Q. I am a dental hygienist. Is it true that I need to ask a dentist to write a prescription before I can use fluoride varnish for a patient?

Fluoride varnish is a Prescription Only Medicine and therefore a prescription must be written by a dentist prior to it being applied by a Dental Care Professional. A recent decision made by the Committee on Human Medicines of the Medicines and Healthcare Products Regulatory Agency will eventually allow dental therapists and dental hygienists to perform the following functions under a Patient Group Direction:

• the administration of local anaesthetics
• the sale, supply or oral administration of fluoride supplements and toothpastes with high fluoride content.

The Department of Health has confirmed that since the 1 June 2010, dental care professionals no longer require a patient-specific directive (written prescription) in order to administer local anaesthetic or fluoride supplements and high-fluoride content toothpaste, with the proviso that the treatment is being provided under a NHS contract.

However, these medicines still need to have a patient group directive in place in order for dental care professionals to legally administer them to patients. The Department tells DPL that it is currently working on the wording of this directive and a template for use in NHS settings should soon be available for download. A message from the Chief Dental Officer is also believed to be imminent.

Unfortunately this means that dental hygienists and therapists working in private practices or seeing an NHS patient privately, may still require a patient-specific directive (written prescription).

In earlier guidance (Patient Group Directives) prepared by UK Medicines Information (UKMi) it had been suggested that a practice registered with the Care Quality Commission(CQC) in England or the Scottish Commission for the Regulation of Social Care in Scotland, the Care Standards Inspectorate for Wales in Wales, and the Regulation and Quality Improvement Authority in Northern Ireland may be eligible for inclusion in a patient group directive. Although registration has already begun in Wales, private practices in the UK are not required to complete registration until April 2011. The Department of Health has told Dental Protection that in the period before private practices are required to register with CQC in 2011 they will be considering whether making these additional changes would be appropriate. Meanwhile the DOH will see that the UKMi guidance is amended.

Until such time as any additional changes have been made the situation remains as shown above.

GDC guidance on this subject is available here

The associated press release from Dental Protection can be found here