a professional association to represent
W
Incumbent president Michaela ONeill Ex-president Marina Harris

40.
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Organisationsand
associations
general public.
The BSDHT directs the decision-making
processes within the society and provides
mechanisms to monitor progress and success. The
plan is all-embracing and affects all aspects of the
society’s business.
The society seeks to increase the range of
benefits offered to members by:
• Representing members at national level,
www.dentistry.co.uk
particularly in the political arena
• Providing services to members
• Supporting members on issues that affect their
working lives
• Producing a publication that educates, updates
and inspires
• Providing CPD opportunities, both locally and
nationally
• Helping members to find employment and
provide guidance on contractual matters, as well
as salaries, and access to a 24/7 legal helpline
• Listening to members and responding
accordingly.
All dental hygienists and therapists, and
students thereof, should be members of the society.
Ex-president Sally Simpson Ex-president Julie Rosse

41.
46
Organisationsand
associations
The BADT –
opening doors
Katrina Matthews pays tribute to her ‘dental therapist family’
concept of dental therapy began to take seed. The
early role of the dental auxiliary evolved into the
dental therapist we know today, with a slow shift
It was way back in 1950, when the state of
children’s dental health was at a low and there was
a shortage of dentists in the school services that the

42.
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Organisationsand
associations
www.dentistry.co.uk
towards the doors opening for them to practise in
a primary care environment.
Along the way, there were expectations placed
upon them that required patient management
skills, an ability to educate patients in oral health
care and above all, an affinity with patients and
fellow dental professionals alike.
Bridge the gap
Slowly, the training developed into what we now
know today – with much tenacious persuasion by
those who cared passionately about the role. These
‘gentle persuaders’ blossomed along the way and,
today, the British Association of Dental Therapists
(BADT) still has that tenacity and staying power of
their predecessors some six decades earlier.
I qualified in 1974 and immediately joined the
BADT and have been a member ever since. It was
the only association for dental therapists until
very recently, and I always felt it was my ‘dental
therapist family’; so many people didn’t know (and
perhaps are still learning!) about our profession.
For many years, we were a very rare
occupation. The support and friendship has been
invaluable. The achievements of the BADT over
the years has been amazing – working in practice
and extended duties and raising our profile
within the dental profession among them. We
were always that person bridging the gap between
dental nurse and dentist so we learnt excellent
negotiating skills and quickly became a solid,
valued member of the team.
Our special clinician/patient dynamic and
the long-standing and close association with
the education, care and treatment of children’s
teeth puts us at an advantage when it comes to
a full understanding of the implications of poor
oral hygiene, as well as the impact this has on
their overall health and wellbeing. Once again,
children’s dental health is in the spotlight and the
lifted restrictions by the regulators, which allows
us direct access, and underpins all that the BADT
stands and fought for.
Advise, support and protect
Today, more than 500 members rely on us to
advise, support and protect their interests. In
this new dawn in dentistry, how you practise
and what you can do may seem daunting and
it is a role that requires careful navigation. For
this reason, members are encouraged to look
to us for assistance and we offer students and
newly qualifieds reduced membership fees and
access to some of the leading clinicians within
dental therapy. This deep vault of knowledge
held by experienced dental therapists – working
in all areas of dentistry – is a hidden gem in the
membership benefits.
The council recently secured the help of patient
membership scheme experts, Privilege Plan,
to make it easier for its members to pay their
fees by now accepting Direct Debit payments.
Membership includes a quarterly peer-reviewed
journal that includes two hours of non-verifiable
CPD, accredited by Colgate. Online access is also
available to previous issues of Dental Therapy
Update. The journal aims to inform members
of new clinical protocols and theory, keep them
abreast of relevant news and views and highlight
key courses and conferences, as well as offer insight
into the working lives of therapist colleagues.
Katrina Matthews works for Central
London Community Health Care NHS
Trust as manager for dental therapy and
oral health promotion in the Specialist
and Community Dental Services. Katrina
qualified in 1974 and spent years as a
tutor. She manages a team of dental
therapists working across central and
west London and a team of oral health
promoters over four Trust areas. Katrina
has spent the last 15 years working
clinically in the specialist service,
alongside a wide range of specialities and
combine this with her interests in a range
of dental public health programmes
in the community, including fluoride
varnish, adults with learning difficulty,
early years settings, homeless and
training of health, local authority and
educational professionals.

43.
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Organisationsand
associations
The BADT has a vibrant social media presence,
too, both on Twitter and Facebook and encourages
members to share thoughts, comments and discuss
common challenges in its own online forum at
www.badt.org. There is a monthly e-newsletter to
complement this, and to make it easy for our busy
members to navigate their way directly to what
they need to know.
Heart
So, although our association took root slowly, the
heart of it remains the same. In her short time as
president, Fiona Sandom has displayed the same
passion as those who went before her, having
For more information, visit www.badt.org.
secured commitment from all four chief dental
officers to understand and work towards solving
issues affecting dental therapists. Some barriers to
care remain within NHS regulations and prescribing
rights and, although we aware that time frames to
resolving these issues are lengthy, the BADT is in it
for the long haul – much as it has ever been.
Council is working towards understanding these
barriers so we can use our full scope of practice
directly with patients and therefore increasing
their access to dental care.

44.
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Organisationsand
associations
Who’s whoA guide to the people and
groups in the world
of dentistry
Month and Mouth Cancer Action Month. As a self-
funded charity, the Foundation is very grateful to the
support of its members, which enables it to provide
such a wide range of important services.
National Smile Month is the Foundation’s pro-
active campaign designed to raise awareness of dental
and oral health over one month. The campaign has
now been running for 35 years and is one of the best
established worldwide public awareness campaigns
dedicated to the promotion of oral health. It
encourages dentists, dental hygienists and therapists,
and other dental professionals to get involved and
spread good oral health messages to the public.
Over the years, National Smile Month has been
a great way for dental practices to organise themed
events and publicise their business, as well as
spreading a good oral health message to the public.
It is also an excellent way for practices to encourage
patients to maintain regular dental visits.
A full range of patient awareness literature
covering a wide range of dental topics is available
as a resource to members and non-members of the
British Dental Health Foundation to help educate and
motivate patients. The range of resources includes
leaflets, posters, stickers, books, DVDs and lots of fun
dental motivators. The core of this material is the 50
titles in the ‘Tell me about…’ series, giving patients
information on virtually every aspect of dental care.
The BDHF also runs a dental advice line, the
National Dental Helpline.
For more, email sarah@dentalhealth.org.
British Dental
Industry Association
Members of the British Dental Industry Association
(BDIA) do more than just sell products and services
to dentists and laboratories. Working with the
profession, they help dentists deliver quality care
to their patients. It is a partnership that can be
rewarding to all concerned, including patients.
Suppliers are constantly researching new products
B is for. . .
British Association of
Dental Therapists
The BADT promotes the
advancement of dental therapy
within the dental profession.
Membership is available to:
• All qualified dental therapists (newly qualified
therapists receive a 50% discount for their first
year of membership)
• Dental therapy students (student membership is
free)
• Associate membership for all members of the dental
team
• Overseas members welcome
• Payment is available online, taken securely via
Worldpay.
For more, visit www.badt.o rg.uk.
British Dental Health
Foundation
The British Dental Health
Foundation is a national charity
dedicated to promoting the
benefits of oral healthcare to the
public. It aims to serve the public
interest by improving awareness of,
and access to, the means of maintaining better oral
health. As well as aiming to bring about improved
standards of oral health care in the UK, the Foundation
has a vastly growing overseas market, under the arm of
the International Dental Health Foundation.
The Foundation keeps in close communication with
its members, who can benefit from direct involvement
in its activities and campaigns, such as National Smile

45.
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Organisationsand
associations
www.dentistry.co.uk
and services as well as developing established ones.
Members of the dental team who work with BDIA
members can be assured of a reliable service and
continued support.
They can be sure that the products and services
they buy are of high quality and conform to all
regulations and requirements of both UK and EU
legislation, which is particularly important when
investing in capital equipment. The BDIA also
works in harmony with other dental associations
to make sure that the products offered are what the
dentist or dental care professional needs.
The BDIA ensures the staff of its member
companies are able to provide a good service to
the dental team, who in turn can give the best to
the patient. The BDIA runs courses every year to
familiarise those new to dentistry with the basic
knowledge they need. Most companies also offer
training to dental teams to make the transition to a
new product as smooth as possible.
So, BDIA members are committed to providing
the same high standards of quality as you are, giving
you peace of mind when delivering dentistry to
patients and clients. In summary, they:
• Comply with a strict code of practice, meaning
they are committed to providing the highest
quality products and exceptional levels of customer
service, minimising downtime and giving you the
confidence to run a busy practice or laboratory
• Research and develop new materials, equipment
and technologies, providing you with more choice
and the ability to work more efficiently and
effectively
• Provide courses and seminars to support you with
the adoption of these innovations within the dental
practice or laboratory
• Are actively encouraged to train their staff, ensuring
they have the relevant knowledge to understand the
ever changing needs of the dental team.
The BDIA is a primary source of information on
dental suppliers and brands. When you are trying
to source a particular product or replace a piece of
equipment, rather than searching aimlessly through
the internet, you may find it useful to search the
online product and brand locators on the BDIA
website, www.bdia.org.uk.
British Society of Dental
Hygiene & Therapy
The BSDHT
welcomes
members who
are dental
hygienists,
dental hygienist-therapists and students. The BSDHT
is a major organisation within dentistry that exists to
represent your interests. For example, representatives
of the BSDHT maintain an ongoing dialogue with the
General Dental Council (GDC), the Departments of
Health and all the main groups representing dental
care professionals. The BSDHT attends meetings of
the dental All Party Parliamentary Group (APPG),
bringing dental hygiene and therapy to the attention
of government ministers and MPs.
The BSDHT (formerly British Dental Hygienists’
Association, BDHA) was set up in 1949 by a group
of 12 dental hygienists who felt the time was right
to organise a professional association to represent
the interests of their profession. Over 60 years later,
the BSDHT is a nationally recognised body that
represents around 3,600 members across the UK and
beyond. There is 50% discount for newly qualified
people for their first year of membership.
The mission
• Promote the study of oral health and to provide
a consultative body to whom reference may be
made by public or private bodies for guidance
in connection with the dental hygienist/dental
therapist profession
• Maintain the honour and interests of the dental
hygienist/dental therapist profession
• Represent and safeguard the common interests of
members
• Provide opportunities for post qualification
education.
The aim
• Represent members at national level, particularly in
the political arena
• Provide services to members
• Support members on issues that affect their

46.
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Organisationsand
associations
working lives
• Produce a publication that educates, updates and
inspires
• Provide CPD opportunities, both locally and
nationally
• Help members to find employment and provide
guidance on contractual matters, as well as salaries,
and access to a 24/7 legal helpline
• Listen to members and respond accordingly.
For more information, visit www.bsdht.org.uk.
British Society of
Periodontology
The BSP exists to promote the art and science of
periodontology.
Membership includes specialist practitioners,
periodontists, general dentists, consultants and
trainees in restorative dentistry, clinical academics,
DH&Ts, specialist trainees in periodontology and
many others.
For more information, visit www.bsperio.org.uk.
C is for. . .
Care Quality Commission
CQC compliance inspectors started their visits
to dental providers at the end of 2010. Wherever
possible, inspectors give advance notice of
an intended visit, as they do not want patient
appointments to be disrupted or cancelled.
So far, CQC visits have been planned reviews
of compliance where, on the whole, there no
concerns about the provider beforehand. However,
the CQC may make an unannounced visit when
a primary care trust, ‘whistleblower’, or another
agency alerts of a possible major concern.
Compliance inspectors come from a wide range of
backgrounds. They are trained to ‘regulate whether
providers are complying with the regulations’ and use
a number of methods to review compliance. Having
structures and processes in place are obviously
necessary, but the CQC will look to make sure that all
members of staff understand them when they check
that a dental provider complies with these outcomes.
Visits will last for about three hours and, in certain
situations, a second visit may be necessary, with or
without a dental specialist to check more details
or actions required. Although CQC inspectors are
not registered dentists, they can access these dental
specialists who are spread throughout the country,
and have vast experience in appraising, regulating
and running both NHS and private dental practices.
After leaving the practice, the inspector will
compile a report, which will be sent, in draft, to
the dental provider for any comments on factual
accuracy, before it is finalised for publishing on the
CQC website.
D is for. . .
Department of Health
The Department of Health (DH) is responsible for
numerous initiatives to improve oral health for the
nation’s population. It manages the public dental
workforce and reviews the capability and capacity of
it. An increased focus on oral health improvement
will reduce the need for treatment and improve the
efficient use of financial resources.
The chief dental officer (CDO) is the government’s
most senior dental adviser for England and the
professional head of dental staff in England. The
holder of the role has close links with the profession
and other staff across government, both to provide
expert advice and to ensure a coherent input to policy
across government.
The CDO is the government’s senior adviser on
all issues related to dental services and dental public
health. The current CDO is Sara Hurley, she:
• Provides professional leadership to the dental
profession
• Provides advice to ministers and other senior
civil servants on improving oral health, reducing
inequalities and developing high quality services
for patients
• Works closely with the professional regulatory body,
the NHS and dental educators.
For more information contact 0207 210 4850 or
visit www.dh.gov.uk.
Dental Protection
Dental Protection Limited is a member of The
Medical Protection Society Limited group of
companies, the world’s leading defence organisation
helping doctors, dentists and other healthcare

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Organisationsand
associations
professionals to meet their professional obligation
to make suitable indemnity arrangements. It
offers members a first-class service combined
with a wealth of educational information and risk
management material.
Key services
• Protecting the professional integrity of its members
• Advice and assistance, including legal advice
and assistance
in all matters
that challenge
a member’s
professional registration
• Indemnity against costs and damages in dental
negligence claims. Neither Dental Protection or
The Medical Protection Society are insurance
companies; the benefits of membership are
discretionary
• More than 70 dento-legal advisers, who are all
experienced dentists with legal expertise, provide
expert guidance and support to members of the
dental team in difficulty, including emergency
advice available 24 hours a day, seven days a week.
In addition, locally-based teams of dentists and
lawyers with a specialised knowledge of dento-
legal matters support the in-house advisers in all
the nations where there are dental members
• An independent and confidential counselling
service specifically to assist members suffering from
stress as a result of dento-legal issues.
Educational services
Dental Protection provides risk management
publications, seminars and other educational
resources, with the aim of preventing avoidable harm
to patients and reducing risk to members. These
are provided for members either free of charge on
request, or at preferential rates.
For more information, visit www.dentalprotection.
org/uk.
G is for. . .
General Dental Council
The GDC is the organisation that regulates dental
professionals in the UK. By law, all dentists, dental
nurses, dental technicians, clinical dental technicians,
dental hygienists, dental therapists and orthodontic
therapists must be registered with the GDC to work
in the UK. The GDC’s purpose is to protect the public
by regulating the dental team. It does that by:
• Registering qualified professionals
• Setting standards of dental practice and conduct
• Assuring the quality of dental education
• Ensuring professionals keep their skills up to date
• Investigating allegations and complaints about
dentists or dental care professionals and taking
appropriate action
• Working to strengthen patient protection.
Registration
The GDC has two registers; the Dentists Register and
the Dental Care Professionals Register. These
are updated daily and are publicly available on
the GDC’s website, www.gdc-uk.org. The GDC can
prosecute people who practise dentistry, but who
aren’t registered.
A list of dental specialists is also held. Any
registered dentist can work in a particular branch of
dentistry but only those on the 13 Specialist Lists can
call themselves a specialist.
Standards
All dental patients are entitled to high standards
of professional and personal behaviour from those
providing their care. Every registrant is expected
to meet the GDC’s Standards for the Dental Team,
which sets out nine key principles of ethical practice.
In addition, there are supplementary guidance
sheets on topics such as advertising and prescribing
medicines. Action can be taken against registrants
who do not follow these principles.
Education and quality assurance
Currently, the aim of the GDC’s quality assurance
process is to check whether courses for dentists
and dental care professionals meet its training
requirements, which are outlined in Preparing
for practice – Dental team learning outcomes for
registration. Dental professionals are required to keep
their skills and knowledge up to date by carrying out
continuing professional development (CPD).
Complaints
Most dental professionals are competent,
www.dentistry.co.uk

48.
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Organisationsand
associations
conscientious people who patients can have
complete confidence in. But there are times when
the behaviour or health of a dental professional may
cause concern. The GDC can act on complaints
from patients or information received from other
organisations (for example, the police or the
NHS), which questions whether a registered dental
professional should be practising.
Action can be taken if a registrant’s fitness to
practise may be impaired due to their health,
conduct – including convictions and cautions –
and performance.
Fitness to practise hearings
As part of its duty to protect the public, the GDC
holds formal hearings into cases about dental
professionals. The fitness to practise process begins
when the complaint is assigned to a caseworker,
who starts by comparing the complaint to the GDC
Standards for the Dental Team to assess what should
happen next.
If a committee decides to erase or suspend a
dental professional, they have 28 days to lodge an
appeal with the High Court on the basis that the
decision was too harsh. If the court agrees, it can
substitute a different decision or send the case back
to the Conduct Committee to dispose of the case
according to the court’s directions.
The Professional Standards Authority for Health
and Social Care (PSA) has the power to appeal a
Practice Committee decision if they consider that the
outcome was unduly lenient.
For more details on any of these issues, please log
on to www.gdc-uk.org or call the customer advice
and information team on 020 7167 6000.
H is for. . .
Hygienist Direct
A website that allows registered dental hygienists
and therapists to advertise their services to the public
while complying with GDC guidance.
Twenty-five per cent of funds raised from
membership fees will go towards a new DH&T
Benevolent Fund
For more information, visit www.hygienistdirect.
co.uk.
I is for. . .
International Federation of
Dental Hygienists
The IFDH was officially formed on June 28 1986 in
Oslo, Norway. The forerunner was The International
Liaison Committee on Dental Hygiene, established
in 1973, by some European countries, the USA,
Canada and Japan. The IFDH is an international,
non-governmental, non-profit organisation. It unites
dental hygiene associations from around the world in
their common cause of promoting dental health. The
stated purposes of the federation are to:
• Safeguard and defend the interests of the profession
of dental hygiene, represent and advance the
profession of dental hygiene
• Promote professional alliances with its association
members as well as with other associations,
federations and organisations whose objectives
are similar
• Promote and coordinate the exchange of knowledge
and information about the profession, its education,
and its practice
• Promote access to quality preventive oral health
services
• Increase public awareness that oral disease can be
prevented through proven regimens
• Provide a forum for the understanding and
discussion of issues pertaining to dental hygiene.
T is for. . .
Tooth Whitening
Information Group
TWIG was formed to unite people with a common
purpose. Its mission statement is to work together
to provide:
• Clear guidance and supporting material for
professionals on tooth whitening
• Clear information for the public
• Support to the official bodes who tackle illegal sales
and illegal whitening.

49.
Keyclinical
protocols
56
The proper
way to scoreThe British Society of Periodontology’s guide to
periodontal assessment
thorough assessment and a consistent protocol
from the practice team. But just why is it so
important we involve our patients in determining
the level of their periodontal health?
1. Because they have a right to know
2. It is our ethical duty to assess, diagnose and
educate patients
3. Defence organisations have noted that their
highest litigation costs are due to an increase in
undiagnosed periodontal disease. Supervised
neglect and failure to refer results in the ongoing
existence of disease is a threat to systemic health
and increased litigation within the profession
atients’ understanding of periodontal
disease is evolving, largely as a result
of media coverage and also because of
marketing by consumer healthcare companies
(Balanoff and Duvall, 2010). However, despite
the increasing emphasis on periodontal health
and the oral systemic link, periodontal disease
remains prevalent. As shown in the Adult Dental
Health Survey, ‘83% of people show signs of gum
disease’ (Office for National Statistics, 2009).
Patient awareness and treatment acceptance,
especially in the early stages of disease (when it is
often asymptomatic) can be encouraged through
P
Code Definition Treatment required
0 No pockets >3.5mm, no calculus/
overhangs, no bleeding after probing
(black band completely visible)
No need for periodontal treatment
1 No pockets >3.5mm, no calculus/
overhangs, but bleeding after probing
(black band completely visible)
Oral hygiene instruction (OHI)
2 No pockets >3.5mm, but supra- or
subgingival calculus/overhangs (black
band completely visible)
OHI, removal of plaque retentive
factors, including all supra- and
subgingival calculus
3 Probing depth 3.5-5.5mm (black band
partially visible, indicating pocket of
4-5mm)
OHI, root surface debridement (RSD)
4 Probing depth >5.5mm (black band
entirely within the pocket, indicating
pocket of 6mm or more)
OHI, RSD. Assess the need for more
complex treatment; referral to a
specialist may be indicated
* Furcation involvement OHI, RSD. Assess the need for more
complex treatment; referral to a
specialist may be indicated.

50.
Keyclinical
protocols
57
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(Mitchell, 2010)
4. It affords the opportunity for the practice to
provide optimal patient care while enhancing
practice-building opportunities. Many clinicians
feel uncomfortable mentioning profit and ethics
in the same sentence but, the fact is, dental
practices are businesses that must generate
revenue and profit while providing excellent
care (Balanoff and Duvall, 2010)
5. It is important to assess the periodontal
condition before commencing restorative
treatment as there is evidence to suggest that,
once the foundation of the periodontium is
stable and a good level of plaque control is
achieved, the restorative treatment will have
better long-term prognosis (preshaw, 2008/9)
6. In line with Care Quality Commission
regulations, all patients should have ‘a full
examination of both the hard and soft tissues
and supporting structures of the oral cavity
using diagnostic aids such as radiographs as and
when necessary’. This includes diagnostic and
screening procedures for periodontal disease
(Care Quality Commission, 2010).
All new patients must be screened and evaluated
for periodontal disease and it should be routine
practice to probe every patient each time he or she
is seen at recall.
Periodontal protocol
It is important to make a clear distinction between
preventive care and periodontal therapy. The
‘routine scale and polish trap’ can induce a false
sense of security in our patients for it communicates
that all is well (Mitchell, 2010). In a well-defined
periodontal protocol, patients are graded by their
disease and risk level and the definition of disease is
made clear. A good example of such a protocol is the
Basic Periodontal Examination (BPE), which was
developed by the British Society of Periodontology
from the Community Periodontal Index of Treatment
Needs (CPITN) (British Society of Periodontology,
2011). It is essentially a method of screening
patients to estimate the level of disease present
and the treatment required for each level. The BPE
examination and scoring system divides the mouth
into sextants. All the teeth in a sextant are examined
and scored accordingly. The scores are detailed
in the table on the opposite page. It is important
to remember that in addition to BPE scores, a
periodontal data chart is needed to determine the
severity of disease, and provide a baseline for later
comparison to assess the effects of the treatment
(British Society of Periodontology, 2011).
Communicating with patients
Encourage patients to assume some responsibility
for their role in controlling the disease.
• When chatting to patients about their perio score
it helps to have a typodont of the periodontium
and a BPE probe to hand, as these can be used to
illustrate various aspects of the disease
• Technology can help patients ‘own’ their disease and
diagnosis. Responsive software systems generate
verbal feedback during probing and charting,
which helps keep patients involved because they
can hear the message generated by an ‘objective
third party’ (the computer). You can provide the
patient with a print-out of your findings
• In the absence of technology, talk patients through
examinations by using personal diagnosis.
Disclose teeth and show them any areas of plaque
accumulation. With a BPE probe point out any
‘hot spots’ (where there is bleeding on probing),
demonstrate the depth of periodontal pockets and
reinforce the message with radiographic evidence
• Always back up any information you have given
with educational literature.
Younger patients
In 2012, the British Society of Periodontology
(BSP) and The British Society of Paediatric
Dentistry collaborated to produce Guidelines
for Periodontal Screening and Management of
Children and Adolescents Under 18 Years of
Age as it had been realised that there is a need to
identify early signs of disease in younger patients.
All clinicians should make themselves aware of this
advice, which is available from the BSP website.
For references, contact Julian@dentistry.co.uk.