The Health Practitioners Competence Assurance Act 2003 (the Act) describes a scope of practice as the health service that a practitioner registered in that scope of practice is permitted to perform, subject to any conditions for the time being imposed by the responsible authority.
The Council publishes a scope of practice as a Notice in the New Zealand Gazette under section 11 of the Act.
The scope of practice for oral health therapy came into effect on 1 November 2017.
Scope of practice for oral health therapy
The scope of practice for oral health therapy is the practice of oral health therapy as set out in the documented “Detailed Scope of Practice for Oral Health Therapy” produced and published from time to time by the Dental Council. Oral health therapy is a part of the practice of dentistry.
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.
Oral health education, disease prevention and oral health promotion for individuals and communities are core activities, aimed at achieving and maintaining oral health as an integral part of general health.
Oral health therapists practise as part of the dental team, and work collaboratively with other oral health practitioners and health practitioners to provide appropriate and comprehensive care to the benefit of patients’ overall health.
Oral health therapists and dentists have a consultative professional relationship. The relationship may be held by the oral health therapist with one dentist or dental specialist, or with a number of dentists/dental specialists. The establishment and maintenance of the consultative professional relationship is required for the practice of oral health therapy.
Practitioners within the consultative professional relationship are jointly responsible and accountable for the standard of decisions and care delivered to patients based on professional advice sought and given. Practitioners may wish to jointly develop a document containing agreed processes to support the consultative professional relationship and ensure advice is readily available when needed, however this is not mandatory.
Areas of oral health practice not included in an oral health therapist’s education must not be undertaken unless the practitioner has since completed appropriate further education and practises within the detailed oral health therapy scope of practice and to the standards required by the Council.
Detailed scope of practice for oral health therapy
Practised commensurate with the oral health therapist’s approved education, training and competence, oral health therapy involves:
- Obtaining and assessing medical and oral health histories
- Examining oral tissues and recognising abnormalities
- Taking and interpreting intra and extra-oral radiographs
- Taking intra and extra-oral photographs
- Diagnosing dental caries for patients up to age 18
- Diagnosing periodontal disease
- Preparing oral health care plans
- Consulting with other health practitioners as appropriate
- Referring as necessary to the appropriate practitioner/agency
- Obtaining informed consent
- Providing oral health education, information and counselling to patients
- Applying and dispensing non-prescription preventive agents
- Applying and dispensing prescription medicines and preventive agents
- Applying and dispensing topical agents for the treatment of tooth surface sensitivity and tooth discolouration
- Applying fissure sealants
- Administering topical local anaesthetic
- Administering local anaesthetic using dentoalveolar infiltration and inferior dental nerve block techniques
- Removing hard and soft deposits from all tooth surfaces
- Restorative activities for patients up to age 18:
- Preparing cavities and restoring primary and permanent teeth using direct placement of dental materials
- Extracting primary teeth
- Performing pulpotomies on primary teeth
- Preparing primary teeth for, and placing, stainless steel crowns
- Recontouring and polishing restorations
- Taking impressions, recording occlusal relationships, and making study models
- Constructing and fitting mouthguards and bleaching trays
- Performing postoperative procedures such as removal of sutures and placement and removal of periodontal dressings
- Promoting the oral health of communities by:
- raising awareness of oral health and its effect on general health and well-being
- designing and implementing oral health promotion projects, and evaluating their effectiveness, in response to the oral health needs of specific communities
- Assisting the dentist or dental specialist in implementing orthodontic treatment plans through performing the following orthodontic procedures:
- Tracing cephalometric radiographs
- Fabricating retainers, and undertaking other simple laboratory procedures of an orthodontic nature
- Assisting the dentist or dental specialist in implementing orthodontic treatment plans, as directed by the dentist or dental specialist who is responsible for the patient’s clinical care outcomes and is on-site at the time, through performing the following orthodontic procedures:
- Placing separators
- Sizing and cementing metal bands including loose bands during treatment
- Preparing teeth for bonding fixed attachments and fixed retainers
- Indirect bonding of brackets as set up by the dentist or dental specialist
- Placing archwires when necessary (as formed by the dentist or dental specialist) and replacing ligatures/closing self- ligating brackets
- Trial fitting removable appliances. This does not include activation
- Removing archwires after removing elastomeric or wire ligatures, or opening self- ligating brackets
- Removing fixed orthodontic attachments and retainers
- Removing adhesives after the removal of fixed attachments
- Fitting passive removable retainers
- Bonding preformed fixed retainers.