How does a dentist or practice manager choose between a dental therapist, a dental hygienist or an oral health therapist and then make the relationship work for the good of the business? Chris Sheedy sought answers from the experts.
One of the greatest ways to build a dental business is through specialisation and performance of more complex procedures. However, this involves the dentist freeing themselves up from everyday dental work and developing the time, and skills, to take on such procedures. In order to do this, the dentist must bring on board people who can look after the basics. They must seek clinicians who can develop and maintain relationships with patients, ensure preventive work is carried out and become a vital member of the practice team. These clinicians then refer more complex work to the dentist.
The obvious hire is a dental hygienist, dental therapist or an oral health therapist, but which is the best choice? There is no one-size-fits-all answer, says Dr Melanie Hayes, national president of the Dental Hygienists’ Association of Australia (DHAA). The answer very much depends on the skill sets already in your practice and the shape and size of your market. “The basic difference, first of all, is that dental hygienists are trained in preventive procedures so they can treat patients of all ages and look after general oral hygiene matters as well as X-rays, mouth guards and health promotion activities,” Dr Hayes says. “Dual qualified oral health therapists, on the other hand, have the training to be dental hygienists but can also do work in the field of dental therapy. This means they can do the previously mentioned preventive procedures but can also perform fillings and extractions for children and adolescents. “So, it depends on the needs of the practice and on their community.
If there is a need in a practice for someone to do restorative work with children and adolescents then that would be a skill a dental or oral health therapist would have. If the practice simply wants someone who has a preventive health focus then the answer could be a hygienist or an oral health therapist—either would fit that role.” The specific skill set a hygienist or an oral health therapist would bring on board is not the only powerful benefit they offer to a practice, says Associate Professor Julie Satur from the Melbourne Dental School at the University of Melbourne. The behavioural sciences background of such a specialist means they are also likely very good with people. “Dental and oral health therapists are good at providing care for children and that is a real strength in private practice. Kids can be challenging and these specialists are very good at dealing with that,” says Dr Satur, an Associate Professor of Oral Health and director of the University of Melbourne’s Bachelor of Oral Health program. “And let’s not forget about dental therapists.
There are around 1000 of them in Australia, similar to the number of hygienists and oral health therapists. If a practice has a dental therapist and a dental hygienist, it is the equivalent of having one or two oral health therapists. “An oral health therapist can do a lot of technical work such as check-ups, fillings, X-rays and preventive care. They can diagnose and treat periodontal disease. But most important is the fact that they are preventively oriented. That does make them good with people. The underlying philosophy of oral health therapy is prevention first. That means oral health therapists, dental therapists and hygienists work with people’s behaviours and habits.” Dr Hayes agrees that this is a major strength of such clinicians. Oral health therapists and hygienists talk to patients a great deal about prevention of oral disease—they establish great rapport with patients, she says. This, if the role is properly and effectively merged into the practice’s processes, is a very powerful driver of business through patient trust, comfort and respect. So the question that follows is how a dentist or practice manager successfully introduces such a role—that of hygienist, dental therapist or oral health therapist—into their business.
How do they ensure the business benefits from the addition of a new type of talent? First of all, Dr Satur explains, as with all hires, the employer must ensure the new employee is a good fit for the business in terms of personality and motivation. Without this basic building block, even the finest plans are likely to come undone. Then, when the right person is settled upon, the real work begins. “It is very important that in the early stages of the relationship, the dentist and the therapist have conversations around how they are going to work together,” Dr Satur says. “In fact, regulation demands they develop what is called a ‘structured professional relationship’. That requires everyone to sit down together and figure out how the relationship is going to work. “An oral health therapist’s expertise in working with children can be a great asset. It really adds depth.
So how do you work that into the processes? Some practices might send patients to the oral health therapist first. Others might decide all patients see the dentist first. Plus, some dental and oral health therapists are also adding skills to provide restorative services for adults, which extends the practice service model even further,” says Dr Satur. Get the discussed relationship down on paper, Dr Hayes says. Don’t just settle on a spoken agreement. “We encourage our members to have their working relationship or employment terms in a written contract,” she says. “A lot of the time a process is verbalised but not written down. Having it in writing is good for clarity of the agreement, for avoidance of misunderstandings, and in case of discrepancies down the track.”
And a common problem area is a simple misunderstanding of industrial relations policies, regulations and guidelines by dentists and practice managers. “Dental hygienists don’t have a listed award rate, for instance,” Dr Hayes says. “It is up to the practice and the hygienist to negotiate payment and conditions. To assist in this process the Dental Hygienists’ Association of Australia has a dedicated industrial relations advice line. It’s a free service for our members and for their practice managers to access if they need advice on employment issues.” It is worth getting right. The employment and induction of a dental hygienist or an oral health therapist can be a powerful driver for a dental business if it is performed correctly. “Many practices find once they employ a hygienist or an oral health therapist, it positively changes the way they deliver their care because of the skill set that comes in,” Dr Satur says. “Most dentists and practice managers never look back once they employ such a specialist.”
