Why dental registration matters

Stephen Murray considers the importance of dental regulation in Ireland

An article in Irish Dentistry’s Regulation Debate asked ‘does every dental professional have the right to regulation?’ (January 2016)

I think a more fundamental question is ‘does every patient have a right to be treated by someone who is regulated?’ – and to me, regulation starts with registration.

Certainly, you don’t have to be registered to be regulated (which is essentially what the Department of Health wants) but that makes smooth regulation much more complicated. Why would we want a system that is more complicated? Who does that benefit? Certainly not the patient or the people providing the service to the patient.

The benefit of a register for dental professionals practising independently is obvious. So much so, it should be publicly available online 24 hours a day and regularly updated. Possession of a qualification is not the same as an entitlement to practise. It is up to the Dental Council, as the competent body, to determine who can practise dentistry.

Why would we want a system that is more complicated? Who does that benefit?

Instances do occur of unregistered ‘dentists’ practising dentistry. I use the quotation marks, because if you’re not registered with the Dental Council, then you’re not a dentist in this country. You may be a dentist somewhere else, but here you are a person who shouldn’t be doing dentistry.

Similarly, we have dentists who are dentists and wish to be specialists when no register exists for that specialty, or claim to be specialists and clearly aren’t on a register that does exist. Registration solves that problem a lot faster. It is still a problem to regulate for the unregistered, but it speeds up the investigation and empowers the patient, too.

Don’t ask, don’t tell

Swords Orthodontics was among the first group of practices to train orthodontic therapists (OT) in Ireland. The OT is a dental professional trained and then examined and certified to carry out a wide range of orthodontic procedures under an orthodontist’s supervision.

Although legislation and a scope of practice existed to allow for OTs, it was only relatively recently that therapist training schemes were accredited and team members were appointed to the position. Up until then, there was a ‘don’t ask, don’t tell’ position on nurses carrying out orthodontics in Ireland.

It is an insult to the individual team member who made the sacrifices to study for this – or any – qualification, not to have it recognised

It should be a lot less ambiguous with a register, because, should there ever be a complaint, it is easy to find out if a team member is a therapist or a nurse. If there is no register, the paperwork in sorting out any complaint has to start with the team member unframing certificates and exhuming coursework signatures and presenting them.

It is an insult to the individual team member who made the sacrifices to study for this – or any – qualification, not to have it recognised by having a list of peers to join.

As an employer, I have also taken on the training of two dental nurses, and it’s certainly frustrating to the person that signed the cheques for the courses and maintains the environment for the accreditation that there is no professional register for them at the end of it.

Pressure on the professional

Registering the dental professional also allows continuing professional development (CPD) to be administered relatively systematically. If there is no register, how does the Dental Council start to monitor who is obliged to complete what CPD and when? For all dental professionals, obliging the CPD to involve some teaching outside the practice reduces the Nuremberg defence of ‘my dentist told me to do it’ and ‘we have always done it this way’.

Registering the therapist (or any other dental professional) allows for a simpler fitness to practise procedure – if they aren’t fit to practise, then professional penalties exist, including removal from a register. If there is no registration in the first place, then it can’t be taken away.

If there is no register, how does the Dental Council start to monitor who is obliged to complete what CPD and when

What an alternative sanction would be, and how it could easily be policed, is difficult to imagine, and the Department of Health haven’t given us any clues on it, other than to leave it to the Dental Council, which (like the rest of us) doesn’t seem to think that is the best way to do it.

Questionable motive

In Irish Dentistry’s January issue, the Department of Health hints that the proposals against dental regulation in the new Dental Bill are a Europe-driven legislation, but it contradicts a fundamental European principle of free movement of labour. How does a dental professional move jobs easily within Ireland or to other EU countries, particularly the UK, where the qualification is likely to be most compatible? As an employer, checking a registration would be the first step in considering a potential employee.

I think the first step in managing the highest standards of dentistry in Ireland is to have a list of the people who have demonstrated they are fit to practise them.

So I conclude with this: turkeys don’t vote for Christmas. Almost every imaginable worker wants less regulation, and yet this is one area where all professionals in the dental team – and the Dental Council that governs them – want more regulation. Why would the government think it a good idea to deny us this?

Stephen Murray FDS MOrth is principal orthodontist of Swords Orthodontics. He graduated in dentistry from Queen’s University Belfast and gained a masters in orthodontics from Newcastle University in 1999. He is a member of the Orthodontic Society of Ireland (OSI). The views in this article are his own, and do not reflect those of the OSI.