Kevin Lewis column

Regular columnist Kevin Lewis ponders how, in these diverse times, defining the term ‘dentistry’ is becoming more and more difficult.

Identity crisis

History has a reassuring tendency to repeat itself, and much of what causes the greatest surprise, instability and upset in one field is already yesterday’s news in another. The real disappointment is perhaps how rarely we take full advantage of ready-made solutions that others have created for us out of their own similar experiences beyond dentistry.

I think it is gradually dawning upon UK dentists that the recent visitors to the sacred grass of the members’ enclosure that was once reserved exclusively for dentists are neither itinerant campers nor short-term squatters. In most cases they are here by right, and here to stay.

After all, barristers lost their monopoly on many of their historic rights of court audience some time ago. Solicitors lost their monopoly firstly on conveyancing and later (through Bar Direct) their traditional ‘gatekeeper’ function regarding access to the Bar. Opticians lost their monopoly on the supply of spectacle frames and pharmacists were often helpless onlookers as medical practitioners turned in-house dispensing into a profitable art form.

In many cases these professions survived and thrived because they learned to adapt to the new world. It is easy to assume that we in the dental profession have been singled out for special (and unfair) treatment, but in fact our identity crisis has simply occurred later than for others. For example, the Ward Sister used to exert her iron rule over her ward and Sister was accountable to Matron. And that meant Accountable with a capital ‘A’.

Consultants were then the kings and queens of just about everything else. But that was before the NHS discovered managers, of course, at a time when you could still eat your breakfast off the floor of those spotless, polished wards while admiring those freshly laundered starched uniforms.

In recent years, managers have seemed to understand nothing about clinical care, and even less about management. But they knew everything about budgets, league tables and star ratings. The days of floor polish, starch and iodine were also the days of strict visiting hours, when you sat on a patient’s bed at your peril – especially if Matron was looking. Now you can visit at all hours, and sit on beds whenever you choose – but nobody does, because their fear is not of Matron’s wrath, but of what they might catch. Before long it will be the visitors who will be wearing the gloves, masks and gowns – for their own protection.

So here in dentistry, at long last, clinical dental technicians can offer their services direct to the public, and the construction of dentures is no longer the sole preserve of dentists. Thank goodness for that – and not a minute too soon, if you ask me.

What’s in a name
Historically, the British Dental Hygienists’ Association (BDHA) and the British Association for Dental Therapists (BADT) have been separate, distinct organisations. Indeed, I was once the proud vice president of the latter. Dental hygiene and dental therapy had very different roots, of course, having originally been trained separately and until relatively recently therapists were precluded from working outside the public sector. Since last July we have no longer had two separate lists of procedures that each can undertake. Indeed, we don’t even have one list now, as both groups – like any other registrant (including dentists) – must simply work within the limits of their training, skills and competence.

The edges of dental hygiene and dental therapy have been blurred, therefore, and many of today’s registrants are effectively doubly qualified as hygienist therapists. The recent re-naming of BDHA (now the BSDHT – the British Society of Dental Hygiene and Therapy) should not be assumed to imply a merging of the two associations, however much a cursory glance at the title might suggest otherwise. Hygienists and therapists, just like dentists, have a lot of change to adjust to and territorial issues to resolve, and in this connection, the distinction between the old and new title is subtle, but fundamental.

Here in the UK the terms ‘dental nurse’ and ‘dental surgery assistant’ will soon be protected by law for the exclusive use of registered dental nurses. In days gone by, it was de rigeur to refer to them as dental surgery assistants, and the term ‘dental nurse’ was almost frowned upon. This situation was then reversed and the relevant association (formerly the ABDSA) was duly renamed (BADN). In Australia, strangely enough, the dental nurses are emphatically ‘dental assistants’ and won’t answer to any other soubriquet. They are not registered, although the prosthetists (clinical dental technicians) and technicians mostly are. It’s a funny old world.

It may or may not be a coincidence that, just as the massed ranks of all the above mentioned are pitching their tents on the hallowed turf of dentistry – and not just in the outfield, but quite close to the centre circle too – many dentists are inching their way out towards the corner flags of dentistry, towards what might be termed ‘complementary therapy’ ‘alternative medicine’, ‘cosmetic surgery’ or at least ‘health & beauty’. At the same time, the existing purveyors of these very services in health & beauty salons, tanning clinics and the like are eyeing up some suitably synergistic areas of ‘dentistry’ – like tooth whitening and the application of tooth jewellery.

There has always been a bit of a turf war between the oral & maxillofacial surgeons, and the cosmetic surgeons – more acute in some countries than in others, I must say – but an accommodation is usually reached between the two until the market gets too crowded (or individuals perceive it to be so because they are feeling the commercial pinch). Sooner or later, someone will cry foul and then the fun and games really starts.

Diversity of supply and patient choice is important. But so too is public safety. And we need to bear in mind that protectionism and self-interest not infrequently masquerade as a concern for public safety. The conundrum for the GDC to resolve – and I don’t envy them the task – is to define what does and does not constitute ‘dentistry’. And this increasingly depends upon who’s asking, why, and when, because this is fast becoming a shifting and unstable platform. If we don’t know for sure what ‘dentistry’ is, what hope have the patients got? Not to mention the potential identity crisis for this very publication – perish the thought!

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