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Scope of Practice (SOP) refers to the range of procedures that can be performed by practitioners registered with the Australian Health Practitioner Regulation Agency (Ahpra) under the National Law.

Registered dental practitioners include dental specialists, dentists, dental prosthetists (DP), dental hygienists (DH), dental therapists (DT), and oral health therapists (OHT).

These practitioners may perform ‘restricted dental acts’ as described in Section 121 of the Health Practitioner Regulation National Law 2010 (Cth) (the National Law), and only according to their individual Scope of Practice (SOP).

Dentists may practise any activities within the definition of dentistry. Dental prosthetists (DP), dental hygienists (DH), dental therapists (DT), and oral health therapists (OHT) have a narrower range of practice.

The Ahpra Code of conduct (the code) describes the professional behaviour expected of registered health care practitioners by the National Boards.

Expectations of the DBA

The DBA Guidelines for Scope of Practice state dentistry involves assessing, preventing, diagnosing, advising on, and treating any injuries, diseases, deficiencies, deformities or lesions on or of the human teeth, mouth or jaws or associated structures.

All dental practitioners are members of the healthcare team and are expected to work with other members of that team to provide the best possible care and outcomes for their patients.

Each practitioner has a responsibility to refer, delegate or handover to the member of the team who is best placed to manage a patient’s care. A dental practitioner must not direct anyone, whether registered or not, to undertake dental treatment or give advice that is outside that person’s education and competence.

Practitioners are expected to practice within the Scope of Practice of their division as well as within their individual/ personal SOP. Each practitioner is solely responsible for determining their own personal SOP and for working within this scope.

Questions around Scope of Practice

It is common for dentists to question exactly what they, and each of their colleagues, can and cannot do.

An important distinction needs to be made between the SOP of the profession/ division, and individual SOP. The DBA has resources to guide practitioners on their Know your scope webpage.

The SOP of the profession is broadly defined by the range of activities and responsibilities that each practitioner division can perform under the National Law. The SOP of each practitioner division is defined by the competencies gained during the approved program of study and can vary depending on the place of training.

Individual scope is determined by each practitioner’s education, training, competence and experience, and can vary from person to person. For example, some practitioners are experienced and confident to provide more complex oral surgery than others, or to perform more difficult endodontic procedures. Other practitioners choose to always refer such cases.

Although Dentists may practice any activities within the definition of dentistry, dentists need to be familiar with the DBA SOP documents and use their own professional judgement to ensure they are working within their individual SOP to provide the best care possible for their patients.

Scope of Practice for DH, DT and OHT

A similar principle applies for DH, DT and OHT when we consider them generally or the scope of individual practitioners. Here it can be a little more complicated because there is a wider variation between the individual scopes for each practitioner.

All of these practitioners provide oral health care to patients, with differences in their SOP, and with a reduced scope and training compared to a dentist.

The SOP for each practitioner depends on two factors:

1. The type of practitioner training (i.e. DH, DT and OHT)
2. The place of practitioner training (i.e. each University provides different skills and experience).

Dental Hygienists are primarily engaged in treatment of periodontal (soft tissue) disease and preventive services. Hygienists may treat patients of all ages.

Dental Therapists generally restrict their practice to treatment of children, and treatment may include hygiene, restorative and preventive services (i.e. cleaning and fillings), as well as extractions (primary teeth only). Some DT have adult scope and are able to treat patients of all ages, however the scope of treatment they perform remains limited. They do not perform complex restorative work (fixed and removable prosthodontics), permanent tooth extractions, permanent endodontics or complex restorations.

Oral Health Therapists may provide both hygiene (like Hygienists) and restorative (like Dental Therapists) services. They may treat children and adults depending on where they trained. It is important to remember that SOP is distinct from the age of the patients that can be treated. For example, OHT with adult scope are still limited in their treatment procedures and cannot perform extractions or root canal therapy on permanent teeth, implants, crowns and bridges, dentures or oral surgery.

Scope of Practice for DP

Dental prosthetists are also registered dental practitioners who work as independent practitioners in the assessment, treatment, management and provision of removable dentures, and flexible removable mouthguards used for sporting activities and may work as part of the dental team in providing implant-retained overdentures, immediate dentures, splints and anti-snoring devices.

Dental prosthetists have Provider Numbers allowing them to provide services for patients through private billing arrangements, often supported by private health insurers. They also service patients accessing benefits from the Department of Veterans’ Affairs and individual state-based denture schemes.

What can a Dental Assistant do?

A dental assistant is not a registered practitioner and does not have a defined SOP under the National Law. They cannot perform ‘restricted dental acts’ so dentists should not allow their assistants to perform tasks that are restricted to registered dental practitioners.

Dental assistants are not required to have completed a training program. However, a dental assistant who has completed a nationally recognised training program (Certificate III or Certificate IV) has the necessary skills and experience to perform certain procedures. The dental practitioner is responsible for the supervision of the dental assistant performing these procedures.

There is a national register on vocational education and training (VET) in Australia, and it shows the current nationally recognised training programs in Dental Assisting. The national register documents the expected competencies achieved in these courses and outlines the particular procedures that an individual dental assistant has been trained to do. There are core units of competency, as well as electives.

Background

• In 2016 the ADC (Australian Dental Council) published the updated professional-competencies of each of the five divisions of dental practitioner for general registration.
• In July 2020 the Dental Board of Australia (DBA) revised the Scope of Practice allowing DH, DT and OHT to work independently of dentists and thereby removed the need for a Structured Professional Relationship.
• In July 2022 Allied Dental Practitioners became eligible to apply for their own provider number/s.

Key points

Only registered dental practitioners can perform restricted dental acts.

The type of treatment that can be provided by a practitioner is dictated by their scope of practice.

SOP differs both between and within groups (SOP of the profession versus individual SOP).

To determine their SOP, a registered dental practitioner must consider and comply with:

1. The SOP for their division of practitioner (e.g. dentists compared with hygienists).
2. The individual SOP based the level of education, training, competency and experience.

References

The following relevant documents can be found on the Dental Board of Australia’s (DBA) website:

• DBA Guidelines for Scope of Practice dentalboard.gov.au/Codes-Guidelines/Policies-Codes-Guidelines.aspx
• DBA Scope of Practice Registration Standard dentalboard.gov.au/Registration-Standards.aspx
• DBA Dental FAQ – Scope of Practice registration standard dentalboard.gov.au/Codes-Guidelines/FAQ.aspx

Further information is available here: Dental Assistants – Australian Dental Association NSW