Scopes of practice competencies for dental therapists

A competent dental therapist is one who applies knowledge, skills, attitudes, communication, and judgement to the delivery of appropriate oral health care in accordance with the scope of practice within which they are registered.

 Understanding current scientific knowledge

A competent dental therapist understands current biological, physical, cultural, social, and psychological factors involved in dental and oral disease, and in attaining and maintaining oral health.

Measuring understanding

The dental therapist:

  • demonstrates an understanding of biological, physical, cultural, social, and psychological factors in dental therapy
  • communicates this knowledge to patients and the wider community
  • demonstrates familiarity with, and implements, oral health maintenance programmes.

 Obtaining patient information

A competent dental therapist obtains, by interview and examination, patient information needed to deliver oral health care, and records this information logically, legibly, and securely. The dental therapist also complies with the Dental Council’s patient information and records practice standard.

Measuring patient information

Records show:

  • an adequate medical history
  • an adequate dental history
  • adequate charting, demonstrating that all dental tissues and associated structures have been examined closely
  • evidence of posterior bitewing and periapical radiographs as appropriate to diagnose and manage dental caries
  • evidence of adopted Care/Treatment Plan
  • evidence of consent to Care/Treatment Plan received.

 Analysing information and planning an oral health care programme

A competent dental therapist assesses client or patient information to identify oral health problems. The dental therapist then formulates an evidence-based intervention programme that  that addresses these problems and includes:

  • priority of management
  • patient options
  • predicted outcome
  • the extent and duration of the intervention.

Measuring analysis and planning

The dental therapist demonstrates and records:

  • accurate information on teeth present/missing or restored
  • any potentially harmful conditions e.g. enamel caries, gingivitis, calculus
  • an adequate, evidence based, prioritised preventive/treatment protocols which include application of radiograph results where appropriate
  • any period of recall/review according to District Health Board (DHB) or practice criteria.

 Providing oral health care

A competent dental therapist clearly communicates the details of an oral health care plan to patients to obtain informed consent. Where necessary, a competent dental therapist carries out agreed procedures and manages any complications. The dental therapist provides patients and parents with full explanations and information to make informed decisions.

Measuring clinical competence in preventative care

The dental therapist demonstrates clinical competence in:

  • placing fissure sealants and preventive coatings according to DHB or practice criteria
  • applying topical fluorides based on the assessment of the caries risk of the patient, derived from DHB or practice protocols.

Measuring clinical competence in restorative intervention

The dental therapist:

  • records decisions as to need for restorative intervention
  • records decisions as to the selection of materials
  • considers any current DHB or practice guidelines in decision-making
  • restores integrity and function of the tooth
  • alleviates pain.

Measuring clinical competence in use of local anaesthetics

The dental therapist demonstrates clinical competence in:

  • using correct solutions and technique
  • confirming adequate anaesthesia is achieved.

Measuring clinical competence in radiography

The dental therapist demonstrates clinical competence in:

  • complying with guidelines for the use of bitewing/periapical radiographs. For further information refer to School Dental Service Guidelines – Use of Radiography and Code of Safe Practice for the use of x-rays in dentistry , NRL C7
  • relating patients’ needs with the relevant structures in view
  • providing adequate film quality, correctly mounted
  • taking a view ideal for diagnosis
  • practising satisfactory radiation safety
  • using bitewing and periapical radiographs as appropriate  to diagnose and manage dental caries
  • applying preventative/treatment options based on the depth of lesions identified in radiographs
  • recording accurate reports.

Measuring clinical competence in oral health promotion

The dental therapist:

  • provides ‘one on one’ counsel and advice to encourage sound attitudes and practices
  • demonstrates a commitment to oral health promotion by working with other health personnel and/or educational staff where appropriate
  • communicates the importance of issues such as diet, smoking, etc on oral health
  • expresses a professional view on fluoride, amalgam and other topical public issues.

Knowing when to refer

A competent dental therapist refers for advice or treatment where diagnosis and treatment planning indicates that the patient requires a level of knowledge or skills greater than those of the dental practitioner. Any recertification programme or Dental Council minimum recertification requirements are fulfilled.

Measuring clinical competence in referrals

  • the dental therapist demonstrates clinical competence in: obtaining advice from other health professionals where necessary
  • having in place a written agreement with a dentist(s) for professional advice
  • making appropriate referrals
  • completes relevant documentation.

Assessing the effectiveness of oral health strategies

A competent dental therapist objectively assesses both short-term and long-term outcomes of oral health strategies.

Measuring competence in assessing effectiveness

The dental therapist demonstrates competence in:

  • understanding the prognosis for treatment strategies offered to individuals and to the community at large
  • communicating this knowledge to patients and the wider community.

 Communicating effectively

A competent dental therapist communicates effectively with and educates patients, other health workers, and the public on oral health matters.

Measuring competence in communications

With patients, the dental therapist demonstrates:

  • good rapport
  • empathy
  • explanation of findings, treatment options and likely outcomes in easily understood language to ensure informed consent
  • spoken English equivalent to 7.5 on the Academic Skills Category of the International English Language Testing System with no less than 7 in each of the four bands.
  • information is adapted to patient’s level of comprehension
  • patient’s understanding of the information provided is confirmed
  • the ability to assure patient dignity.

With other health professionals, the dental therapist:

  • refers where necessary
  • seeks advice where necessary
  • contributes dental input to overall health treatment planning.

 Providing a culturally safe practice

The competent dental therapist sees issues from the perspective of people of other cultures and adheres to the Treaty of Waitangi.

Measuring competence in providing a culturally safe practice

The dental therapist demonstrates a commitment to provide a culturally safe practice including:

  • observing cultural etiquette where appropriate
  • considering cultural perspectives in decision-making
  • practises in a way which respects each patients identity
  • facilitates the patient’s access to services and resources
  • shows an understanding of the principles of the Treaty of Waitangi
  • demonstrating awareness of New Zealand’s bicultural society and ensures that Maori receive dental therapy services that meet their needs.

 Preventing cross infection

The competent dental therapist undertakes procedures to ensure compliance with Dental Council infection control practice standard.

Measuring competence in preventing cross infection

With equipment and work surface, the dental therapist:

  • cleans all equipment after use
  • ensures all instruments and equipment are handled and cared for in a manner which prevents cross-infection
  • treats all patient body fluids as potentially infectious
  • defines contaminated and uncontaminated work areas
  • uses Chemical indicators  with every autoclave cycle
  • uses biological indicators (minimum weekly)
  • follows between patient clean-up and disinfection process.

With personal protocols, the dental therapist:

  • demonstrates hand-washing protocols
  • complies with wearing of gloves, masks, protective eyewear, protective clothing during treatment phase
  • maintains personal Infection Control audit monthly.

 Maintaining a safe work environment

The competent dental therapist undertakes occupational health and safety procedures to ensure compliance with relevant laws and practice standards.

Measuring competence in maintaining a safe work environment

The dental therapist demonstrates a safe working environment including:

  • monitoring emergency plans and accident/incident protocols
  • controls identified hazards by using/taking the protective measures supplied/identified
  • arranging equipment in the surgery to enable the therapist and patients to be able to move safely within this environment
  • checking materials for expiry dates and rotating as required
  • keeping hazardous materials in a secure area
  • placing used needles in a Sharps disposal unit
  • placing contaminated waste in a secure container
  • reporting all actual and potential incidents.

 Understanding scientific methodology

The competent dental therapist undertakes research and/or analyses relevant scientific literature, and applies findings to the delivery of appropriate oral health care.

Measuring competence in applying recent knowledge to practice

The dental therapist demonstrates understanding of current issues including:

  • reading scientific publications in oral health
  • remaining current in research informed practice
  • sharing experiences and case studies of dental therapy practice with colleagues.

 Maintaining competence

The competent dental therapist maintains competence by monitoring the outcomes of oral health care delivery, and undertaking continuing personal professional development.

Measuring maintaining competence

The dental therapist reviews their own professional practice including:

  • monitors performance against set standards
  • identifies skills, knowledge and attitudes to be developed
  • identifies learning needs for personal professional development
  • implements an active professional development programme
  • discusses professional issues with colleagues.

The dental therapist demonstrates:

  • compliance with Dental Council practice standards
  • Dental Council minimum recertification requirements are fulfilled.

Understanding and complying with legal requirements

The competent dental therapist understands and complies with the ethical responsibilities and legislative requirements for the safe and competent practice of dental therapy in New Zealand.

Measuring legal understanding and compliance

The dental therapist demonstrates familiarity with, and complies with, relevant legislation and professional standards including:

  • Health Practitioners Competence Assurance Act 2003
  • Health and Disabilities Services Consumer Rights
  • Radiation Protection Act
  • Medicines and Misuse of Drugs legislation
  • Privacy Act and the Health Information Privacy Code
  • Occupational safety and health legislation
  • Children, Young Persons and their Families Act — specifically the protection of children.
  • Dental benefits
  • Dental Council prescribed scopes of dental therapy practice.