Providing treatment as a team
Providing treatment as a team
Periodontal treatment and care can be provided by multiple members of the dental team. Dental hygienists and dental therapists can either work independently, providing care within their scope of practice directly to patients, or under a treatment plan agreed with a dentist. Advice regarding oral health can be delivered by an oral health educator as part of a course of treatment. Irrespective of how periodontal treatment is planned and provided, the aim is always to care for and manage the patient effectively.
When working as part of a team caring holistically for a patient, the key to a successful clinical partnership between members of the dental team is excellent communication. In addition, good communication with the patient about the role of the dentist, dental hygienist, dental therapist or oral health educator in their care is important.
Where treatment is to be provided by a dental hygienist or dental therapist under a treatment plan/ prescription agreed with a dentist, it is vital that the referring dentist communicates in detail the nature of treatment required for each referred patient and what the review process should involve (i.e. who will review the outcomes of treatment and when). See Treatment prescription for more information.
During and after treatment, the dental hygienist, dental therapist or oral health educator should provide feedback about the patient’s response to treatment, including compliance with oral hygiene behaviour change interventions and changes in levels of inflammation and probing pocket depths as appropriate to their role. Comprehensive record keeping and discussions with other dental team members, where appropriate, will facilitate this (see Record keeping).
Local anaesthesia may be beneficial for some patients during non-surgical periodontal therapy and dentists, dental hygienists and dental therapists are allowed, under their scope of practice, to administer it during treatment. As local anaesthetic is a prescription-only medicine, it must be prescribed by a doctor or dentist, or administered by a dental hygienist or dental therapist trained under exemptions to the Human Medicines Regulations (Schedule 17)*.
Where a dental hygienist or dental therapist is not appropriately trained under the exemptions mechanism, a Patient Specific Direction (PSD), where a dentist prescribes local anaesthetic for use by the dental hygienist or dental therapist, is required.§ The PSD should be recorded in the case notes by the prescribing dentist and should include:
- type of anaesthesia (i.e. brand or generic name, strength);
- maximum dosage (i.e. maximum number of cartridges);
- frequency (e.g. as required);
- route of administration (e.g. by injection).
*The amended Human Medicines Regulations (Schedule 17; 2024) include an exemptions mechanism that allows for dental hygienists or therapists with appropriate training to independently provide local anaesthetic which can be used whilst treating their patient.
§Previously, there was provision for local anaesthetic to be used by a dental hygienist or dental therapist under a Patient Group Direction (PGD), a written instruction which allowed listed healthcare professionals to sell, supply or administer named medicines in an identified clinical situation without the need for a written, patient-specific prescription from an approved prescriber. The introduction of the exemptions mechanism means that PGDs should no longer be used for the supply or administration of the listed medicines (i.e. local anaesthetic). Where a PGD is currently used to supply and administer local anaesthetic, practice owners should put in place plans to transition to working under Patient Specific Direction (PSD) or the exemptions mechanism. PGDs cannot be renewed or replaced for listed medicines once expired (maximum 3 years from authorisation).
If a patient is referred to a dental hygienist or dental therapist who is not working under direct access:
Ensure the dental team are familiar with the most recent scope of practice for both dental hygienists and dental therapists.
Ensure that an individualised treatment plan that is specific to the patient has been provided by the referring dentist.
- Should treatment needs change or differ from the original treatment plan, the dental hygienist or dental therapist should liaise with the referring dentist to confirm any changes.
- If local anaesthesia is required, a valid prescription should be written in the case notes so that the dental hygienist or dental therapist can administer it.
Ensure that the patient is aware why they have been referred to the dental hygienist or dental therapist and what to expect during treatment.
Ensure that arrangements for post treatment reassessment are agreed; reassessment can be performed by the dental hygienist, dental therapist or dentist.