Debate: Direct access to dental hygienists; for and against

As many of you have probably heard and read about in recent weeks, the GDC are planning to allow direct access to dental hygienists and other DCPs. So the question on everyone’s lips is, what will this mean for the dental team and their patients?

Currently, both the ‘Standards Guidance’ and ‘Scope of Practice’ state that all members of the dental team must work under the prescription of a dentist. Meaning, dental professionals are able to follow a treatment plan prescribed by dentists, but they are not allowed to diagnose any problems the patient is facing. The proposed change will mean that patients can go directly to a DCP who will be able to examine and diagnose dental problems without the guidance or referral from a dentist.

Those campaigning FOR the change, such as The Direct Access Action Group, argue it will benefit both the patients and the whole dental team. The changes will help save time, allowing patients to access specialist help much faster, in comparison to the current system. The dental team will also benefit from the increased time saving, as it will provide more room for additional patients to join practices and allow more dental advice to be given to patients.

However, in contrast those arguing AGAINST the proposed notion have stated that the lack of patient knowledge will mean the current system is unlikely to radically change. For example, patients are still likely to visit their dentist first, before later making an appointment with a dental hygienist or therapist, as they are unaware of the differences between dental professionals. On the other hand, campaigners for the change, would counteract this argument, stating that simple education from the dental team will eradicate such problems.

Whilst the debate continues, the Direct Access Task and Finish Group are planning to analyse robust evidence from several key stakeholders, before coming to a final decision on 2 July 2012. For those of you interested in having your say in a ‘call for ideas’ questionnaire, head to the GDC website here www.gdc-uk.org. We’d also love to hear your views, are you for or against the change? Comment below or join in the conversation on Twitter, by tweeting to @stockdalemartin.

 

Another barrier to fluoridation: cost

The addition of fluoride to public water supplies is an emotive and controversial topic, and has been so for a long time. In the film Dr Strangelove, General Ripper obsesses over the damage fluoridation could do to ‘precious bodily fluids’, indicating that the debate was well-known enough to parody even in 1964. The 1950s flyer below – sadly not a parody – portrays fluoridation as an attempt by communist infiltrators to weaken America.

Few now believe that fluoridation is a Soviet plot, but the practice still has vehement opponents just as it does ardent supporters.

In his Bad Science column in 2008, Ben Goldacre stated that the evidence was poor on both sides of the argument – that studies on both the benefits and potential harms of fluoridated water were of insufficient quality to make a decision one way or another. Today’s widespread use of fluoride toothpaste and accompanying decrease in caries prevalence makes assessing the impact of fluoridation difficult – and might, indeed, make it unnecessary even if it did confer a theoretical benefit.

One argument in favour is that fluoridation might iron out inequalities in dental health – caries rates remain higher in lower socioeconomic groups, and those with inadequate oral hygiene would benefit the most. Many, though, are opposed on principle to what they consider to be the involuntary medication of the general public.

Regardless of the scientific support for fluoridation, a more prosaic problem may yet present itself should fluoridation go ahead on a wider scale in the UK. The proposed Health and Social Care Bill will give local authorities responsibility for fluoridation consultations. In recent debate in the House of Lords it was pointed out that, since local councils don’t bear the cost of dental treatment, there may be little financial incentive for them to carry out costly fluoridation programmes – couple this with a sceptical public and the whole project might well lose its appeal.

While on the topic of adding things to public supplies, did you know that adding iodine to salt may have raised the world’s IQ? The United States and Kazakhstan are both countries which have countered a shortage of dietary iodine with fortified salt – a cheap, simple and effective measure which prevents mental retardation and goitre.

Unsurprisingly, this has also ignited fury amongst sceptics.

More information on the ‘unholy three’ flyer here:

http://www.spectator.co.uk/alexmassie/5851637/the-unholy-three-threaten-america.thtml

on fluoridation’s cost here:

http://www.dentistry.co.uk/news/4695–Oral-health-Cost-may-quash-fluoride-plans

and on the remarkable success of salt iodisation in Kazakhstan here:

http://www.nytimes.com/2006/12/16/health/16iodine.html?fta=y

Ben Goldacre’s article on the evidence base for fluoridation, and General Rippers’ opinions, can be found at his Bad Science blog:

http://www.badscience.net/2008/02/foreign-substances-in-your-precious-bodily-fluids/

Happy New Year!