Regulation Debate: the fate of dental hygiene in Ireland

At the Irish Dental Hygienists Association’s (IDHA) Annual Winter Scientific Conference in Dublin last year, the Dental Council updated delegates on key policies proposed in the new Dental Bill in Ireland.

Suffice to say, it caused a bit of a stir.

The question of independent practice came to attention and consequently, the Department of Health’s proposal to only subject those dental professionals who practice independently to mandatory registration.

At present, only clinical dental technicians practice independently in Ireland.

This begs the question: what about those dental professionals who do not currently practice independently, such as dental hygienists?

Speak, share and support

In order to understand the importance of this issue, Irish Dentistry is mounting a campaign to support the mandatory regulation of all dental professionals, including hygienists, and to call upon the Department of Health to reevaluate this proposed policy.

Over the next few months, we’ll aim to be at the forefront of the latest updates on the proposed changes, delivering news as it develops in each issue of Irish Dentistry for the coming months.

Here, we speak to the Dental Council, the Department of Health and the IDHA to get to grips with exactly what is going on, and how the deregulation of dental hygienists in the new Dental Bill might affect the public – and the profession.

Be sure to check out the January issue of Irish Dentistry to read more voices from the profession, and join the debate on Twitter by tweeting @IrishDentistry using the hashtag #RegulationDebate. Where do you stand?

Dental Council Ireland

Irish Dentistry: Could you explain what it is the Department of Health is currently debating for dental hygienists in the new Dental Bill?

Dental Council: The issue concerns how all auxiliary dental health care workers will be regulated under the new legislation. At present, any auxiliary dental worker carrying out intraoral procedures must be registered with us. This covers clinical dental technicians, dental hygienists, orthodontic therapists and dental nurses who take radiographs.

The Council sought to have a provision requiring that all auxiliary dental workers must be registered. We sought this to further foster the professionalism of the dental team. Having a professional dental team, committed to continuing professional development and subject to a common code of ethics, can only enhance the quality of treatment and patient safety.

The Council fails to see how the allied dental health care professionals can be effectively regulated if there is no register

In a document entitled Summary of Policy Issues: for inclusion in the new Dental Bill (August 2015), the Department of Health noted ‘that in the case of those allied dental health professionals not allowed to practice independently, the Dental Council, while not registering the professions, may introduce rules to regulation training and education standards and to protect the title of the profession in questions’.

The Council fails to see how the allied dental health care professionals can be effectively regulated if there is no register, and the dental hygienist profession will be most affected by the change.

ID: How did the Council come across it?
DC: The Dental Council was advised of this in August last year when we were presented with a copy of the Summary of Policy Issues: for inclusion in the new Dental Bill by the Department.

ID: How will this affect hygienists?
DC: The Dental Council is seeking to allow dental hygienists to practice independently (which is a step beyond independent access). Any existing dental hygienist who wishes to practice independently will have to undertake additional training. Not all dental hygienists may wish to do this, and some may wish to continue treating on the prescription of the dentist. It is unclear what will happen to these dental hygienists if the Department’s policy is enacted.

ID: What is the likelihood that this will go ahead?
DC: The provisions of the new Dental Bill are a matter for the Houses of the Oireachtas as it will be
primary legislation.

Department of Health (Ireland)

‘The Department of Health is currently preparing new legislation to replace the Dentists Act 1985. Key policy issues that are shaping the drafting of the Bill are based on a comprehensive public consultation process which sought the views of the public and key stakeholders on the new legislation. In forming the policies for inclusion in the Dental Bill, the Department is also considering the question of the proportionality of regulation, an issue that is currently being considered across the European Union. Member States are being asked to examine this issue, and not to go beyond what is necessary when regulating professions.

Of the five classes of allied dental health professions, clinical dental technicians are currently the only profession with independent practice

Regulation of allied dental health professions
‘The regulation of allied dental health professions is one of the key policy issues for inclusion in the new Dental Bill. It is proposed that classes of allied dental health profession that have been determined by the Dental Council as being suitable for independent practice, will have mandatory registration and be made subject to fitness to practice. The Dental Council will make this determination based on suitability to independent practise, and an assessment of the level and nature of any risk to patient safety.

‘Of the five classes of allied dental health professions, clinical dental technicians are currently the only profession with independent practice. While it will be a matter for the Dental Council to make the determination about the suitability of independent practice for each allied profession under the new legislation, it is envisaged that clinical dental technicians will remain practising independently. It is also envisaged that independent practise will be introduced for dental hygienists.

‘Professions not determined by the Dental Council as being suitable for independent practise will not be subject to mandatory registration or fitness to practise. However, the legislation will provide that the Dental Council, while not registering the profession, will introduce rules to regulate training and education and protect titles. This means that allied dental health professionals will have to undertake education/training courses approved by the Dental Council in order to use a protected title. The new legislation will also provide for the prosecution of an offence in the case of a person falsely presenting as having undertaken an approved education/training course or falsely using a protected title.

… allied dental health professionals will have to undertake education/training courses approved by the Dental Council in order to use a protected title

‘The issue of the proportionality of regulation has been a factor in the Department¹s decision not to provide for the mandatory registration of all allied dental health professionals in the new legislation. Independent practise, which will entail mandatory registration, may be introduced in the future for classes of allied dental health profession not currently deemed suitable. This determination will be made by the Dental Council, as appropriate, and provided for in rules.

Next steps
‘A Regulatory Impact Analysis is currently underway, and the drafting of Heads of Bill will be the next step in the process to develop the new legislation. This will be a priority matter for 2016.’

Louise Fleming, president of the IDHA

‘We are strongly urging all parties involved in the decision making process of the Dental Bill to have mandatory registration for all dental hygienists regardless of their working status. It is imperative to the safety of the patient that we are registered and to show that we are competent to carry out treatment within our scope of practice on the public.

‘We have a meeting scheduled with Minster Varadkar for 18 January 2016 where we will highlight the importance of registration again.’

#RegulationDebate

Join the debate on Twitter by tweeting @IrishDentistry and using the hashtag #RegulationDebate. Don’t forget to check out Irish Dentistry’s January issue to read from voices from the profession, including Professor Denise MacCarthy as well as working dental hygienists. Where do you stand?