BSDHT and BADT response to the article, ‘Can a hygienist work without a nurse?’ written by Len D’Cruz and Reena Wadia

Sir,

We write in response to the article, ‘Can a hygienist work without a nurse?’ written by Len D’Cruz and Reena Wadia.1

It seems that article attempts to allay the fears of practice owners and dental hygienists that working without dental nursing support is acceptable as there is no legal or regulatory necessity to do so. The authors quote: ‘…the GDC envisages clinicians such as dentists, hygienists and therapists not working in isolation but with other members of the team who can assist primarily with a response to a medical emergency.’

The authors acknowledge that, ‘Clearly ‘support’ can be provided for administrative tasks, chaperonage and chairside assistance…’ and that GDC Standards for the Dental Team 6.2.2. clearly state: ‘You should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting.’ However, there are no further references to the remaining GDC standards which state:

The only circumstances in which this does not apply are when:

  • Treating patients in an out of hours emergency
  • There are exceptional circumstances – these are unavoidable circumstances which are not routine and could not be foreseen.

The authors, by their own admission, agree that these standards apply to dentists, dental hygienists and therapists. Therefore, there should be no distinction between any of these clinicians when this standard is applied.

A periodontal specialist treating a patient non-surgically would expect to have dental nursing support, however, for many years there has been an acceptance that dental hygienists can work alone without the support of a dental nurse. Now the authors are recommending a risk assessment to be carried out in these situations. A risk assessment cannot fully assess every patient that dental hygienist treats but would give a general view of the risk associatedwith treatments delivered. BSDHT and BADT find this situation and justification for lone working unacceptable.

Furthermore, suggesting that as a referring dentist they should volunteer their own mouth to be the test bed of the skillset of the dental hygienist they wish to refer to and that, ‘if nothing else you will end up with clean teeth and a greater empathy for all dental patients who see you and sometimes cough and splutter their way through treatment because you didn’t give them chance to breathe or swallow or wince in pain when you are a bit heavy handed with the scaler’ is a patronising and demeaning statement which has no place in this article.

We acknowledge the authors do make the point that the ideal is to employ a full-time dental nurse to assist (we prefer the adjunctive ‘support’) the hygienist and that this should not be precluded due to financial considerations. There is also consideration to acknowledge the daily struggle a lone hygienist faces. The ‘helpful’ strategies imparted were predicated with, ‘a hygienist that can do just that (working without assistance) would certainly be seen as an asset to any practice and valued professionally amongst the team’. This implies that a dental hygienist who works with dental nurse support will not be an asset or valued professionally.

The suggested strategies, whilst seeming to be written to help the dental hygienist work more smoothly through the day, still require valuable additional time for preparation, challenges with infection control, safe patient management and contemporaneous record keeping.

An important issue, not discussed in the article, is the stress that lone working places on dental hygienists. This is particularly pertinent to our newly-qualified colleagues who have had full support throughout training but are then expected to work in an environment without nursing support whilst trying to build confidence and competence in their chosen profession.

Despite one of the authors being a dento-legal advisor, our members report that their indemnity providers have advised it would be difficult to support them in any litigation brought against them because they did not have nursing support.

Following publication of this article, as you would expect, we have been inundated with reports of such difficulties from our members and non-members: all are concerned that this ‘in depth’ piece on ‘regulation’ gives further justification to their practice owners to refuse nursing support.

BDJ in Practice’s strapline is ‘This popular publication aims to inform and educate dentists and dental students about developments, trends and issues affecting dental practices in the UK’. The article was aimed at dental hygienists whilst being published for dentists. It begs the question: Why?

As clinicians we are not asking for anything different to what the dentist expects daily: simply parity among the clinical team.

BSDHT and BADT request an apology from the authors, acknowledging the concerns and strength of feeling their article has created among the dental hygiene and dental therapy professions. We would also like to write an article to be published in BDJ in Practice to redress the balance.

Yours sincerely,

Julie Deverick & Debbie McGovern

President BSDHT President BADT

  • 1.D’Cruz L, Wadia R. Can a hygienist work without a nurse? BDJ In Practice 2019; 
“Welcome from the Editor can be found here

 

Please see co-signatories to the letter below:

Abi Morris Debra Thomas Joe Chikosi Louise Goodman Shannon Stevenson
Abigail Whiteway Deepak Simkhada Johanna Moore Louise Gorman Sharon Adams
Adele Fox Diana Dollery Johanna Reid Louise Stanton Sheena Fogg
Ailsa Hall, Diane Paton Jolene Pinder Lucy Barsby Simin Rounagh
Alexandra Bishop Diane Rochford Josephine Rawcliffe Lucy Neshan Simone Ruzario
Alexandra Jorgensen Donna Corey Judith Williams Lucy Thompson Sonia Jones
Alicia Randall Dorina Trissia Judy Caesley Lyn Hinde Sonya Neal
Alina Bachmatchi Eileen Vallely Julie Ellis Lynn Chalinder Sophie Kent
Alisha Anderson Elaine Tilling Julie Wakefield Lynn Munday Sophie Sheen
Alison Griffiths Elizabeth Gee Juliette Reeves Lynne Thomson Coulter Stacey Harrison
Alison Lowe Elizabeth Gillard Juliette Sproston Magdalena Biernacka-Kaczmarek Stefanie Binnee
Alison Stevenson Elizabeth Goodchild Karen Cashmore Maggie Jackson Stephanie Rowena Dodds
Allison Wilson Elizabeth Hudd Karen Dean Maria Bialas Sue Green
Amanda Borthwick Elizabeth Lilly Moffatt Karen Fallon Maria Martinez Suzanne Riordan
Amanda Evans Elizabeth Liversidge Karen Leighton Marisa Scannell Suzanne Threadgold
Amanda Gallie Elizabeth Longworth Karen Rowe Mary Annastasia Kellett Wright Sylwia Bartoszuk
Amanda Skyrme Elizabeth Stockley Karen Valentine Mary Moss Tatiana Knight
Amanda Sowter Ellen Gregory-Evans Karen Wraight Maureen McElligott Theresa Bovington
Amber Ojak Ellie Stiles Katarzyna Jackowska Max O'Neill Tina Nielsen
Amy Blyth Emily Pontin Kate Fry Megan Sheehan Toni McGovern
Amy Carter Emma Bingham Kate Jones Meghan Thomas Tonia Tyreman
Amy Garlick Emma Hornby Kate Mackey Michelle Bygrave Tracey Cope
Amy Hayes Emma L Williams Kate McKenzie Michelle Hawker Tracey Giles
Amy Stevens Emma Rettig Katharine Arnold Michelle Huntington Traci Jones
Amy-Jayne Hardisty Emma Stephenson Katharine Wright Michelle Lyne Tracy Davies
Andrea Hammond Emma Whalley Katherine Brady Michelle Paxton Tracy Doole
Andrea Powell Erica Clatworthy Katherine Field Michelle Rasmussen Tsitsi Plummer
Andrea Wheeldon Erica Leslie Katherine Foster Miranda Steeples Udita Patel
Andreza Tonello Stay Faiza Ullah Katherine Redmond Mittie Shah Vicki Glover
Angela Chambers Faye Donald Katherine Reynolds Molly Hodgetts Vicky Williams
Anna Laskowska Faye Fraser Kathryn Armstrong Morag Powell Victoria Beer
Anna Middleton Fiona Baker Kathryn Birnie Morgan Williams Victoria Jones
Anna Seymour Fiona Noble Kathryn Mayo Morna Baker Victoria Worth
Anne Connor Fiona Sandom Katie Ellis Nafiseh Ghasemi Wannitta Parkin
Anne McIntyre Frances Marriott Katie J Willis Naomi Farrell Wendy Baker
Annette Matthews Frances Sands Katie Parker Natalie Bisby Wendy Regan
Annmarie Yarwood Franchesca White Katie Rowland Nathan Fisher Yazmyn felix
Anwar Pandhair Gabriel Mudzi Katie Shephard Negar Attarzadeh Yvonne Kimbley
Ariana Kicka Gemma Elizabeth Davies Katie Turner Nicol Sculler Zara Taylor
Arlene Struthers Gemma Jeffrey Katrina Clark Nicola Davey Zawditu Dunn
Ashley Rossitter Gemma O’Callaghan Katrina Reid Nicola Francis Zaynab Dar
Ashley Sudlow Geraldine Forrest Katy Gandhi Nicola Hubbard Zeeshan Ahmed
Beata Rzeznik Geraldine Todd Kayleigh Maughan Nicola kempson Zoe Laws
Benjamin Blum Gillian Cliffe Keeley Ross Nicola Perry Zoë Moreton
Bethan Falconer Gillian Mills Kelly Newton Nicola Willetts
Bev Pates Gillian Wilding Kelly Skinner Nicole Mclachlan
Bianca Agirbicean Grace Anderson Kelsey Clark Nikki Kinsman
Bobby Keeling Greta Compton Kerry Robinson Nimisha Patel
Caitlin Goodman Gulab Singh Kim Baxter Nina Ainsworth
Carly Longbottom Hannah Tehver Kimberly Mclean Nina Older
Carrie-Anne Taylor Hannah Weersuriya Kirstie Harper Olga Pisklova
Catherine Barber Harriet Buley Kirstie Thwaites Pamela Currie
Catherine Harris Heather Lewis Kirsty Sim Philip Wood
Catherine Laws Helen Camm Kirsty Smith Poppy Walsh
Catherine Swindlehurst Helen Minnery Kirsty Wickham Prian Varsani
Catherine Tait Helen Norris Laura Andrews Prue Preston
Catherine Van-Bellen Helen Pigg Laura Barry Rachael England
Ceili Banks Helen McAllister Laura Berry Rachael Mounce
Chandni Patel Helene Schirmer - Hyde Laura Ceaser Rachael Robinson
Charley Graham Idalina Silva Laura Cox Rachel Bennett
Charlie Wong Isabella Fabian Laura Field Rachel Bromley
Charlotte Alkemade Ivy Nzuma Laura Mauchan Rachel Butler
Charlotte Baker Jacky Hart Laura McClune Rachel White
Charlotte Bolt Jacqui McNair Laura Thompson Rachelle Peel
Charlotte Bond Jade Hutchison Laura Timmins Rahanuma Miah
Charlotte Garbutt James Moore Lauren Ford Rebecca Cayton
Charlotte Gardner Janani Nakrani Lauren McGovern Renata Ana Sakinyte
Charlotte Green Jane Dale Lauren Nowlan Rhiannon Jones
Charlotte Hinchcliffe Jane Dixon Lauren Skornia Rhonda Harrison
Charlotte Sproston Jane Lowe Leah McAteer Riya Lallbeeharry
Charlotte Thompson Jane Roddam Leanne De Piano Rosie Wright
Chloe Amphlett Janet Eckersley Leanne Jones Roy Anthony
Christina Pope Janet Erridge Lee Walker Rumana Husein
Christina Winterburn Janette Murphy Lee-Anne Smith Ruth Coffey
Christopher Arnold Janine Ford Leigh-Ann Randell Ruth Potterton
Christopher Forrest Jayne Sumner Lesa Glover Ruth Thomas Greenslade
Christy Lush Jennifer Coyle Lesley Mizen Sabina Camber
Ciara Gill Jennifer Godwin Lewis Wigglesworth Sabina Ismail
Claire Brewer Jennifer Joynson Lidia Brion Silva Sadeka Ali
Claire Gallagher Jennifer Pearce Lidiana Santos Sam Davidson
Claire Hodgkinson Jennifer Stennett Linda Koziarska Samantha Airey
Claire McFadden Jenny Ashcroft Linda Allison Samantha Buckland
Clare Burton Jenny Walker Lindsey Peddle Samantha Turner
Clare Clowes Jessica Brudenell-Bush Linzi Anderson Samantha Williams
Clare Gerrish Jessica Liepa Lisa Foulger Barthropp Sanet Taylor
Clare Martin Jill Hetherington Lisa Goddard Sara Cohen
Clare Padgett Jill Young Lisa Highley Sarah Bailey
Clare Taylor Jillian Mitchell Lisa Jane Cameron Sarah Brownlie
Corinne Waterson Jo Dewhurst Lisa Rodway Sarah Cather
Corrinna Townsley Jo Dickinson Lisa Smith Sarah Cox
Courtney Coey Joanna Edwards Lisa Staines Sarah Doran
Danielle Houston Joanna Jurek Loan Rosie Hong Thi Van Sarah Miles
Danielle Owen Joanna Shakespeare Lorna Baeten Sarah Murray
Dave Martin Joanne Bell Lorna Milligan Sarah Patrick
Dawn Hull Joanne Hanson Lorna Ogilvie Sarah Thomson
Debbie Ferguson Joanne Martin Lorna Small Sarah Thorne
Debbie Hemington Jocelyn Harding Louisa Clarke Sarah Townsend
Debra Carnell Jodi Baird Louise Astley Sarah Walker
Debra Mitchard Jodie Blyth Louise Clark Sarah-Jane Martin

 


 

 




Editors Notes

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CONTACT

BSDHT

enquiries@bsdht.org.uk

01788 575050

ABOUT BSDHT

The British Society of Dental Hygiene and Therapy (BSDHT) is a nationally recognised body that represents over 4,000 Dental Hygienists and Dental Therapists across the UK and beyond.

BSDHT maintain an on-going dialogue with the General Dental Council (GDC), the Departments of Health and all of the main groups representing dental care professionals, and attends meetings of the All Party Parliamentary Group (APPG) for Dentistry, bringing dental hygiene and therapy to the attention of government ministers and MP’s.

Visit www.bsdht.org.uk for more information.

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