The orthodontic therapist
Justine Colbeck explains the responsibilities, scope of practice and the support you can get
In order to meet growing demands, nurses working in orthodontics have embraced ever expanding duties. These include taking radiographs, oral hygiene instruction, impressions and clinical photographs by completing post-qualifications via Certificate in Orthodontic Nursing, Certificate in Oral Health Education or Certificate in Dental Radiography.
The role of ‘orthodontic therapist’ joined the dental team in 2007 and training programmes are now available at Preston (UCLan), Bristol, London (King’s), Manchester, Leeds and Warwick taking between 12-18 months. At UCLan for instance, the course comprises of three modules: principles of orthodontic therapy, clinical application of orthodontic therapy and communication, professionalism, leadership and management in orthodontic therapy. These include core CPD topics such as infection control, medical emergencies, radiology, law, ethics and professionalism. The remainder of the training takes place within an orthodontic practice or department under the supervision and guidance of a specialist orthodontist.
Most trainee orthodontic therapists are qualified dental nurses, however hygienists, dental therapists and dental technicians may also apply if they meet the essential criteria.
When the trainee therapists have satisfactorily completed their course, they can then apply to sit the diploma in orthodontic therapy exam at The Royal College of Surgeons of England or the Royal College of Surgeons (Edinburgh).
Scope of practice
The roles of an orthodontic therapist are laid out in the GDC’s Scope of Practice documentation. The specific capabilities of orthodontic therapists can be found in the GDC Preparing for Practice: Dental team learning outcomes for registration document. The British Orthodontic Society (BOS) and the Orthodontic National Group (ONG) have also published guidance on the supervision of orthodontic therapists.
Working under supervision and following a prescription, orthodontic therapists are permitted to undertake numerous orthodontic procedures such as bonding brackets, changing archwires, fitting of passive appliances, retainers, and debonding appliances. If a patient presents as an orthodontic emergency, the orthodontic therapist may carry out limited treatment in the absence of a dentist.
To reflect the changes introduced under direct access, orthodontic therapists can now carry out an Index of Orthodontic Treatment Need (IOTN) screening. They can now also identify, select, prepare and place auxiliaries.
An orthodontic therapist needs their own dedicated clinical space (dental chair), equipment and nursing support, most likely in multi-chair practices and hospital settings. Such arrangements facilitate the supervision required and enable orthodontists to concentrate on treatment planning and finishing procedures.
This model enables more patients to be seen and treated under one orthodontist, increasing the potential for high quality, cost-effective patient care. This growing area of dentistry has significantly increased the orthodontic workforce and has potential to increase access to a specialist led orthodontic service in some areas where this has been a challenge.
Being an orthodontic therapist may involve a change from a more supportive role as a dental nurse to taking a clinical lead. Many students will have never worked in a patient’s mouth before and will require considerable support and encouragement during the year. They are now responsible for patients that have been referred to them and they are likely to be working with a qualified nurse of their own. At UCLan, we help to support this transition by also providing interactive workshops on communication and presentation skills within the course. For more information, please see http://www.uclan.ac.uk/courses/orthodontic_therapy_programme.php