Underused and underpaid: the NHS dental therapist

There are many reports in the media of difficulties in recruiting dentists to work in NHS practices, especially in rural areas. Many will have experienced this first-hand, as this has NHS practices

Reasons for this are multi-factorial, however, and rather than focusing on why there is a shortage of dentists, maybe we should be asking: “Is there an effective alternative to filling these places right now?” The answer, from the British Society of Dental Hygiene and Therapy (BSDHT), is a resounding “Yes”.

The dental therapist is a woefully underused professional

There are other highly skilled dental professionals who are able to offer treatment similar to that of the dentist, such as the dental therapist. They are trained to provide fillings in children and adults, carry out extractions in children, screen for oral cancer, treat periodontal disease, refer patients to other healthcare providers when required, take radiographs (X-rays)… the list goes on.

However, what they cannot do is make crowns, dentures, bridges or carry out root-canal treatment; these procedures are still within the dentist’s remit. Therefore, when a dental therapist carries out routine dental treatment on a patient, the dentist is free to focus their time on more complex treatments, which is cost effective for the practice.

Around 350 dental therapists qualify from UK dental schools annually and there are now more than 3,000 registered with the General Dental Council. This then seems to be an obvious solution to the problem where there is a shortage in the numbers of dentists. It begs the question: why are dental therapists not being utilised much more widely across the UK?

Why aren’t we making better use of the dental therapist?

One obstacle is that within the NHS, only the dentist can open a course of treatment. This means that a patient must be seen by the dentist first for an examination before being referred to the dental therapist, who works under the prescription of the dentist. If the dental therapist saw the patient for the examination, this would be a cost-effective use of everyone’s time; patient, dental therapist and dentist.

Poor remuneration is also cited as an issue for dental therapists as many have to share the treatment fee, or unit of dental activity, with the dentist. Therefore, some dental therapists find that working as a dental hygienist in a private practice is more lucrative. This means they are not using their dental therapy skills, which is obviously detrimental to all concerned.

There has been a perception among the profession that it is not economically viable to employ dental therapists. As the NHS contract can differ from practice to practice, BSDHT recognises that for some practices it may not suit their needs. But overall we believe it would be beneficial to patient access and treatment, and disagree that utilising a dental therapist’s skills would not be profitable for the practice.

Also, there is some lack of understanding from the dental profession about the abilities and training of the dental therapist, which prevents dentists employing this highly skilled professional to enhance their practice.

The dental therapist must be seen as a valuable resource

During 2017-18, there were 45,077 extractions of multiple teeth in under-18s in England, at a cost of £38.9 million. This is a serious problem compounded by a shortage of NHS dentists, denying dental care for many communities.

It’s BSDHT’s aim to highlight the dental therapist as a valuable resource. We can help reduce these figures and alleviate some of the stress placed on principal dentists. It just requires those who can make these changes to take a leap of faith and trust in a professional who can deliver high-quality clinical care to those in need.