Scope of practice competencies for oral health therapists

Oral health therapists provide oral health assessment, diagnosis, management, treatment and preventive care for patients in accordance with the detailed scope of practice, and commensurate with their approved education, training and competence.

A competent oral health therapist is one who meets the competency standards; applying knowledge, skills, attitudes, communication and judgement to the delivery of appropriate oral health care, in accordance with the scope of practice within which they are registered.

Understand the legal requirements of practising in an oral health workplace


A competent oral health therapist understands and complies with the ethical responsibilities and legislative requirements relating to the safe and competent practice of oral health therapy in New Zealand.

Measuring legal understanding

The oral health therapist will:

  • Demonstrate familiarity with, and comply with relevant legislation and Dental Council standards

Behave professionally


A competent oral health therapist behaves professionally at all times.

Measuring professional behaviour

The oral health therapist will:

  • Understand and apply the ethical principles, professional standards and practice standards that govern their behaviour as oral health professionals
  • Prioritise the health needs and safe care of patients
  • Treat patients with dignity and respect at all times
  • Put the interests of patients ahead of personal, financial or other gain
  • Respect patients’ right to complain and enable them to seek redress

Understand current scientific knowledge related to oral health


A competent oral health therapist understands current biological, physical, cultural, social and psychological factors which influence the attainment and maintenance of oral health and uses these factors to inform best practice.

Measuring understanding

The oral health therapist will:

  • Show an understanding of biological, physical, cultural, social and psychological factors in oral health therapy
  • Use this knowledge in the development and delivery of oral health care for individuals and communities
  • Communicate this knowledge to patients, parents/carers, and the wider community

Provide culturally competent practice


A competent oral health therapist sees issues from the perspective of people of other cultures and adheres to the Treaty of Waitangi.

Measuring cultural competence

The oral health therapist will:

  • Demonstrate awareness of New Zealand’s cultural diversity and recognise that culture is not confined to ethnicity
  • Recognise the unique place Māori hold as tangata whenua in New Zealand and the importance of the Treaty of Waitangi
  • Honour  the Treaty of Waitangi principles of partnership, participation and protection in the delivery and promotion of oral healthcare  
  • Practise in a way which respects each patient’s identity
  • Observe cultural etiquette
  • Consider cultural perspective in decision-making
  • Assist patients to receive oral health therapy services which take into account their cultural needs
  • Treat patients fairly and without discrimination, respecting cultural values, personal disabilities and individual differences

Communicate effectively


A competent oral health therapist communicates effectively with patients, other health professionals and the public on oral health matters.

Measuring competence in communication

The oral health therapist will:

  • Communicate honestly, factually and without exaggeration

With patients

  • Demonstrate rapport and empathy
  • Assure patients’ dignity
  • Listen to patients, and respect and consider their preferences and concerns
  • Explain findings, treatment options and likely outcomes in easily understood language to ensure informed consent
  • Recognise communication barriers and meet patients’ individual communication needs
  • Adapt information to patients’ level of comprehension
  • Confirm patients’ understanding of the information provided

With other health professionals

  • Communicate openly in inter-and intra- professional teams for the enhancement of patient care
  • Provide written information and copies of records when making a referral, or providing information, to another health practitioner involved in patient care
  • Behave respectfully in communication to and about colleagues and other health professionals

Promote the oral health of individuals and communities


A competent oral health therapist raises awareness of oral health and its effect on general health and well-being.

Measuring competence in health promotion

The oral health therapist will:

  • Educate patients at all stages in their life, or patients’ family, carers or guardians, about the aetiology and prevention of oral diseases using effective and evidence–based education and communication strategies
  • Promote awareness and understanding of the relationship between oral health and general health
  • Provide ‘one on one’ counsel and advice to encourage sound health attitudes and practices
  • Communicate importance of issues such as diet, smoking, and oral hygiene on oral and general health
  • Design and implement oral health promotion projects and evaluate their effectiveness, in response to the oral health needs of specific communities
  • Demonstrate a commitment to oral health promotion by working with other health personnel and/or educational staff where appropriate
  • Express a professional view on fluoride, amalgam and other topical public issues related to oral health
  • Facilitate patients’ access to services and resources

Obtain patient information


A competent oral health therapist obtains by interview and examination patient information relevant to the delivery of oral health care; record this information logically, legibly; and store securely.

Measuring patient information

The oral health therapist will:

  • Record an accurate patient history to inform patient care
  • Perform an extra-oral examination
  • Detect hard and soft tissue abnormalities, e.g. dental erosion, enamel defects, oral ulceration
  • Detect dental caries for patients up to age 18
  • Detect periodontal disease(s), plaque and calculus
  • Use posterior bitewing and periapical radiographs, and other appropriate tests, to aid in the detection of dental caries and periodontal disease
  • Take intra- and extra-oral photographs
  • Record examination findings, demonstrating that all orofacial tissues have been examined closely
  • Record information on teeth present/missing or restored
  • Ensure records are legible, accurate, up-to-date, complete and relevant
  • Store patient records securely to protect patient confidentiality

Analyse patient information and develop an oral health care plan


A competent oral health therapist assesses information to identify oral health problems and formulate an evidence based oral health care plan that addresses the aetiology of dental and oral disease, the attainment or maintenance of oral health, priority of management, patient options,  anticipated outcomes and the duration of treatment.

Measuring analysis and planning

The oral health therapist will:

  • Assess patient information gathered in the interview and assessment
  • Recognise significant medical, dental and social history and develop the oral health care plan accordingly
  • Diagnose dental caries for patients up to age 18
  • Diagnose periodontal disease(s)
  • Evaluate individual patient risk for oral disease(s)
  • Develop evidence based, prioritised oral health care plans which include individualised strategies for:
    • managing and preventing oral disease and its consequences
    • promoting the attainment and maintenance of oral health
  • Consider and discuss management options, including preventive strategies, and anticipated outcomes
  • Arrange for an appropriate recall/review
  • Seek advice, or refer, to other practitioners when appropriate

Provide or make provision for oral health care


A competent oral health therapist communicates the requirements of an oral health care plan to patients in order to obtain informed consent; where necessary carries out agreed procedures, and manages any complications.

Measuring informed consent

The oral health therapist will:

  • Provide patients, parents or carers with full explanations and information to make informed decisions
  • Allow patients the time they need to make an informed decision
  • Respect the autonomy and freedom of choice of the patient
  • Record the adopted oral health care plan, including any treatment declined or deferred by the patient
  • Record informed consent to the agreed oral health care plan
  • Ensure informed consent remains valid at all times

Measuring preventative care

The oral health therapist will:

  • Place fissure sealants and preventive coatings according to clinical findings and evidence based practice guidelines
  • Apply topical fluorides based on the assessment of the caries risk of the patient, according to clinical findings and evidence based practice guidelines
  • Apply and dispense non-prescription preventive agents
  • Construct and fit mouthguards
  • Recontour and polish restorations
  • Apply and dispense prescription medicines and preventive agents
  • Apply and dispense topical agents for treatment of tooth sensitivity and tooth discolouration

Measuring periodontal management

The oral health therapist will:

  • Debride plaque and calculus from supra and subgingival tooth surfaces
  • Address predisposing factors
  • Give and record self-care instructions
  • Place and remove periodontal dressings
  • Remove sutures
  • Determine a recall regime
  • Manage acute periodontal infection by seeking advice and/or patient referral
  • Refer appropriately

Measuring restorative intervention

The oral health therapist will:

  • Determine the need for restorative intervention
  • Consider current clinical practice guidelines and scientific evidence in decision-making
  • Select the appropriate restorative procedure and dental materials
  • Restore the integrity and function of teeth
  • Alleviate tooth discomfort and/or pain by restorative intervention or deciduous tooth extraction, as appropriate

Measuring use of topical and local anaesthetic

The oral health therapist will:

  • Identify potential risk factors for local anaesthetic administration and respond appropriately; this may include seeking advice, or patient referral
  • Administer topical anaesthetic
  • Use the correct local anaesthetic solution and technique
  • Achieve adequate anaesthesia
  • Understand and manage complications of local anaesthetic

Measuring radiography

The oral health therapist will:

  • Use bitewing, periapical and extra-oral radiographs appropriately
  • Relate radiographs to patient’s needs with relevant structures in view
  • Ensure adequate image quality
  • Ensure ideal view(s) for diagnosis
  • Maintain radiation safety for the patient, staff, public and environment
  • Record radiographic findings

Measuring clinical records

The oral health therapist will:

  • Maintain accurate, time-bound and up-to-date patient records
  • Store and label extra- and intra-oral photographs, and radiographs, to enable identification
  • Store and label study models to enable identification

Measuring orthodontics

The oral health therapist will:

  • Trace cephalometric radiographs
  • Place separators
  • Prepare teeth for bonding of fixed attachments and fixed retainers
  • Size and cement metal bands, including loose bands during treatment
  • Trial fit removable appliances and fit passive removable retainers
  • Remove or replace elastomeric or wire ligatures, and open and close self-ligating brackets
  • Place and remove archwires
  • Carry out indirect bonding of brackets
  • Remove fixed orthodontic attachments and retainers
  • Bond preformed fixed retainers
  • Remove adhesives
  • Fabricate retainers

Other

  • Take impressions and make study models

Refer and collaborate with the appropriate health professionals


A competent oral health therapist refers for advice and/or treatment where diagnosis and management  planning indicates that the patient requires a level of knowledge and/or skills greater than those of the oral health therapist.

Measuring referral and collaboration

The oral health therapist will:

  • Understand the importance of a team-based approach to patient care
  • Establish a collaborative professional relationship with a dentist(s) /dental specialist(s)
  • Obtain advice from colleagues and other health professionals where necessary
  • Collaborate with colleagues and other health practitioners, and contribute to teamwork for enhanced patient outcomes
  • Make appropriate referrals

Assess the effectiveness of oral health strategies


A competent oral health therapist objectively assesses both short term and long term outcomes of oral health strategies.

Measuring assessment of effectiveness

The oral health therapist will:

  • Demonstrate an understanding of the prognosis for treatment strategies offered to individuals and to the community at large
  • Communicate this knowledge to patients, parents and the wider community
  • Review and assess outcomes of care

 

Understand scientific methodology


A competent oral health therapist undertakes research and/or analyses relevant scientific literature and applies findings to the delivery of appropriate oral health care.

Measuring competence in applying recent knowledge to practice

The oral health therapist will:

  • Read and critically analyse scientific publications in oral health
  • Share experiences and case studies of oral health therapy practice with colleagues
  • Demonstrate understanding of current issues including:
    • Recent developments in oral health
    • Evidential base of practice; of new materials and treatment techniques based on research
  • Use scientific knowledge and practice experience to inform oral health practice

Prevent and control infection


A competent oral health therapist undertakes procedures to ensure compliance with the Council's Infection Prevention and Control practice standard.

Measuring infection prevention and control

The oral health therapist will:

  • Treat all patient body fluids as potentially infectious
  • Practise standard precautions routinely, including appropriate hand hygiene protocols, use of personal protective equipment and safe management of sharps and waste
  • Define contaminated and uncontaminated zones and control the extent and spread of contamination in and between these zones
  • Clean all surfaces and equipment in contaminated zones after each patient treatment
  • Reprocess all contaminated reusable items appropriately for their intended use
  • Follow required monitoring and validation protocols for equipment and processes
  • Maintain infection prevention and control documentation

Maintain a safe work environment


A competent oral health therapist undertakes occupational health and safety procedures to ensure compliance with relevant laws and practice standards.

Measuring health and safety

The oral health therapist will:

  • Monitor emergency plans and accident/incident protocols
  • Control identified hazards by using/taking the protective measures supplied/identified
  • Arrange equipment in the surgery to enable practitioners and patients to be able to move safely within this environment
  • Check materials for expiry dates and rotate as required
  • Handle, and dispose of, hazardous and contaminated clinical waste safely
  • Report all actual and potential incidents

Maintain and develop professional practice


A competent oral health therapist reflects upon, self-assesses and develops professional practice by continually monitoring the outcomes of oral health care delivery, and undertaking continuing personal professional development.

Measuring maintenance of competence

The oral health therapist will:

  • Show commitment to learning throughout their career
  • Identify skills, knowledge and attitudes to be developed
  • Identify learning needs for personal professional development
  • Implement an active professional development programme
  • Discuss professional issues with colleagues
  • Fulfil Dental Council recertification programme requirements