Who does what in the dental team

You book a clean and find you are seeing a hygienist, or a filling turns out to be with a dental therapist. It is fair to wonder who they are and how that differs from seeing the dentist. In the UK a dental team includes people registered under different titles, each with its own training and its own limits, alongside some roles that are not registered.

Who is in a dental team?

The General Dental Council (GDC) is the UK regulator of dental professionals. It registers seven titles: dentist, dental hygienist, dental therapist, dental nurse, dental technician, clinical dental technician and orthodontic therapist. Everyone except the dentists is called a dental care professional. Anyone working in the UK under one of these titles must be on the register, and you can search the register on the GDC website.

A title sets the formal boundaries of a role. Inside them, what a person does day to day also depends on their own training and experience, so two people with the same title can offer different things. If you want to know whether someone can do a particular treatment for you, ask the practice. On the NHS, after your check-up, some of your treatment may be done by a hygienist or a therapist, according to the NHS.

Role	Usually does	Does not do
Dental hygienist	Gum care, prevention, advice	Permanent fillings, crowns or veneers made outside the mouth, braces, extractions
Dental therapist	Prevention, gum care, fillings, baby tooth extractions	Crowns or veneers made outside the mouth, pulp work on adult teeth, adult extractions
Dental nurse	Support at the chair, records, infection control	Diagnosing or planning treatment

What does a dental hygienist do?

Hygienists work mainly on keeping gums and teeth healthy. The GDC lists managing gum disease, preventing decay, giving advice on tooth wear and caring for dental implants among their usual tasks, along with examining your mouth, taking and interpreting X-rays, and referring you on when something is outside their scope.

The NHS describes a scale and polish as a clean by the hygienist, carefully removing the plaque and tartar that build up on your teeth. The Oral Health Foundation adds that hygienists show you how to look after your mouth at home.

The GDC says hygienists do not place permanent fillings, provide indirect restorations (crowns or veneers made outside the mouth), carry out orthodontic treatment, make or fit splints, or extract teeth.

What does a dental therapist do?

Therapists do much of what a hygienist does and more, including prevention and gum disease work. The GDC says they also provide direct fillings for patients of all ages, in baby and adult teeth, and on baby teeth they can carry out pulpotomies (a treatment on the pulp, the soft tissue at the centre of a baby tooth), place pre-formed crowns and extract teeth. The Oral Health Foundation notes that many therapists also treat people in schools and care homes.

They still have clear limits. The GDC says therapists do not provide indirect restorations (crowns or veneers made outside the mouth), carry out procedures on the pulp of an adult tooth, extract adult teeth, do orthodontic work, or make or fit splints. Root canal treatment, the NHS says, tackles infection in the pulp. The GDC says that when the treatment needed is outside their scope, a therapist should refer the patient to a dentist or another relevant healthcare practitioner.

What does a dental nurse do?

The GDC describes the dental nurse’s role as broad, with support for the whole team in all aspects of patient care. Typical tasks include:

• helping during examinations and treatments
• preparing the room and equipment
• keeping infection control standards high
• keeping accurate patient records
• reassuring patients during and after treatment
• giving advice on keeping your mouth healthy

The Oral Health Foundation adds that nurses can answer your questions and put you at ease, and may help with reception work.

Nurses do not diagnose disease or plan treatment. The GDC says they work under the prescription, direction or delegation of a dentist or another registered professional. With extra training they can take on more. Some skills, such as taking X-rays, need specific training and certification set by other regulators, the GDC says.

Who else is on the team?

• Dentists usually lead the team and can carry out the full range of dentistry, so long as they are trained, competent and insured for each task.
• Orthodontic therapists carry out parts of orthodontic treatment (braces) as prescribed by an orthodontist or a dentist trained in orthodontics.
• Dental technicians make custom-made dental devices to a dentist’s prescription. The Oral Health Foundation lists dentures, crowns, bridges and braces.
• Clinical dental technicians provide removable appliances, such as dentures, directly to patients with no natural teeth or implants, and to other patients when a dentist refers them.

Can I book a hygienist or therapist directly?

GDC rules allow it. Before 2013 a referral from a dentist was needed. Now patients can see other members of the dental team directly, and hygienists and therapists can carry out their full scope of practice without a referral, where it is safe and appropriate, according to the GDC.

Tooth whitening is the exception. The GDC explains that, under the law on whitening products, hygienists and therapists can only whiten teeth on a dentist’s prescription, with a dentist on the premises supervising the first treatment.

The GDC also says hygienists and therapists seen directly should refer you to a dentist, or another relevant healthcare practitioner, when they find an area of concern or when the treatment you need is outside their scope.

Whether a practice offers direct booking is its own decision. GDC guidance expects those that do to make clear what you can book, how to book it, and what happens if you need something that person cannot provide. The NHS says to tell your dental healthcare professional if you are anxious, and that you can ask them to stop or take a break during a check-up.

When to see a dentist

If something new is worrying you, contact your dental practice rather than waiting for your next appointment. Whichever role you are booked with, the NHS sets out when to get urgent help.

The NHS says to go to A&E or call 999 for any of the above. Do not drive yourself.

For the following, the NHS says to ask for an urgent or emergency dental appointment, or get advice from NHS 111 now:

• a knocked-out tooth or another injury to your teeth
• severe tooth or mouth pain that affects your sleep or daily activities and is not helped by painkillers
• tooth or mouth pain that painkillers help but that is not going away
• swelling, a lump, or a red or white patch in your mouth that is getting bigger or not going away, whether or not it hurts
• a mouth ulcer you have had for 2 weeks or more that has not healed or has got worse
• bleeding or severe pain after a recent tooth removal
• a broken or loose filling, denture, crown, bridge or veneer

You should be offered urgent dental treatment within 24 hours or 7 days, depending on your symptoms, and within 1 hour, or as soon as possible, for a knocked-out adult tooth.

What we would do

For most people new to us, a new patient exam comes first. We examine your teeth, gums and soft tissues, take small X-rays where needed and explain any options. A dental hygiene appointment is with a hygienist, who assesses your gum health, cleans and scales your teeth and finishes with a polish. Most take 20 to 30 minutes.

Our team page lists everyone by practice with their role and, where one is published, their GDC number, so you can match a name to the register. Roles listed include dentists, dental hygienists, dental therapists, dental nurses, treatment coordinators, receptionists and practice managers. Treatment coordinator, receptionist and practice manager are job roles, not among the GDC’s seven titles. Trainee dental nurses, who work while they train for registration, are not yet on the register.

If you are unsure who your appointment is with or what they can do, ask when you book an appointment.

Want us to take a look?

Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.

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