Dental therapists in general dental practice. A literature review and case‐study analysis to determine what works, why, how and in what circumstances

Abstract

Introduction:In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied.Aims: Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. Materials and Methods:The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. Results:Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. Conclusion:Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice. K E Y W O R D S dental therapists, development, general practice, qualitative, realist evaluation, skill-mix, team-work, workforce development How to cite this article: Barnes E, Bullock A, Chestnutt IG, Cowpe J, Moons K, Warren W. Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances. Eur J Dent Educ. 2020;24:109-120. https ://doi.

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions

“…Dental therapist/ hygienists and dental hygienists have a limited scope of practice but are trained to the same standard as dentists in providing these. However, despite the financial benefits of them providing aspects of care, they have not been successfully incorporated into the workforce for a number of reasons [ 119 ]. There are very few specialists in pediatric dentistry and these are concentrated mainly in urban areas or are consultants who manage complex care needs such as children who have craniofacial abnormalities, hypodontia or are medically compromised [ 120 ].…”

Developments in oral health care in the Netherlands between 1995 and 2018

“…The focus on evidence-based clinical guidelines and the establishment of an institution to develop them, for example, can be observed in several other countries as can a similar emergence of dental chains [ 52 – 56 ]. Furthermore, in many countries teamwork in oral health care practices is increasing and task redistributions is under consideration or construction [ 57 – 59 ]. In short, this study provides a useful outline of these cross-border developments from a Dutch perspective.…”

Dental Therapists’ Role in the Provision of Aesthetic Dentistry in Dental Practice

“…3,4 DTs are GDC-registered professionals educated to either diploma or degree-level and are trained to carry out a range of activities that fall short of the more complex work within the dentist's scope of practice. 5 In addition to fulfilling the remits of a dental hygienist, a dental therapist in the UK is also able to carry out extensive non-complex dental treatment, including the placement of direct restorations in both primary and secondary teeth. It is estimated that only a small portion of dental treatment in general dental practice is complex and that up to 75% of dentists' clinical time is spent on work that could be completed by a dental therapist.…”