Dental hygienists and therapists: how much professional autonomy do they have? How much do they want? Results from a UK survey

Objectives To investigate autonomous working among singly and dually qualified dental hygienists and therapists in UK primary care. Earlier studies and policy papers suggest that greater autonomy for these groups may be a desirable workforce planning goal. Methods UK-wide postal surveys of hygienists, hygienist-therapists and therapists. Respondents were asked whether they undertook 15 clinical activities on their own initiative, how comfortable they would feel undertaking such clinical activities if referral from a dentist were not required, and how they perceived dentists’ reactions. Results Overall response rate was 65% (n = 150 hygienists, 183 hygienist-therapists and 152 therapists). Over 80% of hygienists and hygienist-therapists reported undertaking BPEs, history-taking, pocket charting, mucosal examinations and recall interval planning autonomously. Similarly high proportions of hygienist-therapists and therapists reported giving local analgesia and choosing restorative materials autonomously. However, fewer than 50% of all three groups said they undertook dental charting, fissure sealing, resin restorations, taking radiographs, and tooth whitening autonomously. While confidence in undertaking such activities without a dentist’s referral was generally high, it was lower in respect to mucosal examinations, identifying suspicious lesions, interpreting radiographs, tooth whitening, and (except for singly qualified dental therapists) diagnosing caries. Conclusions Results suggest high levels of experience and confidence in their ability to work autonomously across a wide range of investigative activities, treatment decision-making and treatment planning. The exceptions to this pattern are appropriate to the different clinical remit of these groups.