Oral health therapists have much to offer a practice yet many dentists remain confused about what they can and can’t do. By Kerry Faulkner
While the path to becoming qualified as a dentist has been relatively straightforward over the decades, not so the oral health therapist (OHT) whose qualification evolution has been a ‘bit of a dog’s breakfast’ in comparison, according to those teaching in the field.
OHT is a relatively new profession, with the first Bachelor of Oral Health Program created in Queensland jointly by the University of Queensland and Queensland University of Technology in 1998.
OHT courses are now available nationally as three-year courses, combining two previous dental training courses—dental therapist and dental hygienist. The result is that in dental practices across the nation, employees hold at least one of these three different types of qualifications and that’s causing problems according to those working in the field.
The first issue is that qualified OHTs are often under-utilised and are becoming frustrated at not using their full skill set. Secondly, dental practices are running well below optimum efficiency because dentists aren’t delegating work to OHTs that they are perfectly qualified to do.
So how did the mishmash of qualifications come about?
Historically, the dental therapist’s role grew from school dentistry. Today they provide oral health assessment, diagnosis, treatment, management and preventive services from children to adults. The scope of work includes restorative and fillings treatment, tooth removal, additional oral care and oral health promotion.
Dental hygienists provide oral health assessment, diagnosis, treatment, management and education for the prevention of oral disease. Their scope may include periodontal treatment and preventive services.
OHT has evolved to combine the two—dental therapy’s oral health care including restorative treatment and extractions, with dental hygienists’ preventive oral care for all ages, in a degree course that includes additional research and theoretical components.
Very few courses now exist offering just dental therapy or dental hygienist training.
West Australian dental therapist Roseanne Toutountzis has more than 30 years’ experience in the field and says there are so many levels of credentials, dentists themselves are confused.
“Dentists need to sit down and talk to each other and figure out who they want to employ and why. If they want just a hygienist to do scaling and cleaning, then employ one but if you want someone in the practice to do more involved work, then employ someone who can do it and pay them accordingly,” she says.
“As it stands now, new graduates who have all these skills and knowledge are going into practices where they are scaling and cleaning for eight hours. So, there are a lot of frustrated women out there.”
Australian Dental Association president Dr Hugo Sachs agrees that while the role of the dental hygienist is clear-cut, that’s not necessarily the case with therapists.
“Before national registration, many of the state boards defined what a dental therapist could do so there was some form of baseline that everyone could refer to,” he says.
“Of course, they were limited to working with children at that stage. Because there is no defined scope of practice for either a dental therapist and an oral health therapist, coupled with the fact that they are not a homogenous group—some have done a bachelor degree while older therapists were prepared to an advanced diploma level—it leaves the dentist not knowing what should be part of their role and what isn’t.
“Once dentists work in a practice, they know the scope and realise OHTs are actually well trained and then they start to utilise them but it’s a slow process.”—Carol Nevin, lecturer and tutor, Curtin University
“The Dental Board could easily address this by providing clearer advice on what their education and training permits them to do and what they can’t do.”
Curtin University dental therapy lecturer and clinical tutor Carol Nevin explains the confusion is impacting on practice efficiency. Many dentists, she says, are filling their appointment books with work that can easily and efficiently be done by their OHTs.
“Oral health therapists do all the hygiene, periodontal and maintenance. We need to see patients every six, 12 or 18 months and that doesn’t make a lot of money in the practice, but it needs to be done.
“But if a dentist is filling their book making appointments for this and treating children—which takes a lot of time—it’s not cost-effective. So, by not employing a dental therapist, they are limiting themselves and not seeing the broad range of patients that they could.
“Oral therapists are trained in prevention and public health and can spend time with patients talking about hygiene and looking at diets. They can isolate why decay is happening and that’s great but dentists don’t have the time to do that. So, they allow for a more holistic approach to dentistry,” says Nevin.
Nevertheless, research published in the Australian Dental Journal in 2015 aimed at exploring which dentists were most likely to utilise OHTs showed an estimated 62.2 per cent of dentists surveyed did not employ OHTs, hygienists or therapists.
It showed 31.5 per cent of dentists employed either an OHT, hygienist or therapist. Just 12.1 per cent employed an OHT, compared to 18.3 hygienist and 7.4 a dental therapist.
The researchers, from the University of Adelaide, said the study was prompted by an increase in the availability of OHTs in the workforce over the past decade.
They randomly surveyed more than 1100 dentists Australia-wide and found those least likely to employ an OHT were those aged over 50, working solely in the public sector, located in Tasmania, Western Australia, New South Wales or Victoria, and who had a single surgery.
Those more likely to employ OHTs were rural dentists, dentists in multiple surgery practices, and those considering practice expansion. It found dentists in the 20-29-year age group were more likely to employ OHTs, suggesting they adopted more of a team approach to service delivery.
Nevin says a team approach to health care, fostered by utilising OHT, is the way forward, pointing to Canada and the United States where she says it’s not uncommon to have three OHTs per dentist. She says it allows them to use the full range of skills in which they have been trained, to stay fresh and have a variety of tasks to make the work more fulfilling.
“Working as a team like this brings about best practice, and the new scope of practice guidelines in Australia talk about ‘structured professional relationships’ which promotes a more collaborative approach,” she says.
Nevin works at Western Australia’s only dental training facility, where courses for both OHTs and dentists are run by separate universities. She believes some existing dentists don’t realise that the OHT training has evolved to the extent that it has, while newly graduating dentists aren’t given a thorough understanding of exactly the scope of what OHTs can do.
“The dental graduates are quite unaware of what the oral health therapist can do. It’s a lack of awareness of their scope of practice,” she says. “It would be good for them to do some integrated treatment planning of a patient as part of their training, using all the dental disciplines.
“Once dentists work in a practice, they know the scope and realise OHTs are actually well trained and then they start to utilise them but it’s a slow process.”