Dental skill mix: A cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the south of england

Abstract

Background: Research suggests that health professionals who have trained together have a better understandingof one another's scope of practice and are thus equipped for teamwork during their professional careers. Dentalhygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. Thisstudy examines patterns of delegation (selected tasks and patients) by dental students to DHT students training togetherin an integrated team.Methods: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showingthe treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in theSouth of England over two academic years. The data extracted included key procedures delegated by dental students toDHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patientdemography. x2 tests were conducted to investigate the relationship between delegation and patient agegroup, gender, smoking status, payment-exemption status, and social deprivation.Results: A total of 2,063 patients managed during this period received treatments that could be undertaken byeither student type; in total, they received 14,996 treatment procedures. The treatments most commonlydelegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatricextractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to aDHT student. Associations were found between delegation and patient age group and smoking status (P <0.001).Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) andpatients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared withnon-smokers (45% cf. 26%; P <0.001).Conclusions: The findings suggest that delegation of care to DHT students training as a team with dentalstudents, involved significantly greater experience in treating children and adult smokers, and providingpreventive rather than invasive care in this integrated educational and primary care setting. The implicationsfor their contribution to dentistry and the dental team are discussed, along with recommendations forprimary care data recording.