Q. I am a dental hygienist with training in acupuncture. Am I allowed to use these techniques in the dental setting and do I need any additional indemnity?
In 2006, the General Dental Council removed the old restrictive list of duties for hygienists and therapists, and introduced an entirely new concept that allowed all members of the dental team to undertake the provision of dental treatment provided they could demonstrate that they were competent and had received the appropriate training. The definitions of 'competency' and 'appropriate training' however were not clear and many clinicians (dentists and DCPs alike) found themselves in a very difficult position.
In order to deal with this situation, the GDC has since introduced guidance on the scope of practice for the different categories of registrants.
The document outlines the areas of practice that a registrant would be expected to undertake by virtue of their training, those areas of practice that might be undertaken with additional training and, perhaps more importantly, those areas of practice that a particularly registrant group would not be expected to undertake. For example, only a dentist is in a position to examine a patient and indicate the direction the treatment is to take. How that treatment is delivered to the patient can be decided by either the dentist or the DCP and would be dependent on the DCP's experience and expertise.
Just to complicate matters even further, there are some aspects of the provision of dental treatment that the document simply does not cover. Acupuncture would be a good example. In the past the GDC have been a little cautious about its use in dentistry, presumably because they are not quite sure where it fits in. The use of holistic medicine and hypnosis would be other good examples. This lack of clarity from the GDC is not helpful, although they would probably argue that there does have to be a point where the scope of practice has to be at the registrant's discretion.
If a registrant is to consider using these techniques they would need to demonstrate that they are competent to do so and have acquired the necessary training. A training course run for DCPs by a UK dental hospital would probably be regarded as appropriate training.
The difficulty would be how you might decide to use this additional skill in the dental surgery. As a hygienist, if you are using acupuncture as some form of relaxation technique - that would not seem unreasonable. If you intended using acupuncture for the treatment of TMJ dysfunction this would be quite a different matter. For obvious reasons this type of treatment is a long way outside the scope of practice for a hygienist.
The use of acupuncture for a condition that was unrelated to dentistry would also be unacceptable. Indeed it would be necessary to ensure that a clear distinction was made between this alternative practice and the practice of dentistry. You could not, for example, advertise yourself as being a hygienist and in some way give additional credence to the treatment you provide from your GDC registration. On these occasions you would need to obtain additional indemnity from another provider.
Unfortunately there are overlaps which tend to complicate matters even further. It is, for example, the duty of all clinicians to provide advice on smoking cessation and to encourage patients to give up the habit. In the past, acupuncture (rather like hypnosis) has been shown to be quite successful in this respect. It is debatable then whether the use of acupuncture in such a way is part of the practice of dentistry, or outside the dental field.
From Dental Protection's point of view, provided you are using acupuncture as part of dental treatment, then there is no particular difficulty in relation to your indemnity. This may change in the future particularly if the GDC should decide that it falls outside the scope of practice for a hygienist.
Any DCP members finding themselves in a similar situation are invited to contact Dental Protection for advice during office hours on 0845 608 4000.