Use of Local Anaesthetic and Fluoride Varnish by Dental Hygienists and Therapists

An injection of local anaesthetic or the provision of fluoride varnishes are procedues that are controlled by the Medicines Act 1968 because they involve the use of prescription-only medicines (POMs). This means they can only be prescribed by a suitably qualified prescriber. Traditionally this prescriber would be a doctor or a dentist. Legislation was introduced throughout the UK in 2000 that allows certain other healthcare professionals to administer POMs in specific circumstances. This can happen in two ways:

1. Patient Group Directives (PGD) – This is a legal framework that allows a listed group of healthcare professionals to administer medicines to a group of patients (that fulfils certain predefined criteria), without the need for a written patient-specific prescription or instruction from the approved prescriber.
OR
2. An approved prescriber may provide a documented, patient specific direction (PSD) (a written instruction) which allows the healthcare profession to administer a POM to a specific patient.

Following a review of the Medicines Act 1968 by the Department of Health it has become clear that, contrary to previous assumptions, dental nurses, dental hygienists and dental therapists are not included in the group of healthcare professionals allowed to administer medicines under a Patient Group Directive. As a consequence they may only administer local anaesthetic and fluoride varnish to patients on the basis of a PSD. This means that a dentist must write an instruction to the DCP to provide the prescription only medicine to a specific patient.

Dental Protection understands that the Medicines and Healthcare Products Regulatory Agency will be holding a a public consultation around changes to the Medicines Act 1968, to include dental nurses, dental hygienists and dental therapists in the list of qualified healthcare professionals covered by PGDs. Click here for more details

Until these changes occur, it is extremely important when asking a DCP to provide local anaesthetic or fluoride varnish, that members make a specific entry within the patient’s records that provides a direct instruction (PSD) to the DCP. Although there are no specific regulatory requirements as to how a PSD should be worded, it should contain details of the dose, route of administration and frequency. A failure to do so may leave the dentist and the DCP vulnerable to allegations under the Medicines Act 1968.

Issued 23 July 2008