In November 2019, a new scope of practice registration standard was approved by the Council of Australia Governments Health Council. Dr Kiran Keshwara, dentolegal consultant at Dental Protection, looks at what it means for practitioners and patients

An advanced copy of the scope of practice registration standard and scope of practice guidelines have been published and will come into effect from the middle of this year.^[1] When it was approved in late 2019, it was determined that the new standard would not have any adverse effects on patient safety and quality of treatment and could, in fact, increase the dental workforce and access to dentistry, along with reducing patient waiting times, especially in rural and remote areas.

It is worth noting that, confusingly, the documentation that was previously known as Guidelines for scope of practice has been renamed Scope of practice guidelines.

From a practical perspective, a major change is that dental hygienists, dental therapists and oral health therapists are now not specifically required to practise within a structured professional relationship with a dentist. This was a framework for referral and management to a dentist when the care for a patient fell outside the scope of the practice of the dental hygienist, dental therapist or oral health therapist.

This does not, however, mean that dental hygienists, dental therapists and oral health therapists do not need to refer to the appropriate dental practitioner should they feel that the treatment needed by a patient is outside their scope of practice. Practitioners are expected to know when and how to delegate and refer patient care to another practitioner for an opinion and/or treatment.

Dental practitioners are encouraged to maintain strong professional relationships with others in order to provide the highest levels of dental care, and are required to only provide dental treatment for which they are educated and trained and in which they are deemed to be competent. Further, dental practitioners should not direct any person (dental or not) to provide advice or perform treatment outside that person’s competence and scope of practice.

The scope of practice of each dental practitioner division (dentist, dental hygienist, dental prosthetist, dental therapist and oral health therapist) are detailed in the Scope of practice guidelines. 

An individual’s scope of practice will be specific to each person as they may not have enough training to be providing specific treatments. You should assess your own education, training and competence to determine whether you should be providing certain treatments and are encouraged to complete further CPD to maintain and broaden your skills and scope of practice.

It is highlighted in the guidelines that “…you alone are responsible for the decisions, treatment and advice you provide”.  

While this may be a daunting thought for many practitioners, it allows for greater autonomy within dentistry and the treatment of patients. It should be remembered that the treatment and advice you provide will be your responsibility and that when in doubt, a timely referral to another colleague within the dental team will be commended.

The new standard opens the opportunity for all practitioners, including dental hygienists, dental therapists and oral health therapists, to be able to work more independently without having to rely on the presence of, supervision by or a defined relationship with a dentist. While this has positives such as increased access and greater autonomy, it also means that practitioners can be open to more scrutiny and investigation by the Dental Board, especially if they do not refer patients on to the appropriate dental practitioner in a timely manner.