Sir, on reading the letter by A. C. L. Holden (No to direct access; BDJ 2012; 212: 355–356) I was slightly outraged by what I thought were the author's inaccurate, ignorant and small-minded comments and felt compelled to reply. I am a dental therapist (DT) and am currently the North East Representative for the British Association of Dental Therapists (BADT).

The author raised concerns that direct access (DA) would not be in the best interests of patients. However, if a patient presents with a lost restoration and the dentist is busy, with DA we could see the patient, assess best treatment and refer accordingly to the dentist. We do recognise that restorations fail for a number of reasons and what the correct treatment should be.

The author raised the fact that DTs have a shorter education and so it is beyond our competency to diagnose, but if we had DA we could have further training. Indeed it would be foolish and a little insulting to the GDC to assume that we would be allowed to have DA without having any further training to ensure competency. Currently we can prescribe (with additional training), interpret radiographs and are expected to be able to identify caries to be able to remove it, so why with additional training to consolidate and develop our diagnostic skills could we not be allowed to diagnose caries and manage it accordingly?

The author stated that dental surgeons are often the health professionals patients see most frequently. In practices that utilise a DT, it is in fact often she or he who sees the patient most frequently. The dentist does the initial diagnosis and then the DT carries out the oral hygiene advice, scaling or periodontal and restorative treatment (within our scope of practice), which may take several visits alongside any treatment with the dentist. The patient may then go on to be supported by the DT with regular visits for a scale and polish and continued oral hygiene.

The author goes on to say that dentists are relied upon to diagnose oral conditions such as oral cancer and mucosal disorders and that giving DTs the responsibility to diagnose such conditions is 'bordering upon neglecting patients' rights to proper treatment'. At present we do have to rely upon a dentist to make a diagnosis but that is only because DTs cannot diagnose as part of their scope of practice. This doesn't mean we are incapable of diagnosis with further training and change to our scope of practice. DTs receive training in recognising changes in the oral environment and are able to use their clinical judgement and refer to the dentist where they deem it necessary.

In the letter, the issue of public perception is mentioned and the author states 'It is unacceptable to place the public in a situation where their capacity to provide informed consent is impaired due to not knowing by whom they are being treated and what their role is'. My response to this is dentists currently lead the dental team and as such should communicate effectively to their patients what roles members of the team in the practice play. We should all be working together to raise awareness of the different roles within the dental team and make our patients aware of how our scope of practice is expanding with additional skills. If you have a DT in your team you should be making your patients aware of what their role is so that the patient can provide informed consent based on this information. If you are not currently doing this and this is the reason for the impaired ability to consent then you are not fulfilling GDC standards.

Since all the author's points can be contested this group of dentists' argument against DA is invalid. I can only assume that this group of people feel their own role is threatened by the idea of DA. In terms of setting up alone, a DT can already do this and so introducing DA is unlikely to see a significant increase in independent practice in competition with existing practices. Dental teams must work together in the interest of the patient and if DA was to go ahead there would be treatment that dental therapists could not carry out so referrals would be made accordingly and this would be best arranged within a single practice. Introducing DA would mean that patients would be able to see the DT for an oral health needs assessment, routine treatment and preventative practice, freeing up time for the dentist to carry out the more complex treatments. Also, a DT's time is cheaper than that of a dentist. How can this change not be seen as a positive move for both patients and the dental team alike? There would be nothing stopping practices working in the existing way so if you personally do not to want to work in this way then fine, don't; but this may work well for some practices and it would be unfair on both the public and the profession to dismiss this idea.

1. By email