Chapter 21- The Dental Profession.

Lots of different professionals make up the dental team.

Dentists [also known as Dental Surgeons or Dental Practitioners] follow a 5 year degree course at a University Dental School leading to the qualification of Batchelor of Dental Surgery. They then have to be admitted to the register of the GDC [General Dental Council] and have in place Professional Indemnity before they are allowed to use the title of dentist or practice their profession. To go into NHS general practice in the UK they are then required to undergo a year of Foundation Training. There are other branches of practice such as the hospital service, the armed forces, the community dental service all having their own career pathways and requirements.

All dentists from qualification onwards in order to remain on the Dental Register and be allowed to practice have to undergo a mandatory, statutory no of hours ‘Continuing Professional Development’ [CPD] per annum and submit evidence of this to the GDC. They are also required to follow a code of practice set down by the GDC.

In the UK as in the USA and Europe are allowed to use the courtesy title Doctor [Dr] providing they do not imply they have a medical qualification. Some use the title some don’t.

All other personnel within the dental profession are called Dental Care Professionals [DCPS] some are allowed to treat the patient ‘hands on’ within their ‘Scope of Practice’ as laid down by the GDC. All have their own statutory qualifications, code of practice, registration, professional indemnity and CPD requirements.

Dental Hygienists and Therapists.

At one time this was 2 separate professions but has now been combined into a 3 year degree course leading to a degree BSc in Dental Therapy and Hygiene giving those qualified a broader range of skills than just the single diploma qualification.

Dental Technicians.

Dental Technicians are skilled craft personnel who construct dentures, crowns, bridges, orthodontic appliances [braces] and many other appliances on prescription from the dentist. Some technicians take a further qualification to become ‘Clinical Dental Technicians’ and can then treat the patient direct for full dentures or on prescription from a dentist for partial dentures.

Dental Nurses.

Dental Nurses [used to be called Dental Surgery Assistants] assist the dentist while he or she is treating the patient. They are responsible for maintaining a clean, safe environment in the surgery, maintaining and sterilising instruments and equipment, helping with administration and other general duties required for the smooth running of the practice. There are several paths to qualification in practice or a teaching hospital involving training ‘on the job’ with lectures, day release or online learning. Dental Nurses can also take further add on qualifications allowing them to perform such duties as taking Xrays [radiographs] and impressions or becoming an Oral Health Educator.

These are the main members of the dental team most people will come across but there are others such as orthodontic therapists and maxillofacial prosthetists and technologists.

The General Dental Council [GDC].

This is the regulatory body of the Dental Profession [dentists and all DCPs]. Its duties are set out in government legislation. Its role is to protect patients from harm and maintain public confidence in the whole dental profession. It does this by;- maintaining the Dental Register so only those with the relevant qualifications are providing patient care, ensuring all training programs are quality assured, setting the standards required of a dental professional and ensuring all dental care professionals fulfil their CPD to keep their skills and knowledge up to date.

Its other role is to investigate serious allegations of a dental professionals ‘fitness to practice’ with regard to skills, knowledge, character, health, criminal convictions or serious professional misconduct, it has the power to suspend someone’s registration or ‘strike someone from the register’.

The British Dental Association [BDA].

This is the professional body that most dentists belong to. It’s a bit like a cross between a club and a trade union. It provides training programs, CPD, advice, journals, toolkits, literature and much, much more.

In addition there are other Associations for General Dental Practitioners, Specialists and all members of the dental team.

Dental Practices.

Dentists in General Dental Practice in the UK can practice within the NHS, privately or a mixture of both.

A dentist treating patients under the NHS has to have an ‘NHS contract’ with their relevant health authority. The organisation and names of these authorities are constantly changing but this is the gist of it.

Years ago the patient went for treatment and for each ‘item of treatment’ the dentist was paid a certain fee. Patients paid part of this fee with exemptions for certain categories such a pregnant and nursing mothers, people on income support and other benefits, those under 18 or under 19 and in full time education. A form was filled in sent off and the dentist was paid- usually months later.

Now there is an equally unsatisfactory system which is essentially the same system in reverse, the dentist is paid in advance to provide a certain number of ‘Units of Dental Activity’ [UDAs] per year. Each item of treatment falls into a certain ‘band’ of UDAs. Unfortunately this means that the dentist is still paid to ‘do things to patients’ not to advise patients on how not to need treatment by preventing dental disease from occurring. There are other things wrong with this system too numerous to mention such as the dentist only receives the same money for 1 restoration as for 10, with no provision for the extra time, materials, staffing costs etc needed nor is there adequate remuneration for complicated treatments such as root fillings or surgical extractions, patients with special needs needing more time etc. Dentists do not have a ‘list’ like a GP, they are not paid per capita for patients.

All dental practices are small businesses with overheads;- rent, community charge, utilities, staffing costs including salaries, sick pay, maternity pay, pensions, holiday pay, training, dental materials, laboratory costs, costs of good sterilisation practices, property, business and public liability insurance, equipment purchase, running and maintenance, normal property maintenance, professional indemnity, other statutory professional registration such as Care Quality Commission, GDC and ICO, office admin costs such as computer systems, postage, telephone, printing.  The list is endless not to mention an income for the dentist/s.

Sadly with increasing costs, variations in expenses over differing parts of the country and an unsatisfactory remuneration system it is becoming increasingly difficult for dentists to practice within this system and consequently for patients to access NHS treatment. Obviously this has implications for the dental health of the nation especially for those on lower incomes.

This situation cannot go on- this is all I am going to say!

Private practices operate like any other business setting their fees according to their overheads and expenses. They also have the freedom to undertake any type of treatment they may wish, in a manner they see fit, without having to abide by someone else’s rules. Their only obligation apart from statutory obligations is to do their best for the person under their care.

Some private practices operate on a fee per item basis, some on a time basis and most on a mixture of the two. There are also various capitation schemes the most well-known of which is probably Denplan now operated by Simply Health [used to be called the HSA].

Some NHS practices survive by basically subsidising their NHS side with private treatment.

Whoever you choose to provide your dental care, choose someone nice you are going to build a relationship with over many years, especially if you are a worried sort of person at the dentist. How to find them? Same way you find anyone else ask your friends, phone them up and see if they sound helpful are they happy to answer all your questions, visit the website, visit them get some leaflets and see how you feel. You may have a few false starts but hopefully you will eventually find someone you like. You can go to a dentist anywhere not just near where you live, I have people who come from all over the country and abroad and I am sure I am not the only one. There will be dentists who are just as nice and just as competent near where they live but they feel comfortable with me and I am honoured to have them!

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