Updates to the Council’s Restricted activities policy
The Council has updated its Restricted activities policy to better reflect contemporary practice.
In addition, two key changes were made:
- Added an expanded list of activities that suitably trained unregistered assistants can perform under clinical direction and monitoring of a registered oral health practitioner who is onsite.
- Clarified that the management of any disorder or condition/disease of the oral cavity and associated facial structures are restricted procedures, that can only be performed by a registered oral health practitioner.
Within this context and in response to queries, the Council developed advice on the regulatory requirements for the application of silver diamine fluoride (SDF) for registered oral health practitioners. Application of SDF by unregistered persons is not permitted due to the need for an accurate diagnosis to determine the suitability of using SDF in the prevention or management of dental caries or management of dentinal sensitivity, and the associated clinical risks.
Expanded activities for unregistered assistants
The Council considered the approach of comparable regulatory jurisdictions to an expanded role of a dental assistant and increased the list of activities that suitably trained unregistered assistants can perform under clinical direction and monitoring of a registered oral health practitioner who is onsite.
Mechanisms to protect public safety in the policy include:
- The activities are being performed under the supervision of a registered oral health practitioner.
- The unregistered assistant performing these activities must be suitably trained and assessed – preferably through a formal training programme/course or by a competent and experienced oral health practitioner taking on the training responsibility of a particular activity.
- Patients must not be given the impression that unregistered assistants who undertake the activities are doing so in a registered capacity.
- The use or application of a registered medicine will continue to be prescribed by an authorised prescriber or used under a standing order.
- The use of radiation sources is conducted under the applicable Radiation Safety Codes.
The Council included the following activities that can be carried out by unregistered assistants if the above requirements are met:
- Application and removal of dental dam
- Fluoride application for prevention of dental caries using either sodium fluoride varnish or acidulated phosphate fluoride gel
- Application of topical anaesthetics
- Application of desensitizing agents
- Oral irrigation
- Removing periodontal dressings that are uncomplicated
- Removing simple interrupted sutures
- Fabricating a mouthguard
- Fabricating an occlusal rim
- Application of pit and fissure sealants without modification of the tooth surface by the unregistered assistant.
It is the responsibility of the registered oral health practitioner to ensure that an assistant already working in practice has the appropriate training before carrying out these expanded activities, and appropriate supervision is in place to mitigate any potential risk of harm to the public.
The Council has encouraged the dental assisting training programmes to incorporate the new activities into their curriculums to adequately prepare future dental assistants.
Regulatory requirements for the application of silver diamine fluoride (SDF) for registered oral health practitioners
The topical application of SDF to teeth can be an effective treatment for dental caries, prevention of dental caries and dentinal hypersensitivity.
The Council considers:
- The management of any disorder or condition/disease of the oral cavity and associated facial structures that involves surgical or operative procedures below the gingival margin or the surface of the skin, mucous membranes or teeth is a restricted activity, that can only be performed by a registered oral health practitioner.
- The topical application of SDF to manage a carious lesion is considered management of a disease and is a restricted activity, that can only be performed by an appropriately registered oral health practitioner.
- Due to the need for an accurate diagnosis to determine the suitability of using SDF in the prevention or management of dental caries or management of dentinal sensitivity, and the associated clinical risks, the topical application of SDF by unregistered persons is not permitted.
The Council position on the regulatory requirements on the application of SDF can be found under guidance on our website. This includes a table to clarify the requirements for oral health therapists, dental therapists and dental hygienists within the variation of the practitioner’s scope of practice.