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.

Evaluation of Postgraduate Foundation Training for Dental Therapists: Does participation enhance career prospects?

“…These ndings align with previous studies which found poor job satisfaction amongst DTs. (18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment.…”

“…(18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment. Most of the respondents were keen to use and maintain their restorative skills in the future, but the job market was viewed as restrictive for DTs with many practices looking solely for hygienists, or advertising for DTs and then only referring hygiene patients.…”

“…These barriers are widely acknowledged by the profession and this qualitative research supports the ndings of the previous literature, that the current remuneration system limits delegation to DTs. (19,(38)(39)(40)(41) Contrary to these ndings, workforce planning and operational modelling studies suggest that optimal skill-mix and implementation of DTs has signi cant cost-saving potential for NHS services. (13,(42)(43)(44) Furthermore, correct utilisation of DT skills has a potential to increase access to dental care and improve oral health through delegation of up to 77% of clinical time to DTs.…”

Evaluation of Postgraduate Foundation Training for Dental Therapists: Does participation enhance career prospects?

“…These ndings align with previous studies which found poor job satisfaction amongst DTs. (18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment.…”

“…(18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment. Most of the respondents were keen to use and maintain their restorative skills in the future, but the job market was viewed as restrictive for DTs with many practices looking solely for hygienists, or advertising for DTs and then only referring hygiene patients.…”

“…These barriers are widely acknowledged by the profession and this qualitative research supports the ndings of the previous literature, that the current remuneration system limits delegation to DTs. (19,(38)(39)(40)(41) Contrary to these ndings, workforce planning and operational modelling studies suggest that optimal skill-mix and implementation of DTs has signi cant cost-saving potential for NHS services. (13,(42)(43)(44) Furthermore, correct utilisation of DT skills has a potential to increase access to dental care and improve oral health through delegation of up to 77% of clinical time to DTs.…”

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 ].…”

It’s not just about the money: recruitment and retention of clinical staff in general dental practice – part 2: dental care professionals

“…18,19 Previous studies have reported on therapists feeling that they are valued members of the team within general dental practice, 37 yet a lack of understanding from dentists on their scope can affect this, so this may vary between practices where the dentist does understand the role and scope of therapists. 39…”

Evaluation of Postgraduate Foundation Training for Dental Therapists: Does participation enhance career prospects?

“…These ndings align with previous studies which found poor job satisfaction amongst DTs. (18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment.…”

“…(18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment. Most of the respondents were keen to use and maintain their restorative skills in the future, but the job market was viewed as restrictive for DTs with many practices looking solely for hygienists, or advertising for DTs and then only referring hygiene patients.…”

“…These barriers are widely acknowledged by the profession and this qualitative research supports the ndings of the previous literature, that the current remuneration system limits delegation to DTs. (19,(38)(39)(40)(41) Contrary to these ndings, workforce planning and operational modelling studies suggest that optimal skill-mix and implementation of DTs has signi cant cost-saving potential for NHS services. (13,(42)(43)(44) Furthermore, correct utilisation of DT skills has a potential to increase access to dental care and improve oral health through delegation of up to 77% of clinical time to DTs.…”

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 ].…”

It’s not just about the money: recruitment and retention of clinical staff in general dental practice – part 2: dental care professionals

“…18,19 Previous studies have reported on therapists feeling that they are valued members of the team within general dental practice, 37 yet a lack of understanding from dentists on their scope can affect this, so this may vary between practices where the dentist does understand the role and scope of therapists. 39…”

Evaluation of Postgraduate Foundation Training for Dental Therapists: Does participation enhance career prospects?

“…These ndings align with previous studies which found poor job satisfaction amongst DTs. (18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment.…”

“…(18)(19)(20) The perceptions of dentists towards DTs has been well documented and supports the experiences of the respondents; there is a lack of awareness of the DT SOP and reservations about their training and competence. (19,45,48) This lack of acceptability limits job opportunities and as a result DTs are ful lling roles which focus on hygiene and periodontal treatment. Most of the respondents were keen to use and maintain their restorative skills in the future, but the job market was viewed as restrictive for DTs with many practices looking solely for hygienists, or advertising for DTs and then only referring hygiene patients.…”

“…These barriers are widely acknowledged by the profession and this qualitative research supports the ndings of the previous literature, that the current remuneration system limits delegation to DTs. (19,(38)(39)(40)(41) Contrary to these ndings, workforce planning and operational modelling studies suggest that optimal skill-mix and implementation of DTs has signi cant cost-saving potential for NHS services. (13,(42)(43)(44) Furthermore, correct utilisation of DT skills has a potential to increase access to dental care and improve oral health through delegation of up to 77% of clinical time to DTs.…”

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 ].…”

It’s not just about the money: recruitment and retention of clinical staff in general dental practice – part 2: dental care professionals

“…18,19 Previous studies have reported on therapists feeling that they are valued members of the team within general dental practice, 37 yet a lack of understanding from dentists on their scope can affect this, so this may vary between practices where the dentist does understand the role and scope of therapists. 39…”