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Features / June 1, 2016

Regulation Debate: orthodontic therapists

by Guy Hiscott

While we wait to see if there will be further changes in current proposals in the Dental Bill draft – or at least some clarification on issues surrounding mandatory regulation and fitness to practise – Irish Dentistry speaks to Alma McNally, a recent graduate from Trinity College Dublin, about the role of orthodontic therapists in Ireland today and how the changes might affect their position.

Can you explain the current role of orthodontic therapists in Ireland?
Alma: Orthodontic therapists (OT) are relatively new members of the dental field in Ireland and have a key role to play in both public and private practice. OTs undertake a range of procedures appropriate to their skills and experience, while working under the prescription of the specialist orthodontist.

The procedures vary throughout treatment and include record taking, the bonding of fixed appliances, changing of arch wires, advice on appliance care and oral hygiene, and debonding of fixed appliances at the end of treatment.

Orthodontic therapists cannot be held accountable for the treatment they carry out if deregulated

It is essential that the orthodontist is on site while the OT is working as the treatment plan may need to be revised at any stage. Before the OT begins treatment the orthodontist examines the patient and indicates the treatment required. Once treatment is complete the orthodontist then examines the patient before leaving. This maximises the utilisation of all staff members and allows the orthodontist to allocate more time to treatment planning and complex cases.

What are your thoughts on the mandatory regulation of dental professionals?
Alma: As one of the first OTs to have qualified in Ireland, I feel that registration with the Dental Council is of huge importance as it allows us to be held accountable for the treatment we provide to patients. It is essential that patients receive the highest level of care during treatment; when dental professionals are registered with the Dental Council the safety of treatments as well as high standards are assured.

Going forward, it is important that there is active encouragement for CPD training to ensure all members of the team are familiar with new guidelines and best practice, and to allow treatment to be carried out competently within our scope of practice and to the best standards. In order for our scope of practice to be protected and followed it is essential to be regulated.

How do you think these proposals might affect orthodontic therapists’ standing in Ireland?
Alma: If OTs are deregulated, it will affect the level of care patients receive, as therapists cannot be held accountable for the treatment they carry out. There will be no benchmark for the level of care provided, and no guidelines for CPD or continued training.

Professional development is essential to all areas of dentistry with advances in new systems and technologies – if OTs are not up to date with these they cannot provide the best treatment to patients.

Deregulation will lead to a reduction in the standards of treatment provided and put patients at unnecessary risk

How do you think these proposals might affect patients, and their view of orthodontic therapists and dental professionals?
Alma: Deregulation will have a huge effect on patients as they may not receive the level of care they are entitled to, depending on who they see. As there would be no legal body for OTs to answer to, patients would not be able to guarantee that all OTs will have continued with professional development and maintained the highest standards of practice that are required to treat the patient safely.

Dentistry has its fair share of negative press and this may only worsen the situation, which may lead to patients losing confidence in dental professionals – who have undoubtedly spent many years building and maintaining a good patient rapport to ensure successful treatment.

What do you hope to see as the outcome in the new Dental Bill?
Alma: I hope that the government listens to the dental health professionals who work closely with patients and the public and who understand their needs. All members of the dental team, including nurses, hygienists and the dentist, as well as the Dental Council, have voiced their opinions on the proposed deregulation of allied dental health professionals.

The general view is that deregulation will lead to a reduction in the standards of treatment provided and put patients at unnecessary risk due to insufficient training and the lack of CPD. I hope our voices do not go unheard.


Alma McNally qualified as an orthodontic therapist with first class honours from Trinity College Dublin in 2015. During this time she received the award for highest achiever. Previous to this Alma qualified as a dental hygienist from University College Cork.