Dental nurse

Dental nurses work as part of a dental team in a variety of clinical and non clinical settings. The term Dental nurse has a defined meaning within the UK. From 30 July 2008, all Dental nurses in the UK must be registered with the General Dental Council to continue working legally.^[1]

Role & Responsibility

Dental nurses are responsible for ensuring the Dentist or Oral Surgeon's operating list runs smoothly during the course of a clinical session. This can include, but is not limited to:

• Prepare and maintain the clinical environment
• Carry out Infection Control Measures compliant with Department of Health's HTM 01-05 Decontamination in Primary Dental Care settings
• Record clinical charting during routine dental examinations
• Prepare, mix and handle dental materials e.g. Amalgam, Alginate etc.
• Provide chairside support during clinical sessions
• Maintain and records patients records
• Prepare materials and equipment for dental radiography
• Process dental radiographs
• Monitor and reassure patients undergoing dental treatment
• Provide advice to patients and refer clinical questions to Dental Surgeons
• Assist and support clinical team members in the event of a medical emergency
• Assist with reception and administration tasks e.g. booking appointments and taking payments
• Assist with dealing with complaints and referring them to a Dental Surgeon / Practice Manager

After a Consultation with the General Dental Council who regulate the scope of practice of all GDC registered Dental Care Professionals a publication was released in April 2009 listing the full scope of practice of Dental Nurses in the United Kingdom:

• Provide Oral Health Advice and support other members of the dental team educating patient in oral health
• Assist the Clinician with treating and monitoring patients undergoing conscious sedation
• Assisting the Clinician with treating patient who are declared as special needs
• Intra Oral Photography
• Shade Taking
• Placing rubber dam equipment
• Measure and record plaque indices
• Pour, Cast and trim study models
• Removal of sutures after the wound has been reviewed by a Dental Surgeon
• Application of fluoride under the prescription of a Dental Surgeon following attendance of an approved course
• Construction of occlusal Rims and special trays
• Repair the acrylic component of removable appliances
• Tracing Cephalographs
• Apply topical local anaesthetics under the prescription of a Dental Surgeon
• Taking Impressions on prescription of a Dental Surgeon / GDC Registered CDT
• Taking of Radiographs on prescription of a IRMER Practitioner / Dental Surgeon after attending an approved course

Dental Nurses in the UK

Qualifications

Previously, no academic qualifications were needed to work as a Dental nurse in the UK. The vast majority of Dental nurses began their careers with in house training (under the direct supervision of a senior Dental nurse or Dentist). However employers now, including hospitals and the community dental service, now require all Dental nurses to have obtained recognized qualification, following the GDC (general dental council) new register for dental care professionals.

Qualifications recognized by the GDC for registration after 30 July 2008 are:^[2]

(UK)

• The National Certificate awarded by the National Examining Board for Dental Nurses (NEBDN)
• NVQ level 3 in Oral Healthcare
• SVQ Level 3 in Oral Healthcare
• Certificate of Proficiency in Dental Nursing
• Certificate of Higher Education in Dental Nursing–1 year programme

Dental hospitals and further education colleges run courses on a full-time and part-time basis. The Certificate of Higher Education in Dental Nursing previously only offered at Portsmouth University, is now also available at Teeside University

Most Dental nurses, who start their career in general dental practice, have to study in the evenings or on day release, this requires a lot of self discipline.

A small proportion of Dental nurses start their career in a hospital. They will attend lectures, usually at a school of dental nursing several times a week. Their practical experience is gained from placements on specialists clinics within the hospital. As a rule, at the end of their training period, they are required to take a hospital proficiency test preceding the NEBDN examination.

The NEBDN certificate is awarded to Dental nurses who have successfully passed the examination and completed two years of full-time surgery experience.

The NEBDN exam consists of a written paper, spotter, practical and oral test. The NEBDN exam takes place twice a year, in May and November.^[3]

Candidates must score 75% (or more) in each test in order to successfully pass, otherwise the candidate will be failed and will have to resit the exam again later in the year or at the next sitting.

The NVQ level 3 in oral healthcare is a fairly new qualification that has been approved by the NEBDN. Rather than the tradition studying and examination of the NEBDN certificate, Student dental nurses completes modules throughout their course, which counts towards their final examination. The NVQ however is only recognized in the UK.

Post qualifications

Qualified Dental nurses can increase their knowledge and skills by studying for NEBDN post-qualification certificates. These are available in a number of specialist areas, most Dental Schools in the UK offer the following qualifications on a yearly basis:

• NEBDN Certificate in Oral Health Education
• NEBDN Certificate in Conscious Dental Sedation Nursing
• NEBDN Certificate in Special Care Dental Nursing
• NEBDN Certificate in Orthodontic Nursing
• NEBDN Certificate in Dental Radiography Nursing

Fluoride Dental Nurses

Following the increased scope of practice in April 2009 the GDC have permitted the application of topical fluoride to be applied by a Dental Nurse on Prescription from a GDC Registered Dental Surgeon. This can be either be a one off application or as part of an extended treatment plan normally a maximum of four applications per year. The role of Dental Nurses applying fluoride in England was introduced in conjunction with the GDC and The Department of Health to improve Oral Health as part of their publication Improving Better Oral Health the applications were carried out as part of a trial by Salford PCT an area that has been hit by the worst rates of decayed teeth filled and extracted in children in the North West of England. At present the role of Fluoride application by Dental Nurses is being slowly introduced around other parts of England. The training is normally provided and funded by the local Primary Care Trust. In order to qualify for a place on a course funded by the PCT the pre requisites are the Dental Nurse should:

• GDC Registered
• Work within an NHS Practice
• Good character and health
• Good manual dexterity
• Adequate Indemnity Cover

The training will normally consist of around several weekly workshops over a 6 – 8 week period and will include infection control, CPR and Medical emergencies, dental anatomy, use of fluoride and the application of fluoride. In order for the GDC to fully recognise the course the provider of the course should have employed the services of a specialist in dental public health to oversee the course.

Sedation Dental Nurses

Conscious sedation is a way to manage anxiety in the dental surgery most Primary Care Trust clinics and some independent general dental practices offer sedation services to the public on a referral basis. In addition to the National Dental Nursing qualifications the NEBDN also offer a post graduate course Certificate in Conscious Sedation Dental Nursing. This allows a Dental Nurse to act as an additional nominated person in a dental surgery were treatment under sedation is being carried out. There are 3 types of conscious sedation I.V (Intra Venous) and R.A (Relative Analgesia).

I.V Sedation consists of a drug being injected into the Dorsum (back of the hand) normally Midazolam / Hypnovel.

R.A Sedation consists of a drug being inhaled through a nasal hood and is normally Nitrous Oxide.

Oral Sedation consist of a tablet taken an hour before dental treatment this provides relaxation but does not always work as some people require deeper sedation e.g. I.V Sedation.

The training consists of several monthly workshops and a practical, written and oral examination over a period of 6 months. People attending the course are required to produce a portfolio of evidence consisting of 25 cases were they have assisted with post operative recovery. A further 25 cases of assisting during the administration and treatment of sedation with a minimum of 5 cases I.V and 5 cases R.A.

The Sedation Dental Nurses role may include the following:

• Preparing and checking the sedation equipment
• Preparing and checking resuscitation equipment
• Supporting and reassuring the patient during the administration of sedation
• Monitor the patient vital signs e.g. Pulse, Saturation levels, Blood Pressure
• Assist with the recovery phase and monitor the patient during recovery
• Apply surface anaesthetic to the I.V access site
• Swab the surface with alcohol across the I.V access site
• Prepare the patients arm for venipuncture
• Assist with medical emergencies that may arise
• Weight the patient prior to the sedation session
• Prepare Local Anaesthetic for the Dental Surgeon
• Ensure that the correct records are present and updated
• Support the Dental Surgeon obtain consent and complete medical histories
• Support the Dental Surgeon with Post Operative advice and instructions

Most UK Dental Schools provide the NEBDN course in Sedation Nursing with the cost ranging from £600 for tuition and £150 for the Examination.

GDC Register

The General Dental Council opened the new Register for Dental Care Professionals in July 2006. By July 2008, Dental nurses MUST register with the GDC .This includes anyone working as a dental nurse part-time, or occasionally and temporary/locum dental nurses working independently or through an agency.

CPD

The General Dental Council have stated that part of the conditions of registration includes the completion of Continued Professional Development. At present this consists of 150 hours academic learning based on 5 yearly cycles. The GDC recommend that the 3 core subjects are covered as mandatory CPD this includes:

• CPR and Medical Emergency Management (10 verified hours per 5 yearly cycle)
• Infection Control (5 verified hours per 5 yearly cycle)
• IRMER Radiography (5 verified hours per 5 years cycle)

CPD is split in to two areas Verifiable CPD and Non Verifiable CPD at present the GDC regulations state that a minimum of 50 hours of CPD should be Verifiable for every 5 yearly CPD cycle.

Verifiable CPD

This consist mainly of courses attended e.g. Infection Control. To ensure that the course is classed as verifiable the certificate should state

• GDC registrant’s name
• GDC registrant’s GDC number
• Course title
• CPD hours achieved

The certificate would also state that the course meets the requirements of the GDC’s life long learning policy. All verifiable courses should have a clear aim and objective and list the learning outcomes to be achieved by attending the course. The course provider should also seek a register of attendees and provide the opportunity for written feedback

Non verifiable CPD

Reading a dental publication Watching a dental CD-Rom / DVD Peer Review / Clinical Audit Attending meetings and workshops

Salary

There is no set salary for Dental Nurses in the UK however the BDA have set a scale for recommended rates that should be paid to a Dental Nurse. Most pay is negotiated based on the Dental Nurses experience and qualification. The higher rates of pay are associated with the South of England however on average the rates of pay in general as below:

• Independent Practice Qualified: £12,000 - £15,000 per annum
• Independent Practice Trainee: £8,000 - £10,000 per annum
• Community Dental Clinics (Band 4) - £18,152 - £21,798 per annum
• Hospital Trust Dental Services (Band 4) - £18,152 - £21,798 per annum
• Senior Nurse Community Clinics (Band 5) - £21,176 - £27,534 per annum
• British Army Dental Nurse (Depending on Rank) - £13,377 - £33,223 per annum (Recruit - Staff Sgt)
• TA Reserve Soldier (Depending on Rank) - £34.31 - £83.78 per day (Recruit - Staff Sgt)

Hours and environment

Most Dental Nurses will work 8:30am – 5:30pm and may be required to work on Saturdays and some late evenings most Dental Nurses will work in the following sectors:

• NHS / Private General Practice
• NHS Community Dental Services (Paediatric clinics, referral centres, domiciliary care etc.)
• NHS Hospital and specialist maxillofacial clinics
• HM Armed Forces Regular and Territorial
• HM Prisons
• Specialist private practices e.g. endodontic practices
• Specialist sedation clinics independently owned
• Training providers as Dental Nurse Assessors

HM Forces

Currently there are opportunities to serve abroad with HM Armed Forces as a Dental Nurse. To enlist in the Army, Royal Navy and Royal Air Force the applicant will still be required to carry out compulsory military training this covers the basics of Drill, Weapons Handling, First Aid and survival training. Depending on the force they wish to serve with this could range from 13 – 16 Weeks.

After passing out the soldier will then progress to trade training at Aldershot Barracks were they will attend a 14 week course in dental nursing for applicants who apply to join the Army as a qualified Dental Nurse they would still be required to attend Aldershot Barracks however promotion is very quick in the Royal Army Dental Corps and progression to the rank of Lance Corporal is relatively quick.

For applicants applying to enlist as a Dental Nurse possessing A Levels the British Army have facilities that allow them to train to become Dental Hygienists later on in their career or to train as a role in dental practice management.

On completing both Phase 1 and 2 of their training Dental Nurses in the British Army may be deployed to Germany, Bosnia, Canada and the Middle East.

On completion of training all military Dental Nurses are required to register with the GDC and while on deployment are still bound by the regulations of the GDC.

There is also the opportunity for civilian Dental Nurses to join the Territorial Army however on application to the TA a Dental Nurse must be GDC registered and qualified on enlistment.

To qualify to join the British Army and the TA you will need to attend an interview and Medical and complete a short entrance test. You should ideally be able to run 1 ½ miles in under 12 minuets and have a basic level of physically fitness as training can be mentally and physically demanding.

Career Progression

Dental Nursing once qualified opens a wide variety of future career options with some dental nurses progressing in to other roles:

• Oral Health Educator
• Practice Manager
• Lead / Senior Dental Nurse
• Infection Control Nurse
• Telephone Dental Nurse Advisor (NHS Direct)
• Dental Nurse Trainer / Assessor
• Dental Health Worker
• Dental Hygienist / Therapist

Dental Hygiene / Therapy training

Some Dental Nurses also progress to train to become GDC registered Dental Hygienists / Therapists. Some academic institutions also allow a nationally recognised dental nursing qualification in lieu of one A Level when applying for the Combined Diploma in Dental Hygiene and Therapy or for access to the BSc in Oral Health Science allowing a Dental Nurse to train as a Hygienist and/or Dental Therapist. However all academic institutions require five A* - C grades at GCSE in maths, English and a minimum of one science subject some times two to include Biology and Chemistry. For Bristol School of Dentistry they will accept a student with a Dental Nursing qualification with two post graduate certificates in dental nursing. At present the Diploma course is mainly funded by the Strategic Health Authority meaning that most Diploma students will not pay tuition fees however most Dental Schools are converting to BSc Degrees meaning that the students will be liable for the tuition fees. Diploma students normally apply directly to the academic institution for a place however BSc Students apply through UCAS like BDS students.

Dental Nursing Outside the UK

Australia – At present there is an agreement with the British Association of Dental Nurses and Australia meaning that Australia currently accept the National Certificate and the NVQ 3 in Dental Nursing.

Canada – At present Canada do not recognise any British Dental Nursing qualification. However Canada will consider individual applicant to apply for state registration with their British Qualification accompanied with the NEBDN Certificate in Radiography Dental Nursing plus the sitting of a state Dental Assisting Examination. It is likely that additional training will be required in Canada most Dental Nurses carry out Fluoride applications, Coronal polishing, Impression taking, Fissure Sealing, Denture easing etc.

USA – At present USA does not accept any British Dental Nursing qualifications and anybody wishing to reside as a Dental Assistant in the USA would be required to attend a full 2 year college program. The Dental Assistant is not the U.S equivalent to the UK Dental Nurse.

Cayman Islands – Occasionally the job section on the British Association of Dental Nurses have advertised Dental Nursing roles in the Caymans. The Cayman Island at present accept a British qualification in Dental Nursing however this would also require the NEBDN Certificate in Radiography Dental Nursing.

For the purposes of immigration in most countries although Dental Nursing is a role in demand and in short supply Australia and Canada do not recognise Dental Nursing as a skilled role for an employment visa. The title Dental Nurse is only used in the UK, most counties outside the UK use the title Dental Assistant and the role does not currently list in occupations in demand.

Orthodontic therapy

In 2009 the GDC regulated and introduced the role of Orthodontic Therapists in the UK; this allowed a qualified Dental Nurse to apply for a 1-year course RCS Diploma in Orthodontic Therapy permitting them to apply and remove orthodontic appliances. The qualification is overseen by the FGDP (UK) and is currently available in Leeds Dental Institute and Cardiff School of Dentistry. Following an examination the Student Orthodontic Therapist can apply for registration with the GDC as an Orthodontic Therapist allowing them also to have the prenominal of Diploma Ortho Ther RCSeng. The prospective Dental Nurse should work with a specialist registered orthodontist and have a nationally recognised British Dental Nursing qualification with two years post qualification experience and they desire a NEBDN Certificate in Orthodontic Nursing.

Orthodontic Therapist's role

• Clean and prepare teeth for placement of orthodontic appliances
• Identify and select the correct instruments for orthodontic treatment
• Insert passive removable orthodontic appliances
• Insert active removable orthodontic appliances adjusted by an Orthodontist
• Remove fixed appliances and cement
• Take impressions
• Make orthodontic appliances safe in the absence of the Orthodontist
• Fit orthodontic head gear
• Fit orthodontic facebows after adjusted by an Orthodontist
• Place brackets and bands
• Prepare adjust and remove arch wire
• Fit tooth separators
• Fit bonded retainers
• Give advice on appliance care and oral health instructions

References

1. ^ "Dental Nurse". Learn Direct Careers Advice. http://www.learndirect-advice.co.uk/helpwithyourcareer/jobprofiles/profiles/profile162/. Retrieved 2008-06-07. 
2. ^ "Potential registrant". General Dental Council. http://www.gdc-uk.org/Potential+registrant/Apply+for+registration/Information+Page+1.htm. Retrieved 2008-06-07. 
3. ^ "National Examination". National Examining Board for Dental Nurses. http://www.nebdn.org/. Retrieved 2008-06-07.