Health Professions Council |
|
This Post-Hearing Update should be read
in conjuction with the Preliminary Report for the profession. |
The Council issued its Dental Technicians Scope of Practice (Preliminary Report) in June 1999. The public hearing was held on 2 November 1999. The following are changes to the Preliminary Report which arose from the submissions made either at the public hearing or in subsequent written submissions.
I. SCOPE OF PRACTICE
The Council’s Preliminary Report recommended the following scope of practice for dental technicians:
The practice of dental technology is the fabrication or alteration of a dental appliance or device, in accordance with a prescription from a dentist or denturist, and the repair of such appliances or devices.
A. Inclusion of "Medical Practitioner"
The Council received submissions that indicate that certain medical practitioners write prescriptions for dental appliances or devices. The Council has modified the scope of practice statement to include "medical practitioner."
B. Intraoral Procedures
At the public hearing, representatives of the College of Dental Technicians of British Columbia (the College) and of the Commercial Dental Laboratory Association of British Columbia continued to request an expanded scope of practice which would allow dental technicians to perform intraoral procedures and to provide direct services to the public "on prescription" of a dentist. The Commercial Dental Laboratory Association of British Columbia submitted a post-hearing letter outlining a distinction between minor and major intraoral procedures. Both the College and the Commercial Dental Laboratory Association of British Columbia conceded that there was no current training program in place for this form of advanced or expanded practice, but stated that there were dental technicians who had attended seminars and other types of post-graduate training to learn how to perform these procedures. The Commercial Dental Laboratory Association of British Columbia stated that laboratories were performing intraoral procedures, such as custom staining and bite adjustments, on the referral and request of dentists. The College submitted a post-hearing letter indicating it had reviewed an outline provided by the Commercial Dental Laboratory Association of British Columbia for an educational course for dental technicians. The College indicated that "[T]his course addresses the additional requisite education and skills necessary in the event dental technicians seek licensure for increased scope of practice services." However, it appears that this training has not yet been implemented.
The Council has given careful consideration to the submissions made by the College and the Commercial Dental Laboratory Association of British Columbia. According to submissions made by the Commercial Dental Laboratory Association of British Columbia, dental technicians are requesting a wide variety of intraoral procedures, ranging from custom staining to all manner of impressions to fitting appliances, which may require bite adjustments. Although some dental technicians may be performing intraoral procedures as required and if referred by a dentist, these are not currently within dental technology’s scope. Intraoral procedures would require extensive additional training. All submissions from the dental technology profession, from other dental health professions and from educators of dental practitioners are in agreement on this. In addition to the technical aspects of intraoral procedures, there are issues concerning patient relations and professional ethics which would require additional education and monitoring by the College.
No evidence was presented to the Council to indicate a public interest in dental technicians providing intraoral procedures. Evidence was presented that some dentists find it convenient to refer patients to a dental technician for some specific procedures, such as custom staining or repairs, alterations and even fitting appliances. The submissions from the dentistry profession indicated that dental technicians should not be performing procedures in or below the surface of the teeth, such as would be required for fitting a partial denture.
The College and the Commercial Dental Laboratory Association of British Columbia indicated concern that dental technicians may be operating "illegally" if they perform intraoral procedures without an expanded scope of practice. Under the Council's shared scope of practice model, if a dentist requires such services from a dental technician, the dentist may delegate these procedures to the dental technician following the delegation principles outlined in the Council's Final Report on the Scope of Practice Review. It is also possible that an advanced practice dental technology training program could be implemented that would allow dental technicians to achieve the necessary level of post-graduate training for advanced practice and public safety. At this point, the Council is not prepared to recommend the granting of this expanded scope of practice.
|
The Health Professions Council recommends the following scope of practice for dental technicians:
The practice of dental technology is the fabrication or alteration of a dental appliance or device, in accordance with a prescription from a dentist, denturist or medical practitioner, and the repair of such appliance or device. |
II. OTHER ISSUES
A. Delegation to Unlicensed Persons
At the public hearing, the College continued to advance its concerns about the issue of removal of the current "in house" exemption contained in section 5(2) of the Dental Technicians Regulation. Subsequently, the Council defined "dispense" to include "fabricate" and granted "dispensing" to dentists. In addition, the Council's delegation protocol allows for delegation of a reserved act to an unlicensed person. The College submitted numerous letters which discussed the risk of harm in allowing dentists to fabricate without qualifications to do so, although they acknowledge that some dentists (orthodontists) are qualified to do so.
Under the current Dental Technicians Regulation to the Health Professions Act, non-registrants are prohibited from performing the services provided by dental technicians for anyone. This restriction is subject to an exemption which applies to a person who performs the services of a dental technician under direct supervision and in the office of a dentist and exclusively for the practice of the dentist. (Reg. 509/95, Sec. 5)
The College requests the retention of the prohibition and the elimination of the exemption. It is concerned with the delegation by dentists of this reserved act to non-registrants as a dentist, under the proposed changes recommended by the Council, could hire any number of unlicensed persons and set up a laboratory, outside his or her office, to fabricate dental appliances on a commercial basis.
The College of Dental Surgeons of B.C. objects only to the effect of the prohibition if it would prevent its members from performing these services themselves. The Council has recommended granting to dentists the reserved act of dispensing prescribed appliances or devices for dental conditions. This reserved act has been defined as including "fabrication."
After consideration of the submissions made to the Council, it recommends that the prohibition and the exemption be retained in the following form:
| The Health Professions Council recommends that no person other than a registrant of a regulated health profession acting within their scope of practice may, for another, dispense prescribed appliances or devices for dental conditions unless such person performs such services under direct supervision in the office of a dentist or medical practitioner, and exclusively for the practice of the dentist or medical practitioner. |
B. Barriers to Interdisciplinary Practice
At the public hearing and in subsequent submissions, the Council was made aware of certain restrictions imposed upon denturists and dental technicians working together, which are reflected in current practice.
After reviewing submissions from the College and the College of Denturists of British Columbia, the Council makes the following observations:
The Council sees no impediment to denturists passing on the dentist's prescription for partial dentures or dentures over implants to dental technicians for the fabrication of the appliance or device. Denturists were designated before the reserved acts system was developed. Denturists do not have the reserved act of "prescribing." Therefore, until the Denturists Regulation grants them this reserved act and the Dental Technicians Regulation includes denturists among those from whom dental technicians may receive prescriptions, dental technicians may provide their services to denturists by following the delegation protocol as recommended by the Council in its Final Report on the Scope of Practice Review.
