Dental Tribune United Kingdom Edition

10 Feature May 21-27, 2012United Kingdom Edition S arah Murray (SM): So Christina, Dental Health Spa is five years old this year; what’s on the agenda? Christina Chatfield (CC): Hopefully to see a change in the way that patients can ac- cess hygiene services would be great. I suppose in my na- ivety five years ago I thought that Direct Access was around the corner because of the strong recommendation from the Office of Fair Trading (OFT) to remove the ‘under prescription’ rule. This rec- ommendation came about because of a super complaint made by the Consumers As- sociation (WHICH) in 2003. The OFT report did make a number of recommendations, one was to allow registered professionals with the GDC, other than dentists, to set up and manage the business of dentistry; hence independent practice was born. It is a tough and challenging working en- vironment which any dentist will tell you and it is no dif- ferent for me but it’s certainly not Direct Access. Here we are, nearly a decade on and the OFT are relooking at the issue of Direct Access and diagnosis. All I want to do is treat patients within my scope of practice, and provide my patients with an acces- sible, high quality service. I am sure many dental hygien- istists/therapists want what I want - to be recognised for the high quality of treatment that we can provide with a degree of autonomy. Not everyone wants to work in independent practice like me; independent practice is hard work and is not the team dynamic that all of us wish to work within. I am confident that Direct Access will work well for a dentist- led business, allowing their patients to access their dental hygienist directly. It’s worked for me; I have 4,500 patients who have come in through my door since I opened in 2007 with the majority looking for hygienist care. Many had a dentist, who didn’t have a hy- gienist, and some couldn’t get an appointment to see their hygienist when it suited them, or had to take holiday to at- tend for treatment! Unfortunately the ‘under pre- scription rule’ still stands - a patient cannot see a dental hygienist or therapist to have their prevention and oral hy- giene needs met without a dentist’s permission. How- ever, they can take a copy of their treatment plan to any clinician of their choice. My experience, which is shared by many of my colleagues, is that very few patients are giv- en an in-depth treatment plan, a diagnosis or even an accu- rate BPE. SM: BPE has been around for nearly 25 years and is taught as part of the undergraduate training, irrespective whether the student is studying BDS or hygiene/therapy; they are taught together. All the stu- dents’ learn this in their second year, so it gives them ample time to consolidate this and use it as a diagnostic and treat- ment tool. When our compe- tency is constantly questioned, it should be noted that as our scope of practice has changed over the years, so has the ro- bust core training programme that underpins our profession. CC: Sarah, with such a sim- ple diagnostic treatment tool that’s been around for 25 years, why in the most re- cent Adult Dental Health Sur- vey, are perio disease levels still so high? SM: Well I think people have ‘white coat syndrome’ and get nervous about seeing their den- tist. In a survey by the British Dental Health Foundation for last year’s launch of National Smile Month, it was stated that people were more frightened of their dentist than they were of snakes and spiders. Patients are consumers at the end of the day, who want fresh, white teeth and healthy gums, and they feel that hygienists and thera- pists can provide this and are (as a professional group) pos- sibly seen as less threatening. CC: I agree with you, the Adult Dental Health Survey also said that 12 per cent of the popu- lation do not go to the dentist due to dental anxiety, so, this core group do not receive any oral cancer screening, any prevention advice or smoking cessation advice. Why then, in the 78 per cent that go to the dentist, is the level of peri- odontal disease so high? One might question if the BPE, the very simple diagnostic tool that we are all taught, may not be being used accurately or widely enough. SM: It is true to say that stu- dents know how to carry out a BPE, what pressure to put on the probe (25g of pressure), they know about angulation and they are aware of operator variables, so it is being taught and used in dental school, but we don’t know the uptake of this after they leave. Is it be- ing used? Is it accurate? Do we know how many hygien- ists get a BPE from their den- tist in their treatment plans? How many of the teams actu- ally calibrate with their den- tists to ensure intra and inter operator accuracy? In terms of a clear diagnosis, other than a dentist saying the patient has gum disease – how many times are you advised whether it is chronic or aggressive - you are often left to decide this for yourself. Evidence is the key thing here and whilst we my all know that we often re- ceive no treatment plans or accurate diagnosis we don’t have the evidence. This is why we are asking that dental hy- gienists and therapists help us collate the evidence that we need to support this. Our survey seeks to establish the evidence surrounding refer- ral practice for dental hygiene treatment. Please complete our Survey Monkey questionnaire. Even if you are happy with the status quo, we want your views. Join the 300 who have already completed the survey. You are asked to give your GDC number for validation purposes only this data will be collated without reference to the participant. DT Conversations at the water fountain Dental Hygienists Sarah Murray and Christina Chatfield discuss Direct Access and the importance of having your say on this controversial issue Go to www.surveymonkey. com/s/HK8C56P or go to ww.bsdht.org.uk and click on Direct Access Action Group survey on their front page. The GDC is also asking for your views please take time to fill out their survey, https:// response.questback.com/ thegeneraldentalcouncil/ yvjvmbknii/ Change won’t happen if you say nothing at all. ‘All I want to do is treat patients with- in my scope of prac- tice, and provide my patients with an accessible, high quality service’ About the authors Sarah Murray teaches dental hygiene and therapy at Barts and The London School of Medicine and Dentistry, in addition to teaching at the University of Essex. She believes that both den- tal hygienists and therapists have the skills and abilities to undertake Direct Access for patients acting in the pa- tients’ best interest. Christina Chatfield, a dental hygien- ist, is clinical director and owner of Dental Health Spa Ltd in Brighton. She has more than 20 years’ experi- ence in practice and qualified from Dundee in 1982. She is currently studying a two-year Diploma in Perio at King’s College Dental Hospital in London.