Oral Health Care Teams in Canada

Roles and Responsibilities of Allied Oral Health Care Providers

Allied oral health care providers are an important part of your team. Each member plays a unique role in ensuring that the patient receives the most comprehensive and complete oral health care experience when they visit your practice. Below is a brief description of some of the possible roles that may be part of your practice.

It is important to note, however, that due to the nature of the Canadian health care system and how health professions are regulated, the scope of practice, regulation, and educational requirements of allied oral health care professionals differ by province/territory.  The following descriptions are intended to be general in nature; actual scope and regulation of these providers differs greatly by jurisdiction.

It is important to confirm the scope of practice and regulation of a specific allied oral health care provider in your province of practice.

Certified Dental Assistant

Professional dental assistants are registered, certified and/or licensed dental team members who work together to provide high quality dental care. This is the team member who provides assistance and prepares the patient for treatment, sterilizes instruments, and helps keep the patient's mouth dry during procedures. In some jurisdictions, a dental assistant may also take X-rays and dental impressions, polish and apply fluoride to the patient's teeth, apply and remove rubber dams, place and remove matrix bands and wedges, apply cavity bases and liners, provide dietary counseling, oral hygiene instruction and post-operative instruction, place topical anesthetic, perform coronal whitening, apply pit and fissure sealants and apply desensitizing agents.

In some jurisdictions, dental assistants have the opportunity to receive additional training in direct patient care and may remove sutures, fabricate/place/remove temporary crowns and temporary restorations, place a gingival retraction cord, perform restricted scaling, and provide restorative, orthodontic and preventive services. Dental assistants may also be educators, administrators, clinical technicians, treatment coordinators, receptionists, office managers and sales representatives (CDAA, 2013).

There are several accredited training programs for dental assistants across Canada. Educational requirements to enter these programs include successful completion of high school with an emphasis on sciences, including biology and chemistry. In addition, some programs require their students to have and maintain a valid CPR (cardiopulmonary resuscitation) Level C certificate. Once accepted, dental assistant programs provide training in areas such as microbiology and infection control, preventive dentistry, dental radiography, clinical assisting procedures and community dental health (CDAA, 2014).

It is estimated that there are approximately 26,000 to 29,000 dental assistants in Canada and nearly 20,000 are registered with a provincial dental assisting association.  Of those 20,000 dental assistants approximately 74% are certified/licensed, 99% are female and the average age is 38 years old (CDAA, 2014).

Dental Hygienist

The dental hygienist is registered and trained to clean the patient's teeth and to help the patient develop a home care routine tailored to his or her needs. Dental hygienists may work in a wide variety of practice settings including in their own practice, or independently within a dental health team (Fletcher, 2014).

In Canada, dental hygienists must successfully complete a dental hygiene diploma or bachelor program. The curriculum focuses on oral and clinical science, with an emphasis on health promotion and preventive, motivational and communication strategies (Kanji et al., 2010). To be able to practice, dental hygienists must be registered or licensed by the dental hygiene regulatory authority in their provincial or territorial jurisdiction (CDHA, 2014). Programs range from two to four years at the college or university level or, more recently in private educational settings. The entry-to-practice credential in all provinces is currently at the diploma level.

Regulations vary from province to province, but a dental hygienist's work often includes:

• Taking X-rays
• Taking dental impressions
• Cleaning, polishing and applying fluoride to your teeth
• In some jurisdictions, the dental hygienist may also be allowed to perform a basic exam

Registered Dental Hygienists

Registered dental hygienists in most provinces-excluding P.E.I., N.W.T. and the Yukon-are authorized by provincial governments to assess a patient's oral health and provide dental hygiene care without the presence of a dentist (Bilawka and Craig, 2003). In addition to plaque removal and polishing, independent hygienists may give fluoride treatments, administer local anesthetic for dental hygiene or treatment, apply pit and fissure sealants to the top surfaces of teeth, provide IST and do scaling and root planing. In some provinces, they can prescribe and diagnose X-rays. Additionally, in some provinces, dental hygienists must pursue additional professional training related to specific dental procedures and the operation of an independent practice. Presently, there are about 1,200 independent dental hygienists across Canada.

Dental Technologists/Technicians

Dental technologists/technicians work as part of oral health care teams to fabricate various appliances used by dentists in the treatment of patients. Dental technologists/technicians may fabricate orthodontic devices, full dentures, partial dentures, crowns and bridges from a dentist's prescription. The dental technician/technologist may also produce speciality items such as splints and mouth guards, as well as implant-related restorations.

Dental technology is regulated in all provinces except Manitoba, and is also not regulated in the territories. Regulations vary from province to province, but in general, dental technicians/technologists may perform some or all of the following activities:

• Make, produce, reproduce, construct, furnish, supply, alter and repair complete dentures, removable partial dentures, fixed prosthodontics, fixed and removable orthodontic appliances or any other things to be used in connection with or in the treatment of the human tooth, jaw, or associated structure or tissue
• Repair full or partial dentures that do not require intraoral procedures
• Follow written prescriptions from the dentist
• Perform dental laboratory procedures
• Obtain impressions and fabricate casts under prescription
• Select dental materials for fabrication into dental prostheses
• Practice infection control in dental laboratory
• Practice quality control in dental laboratory
• Maintain laboratory equipment and instruments
• Assess current appliances for mechanical defects, wear, and inappropriate design
• Instruct and supervise registered dental assistants
• Store, handle, and dispose of hazardous materials
• Research product application, new materials and techniques
• Participate in co-operative education programs
• Consult and participate with respect to diagnosis and appropriate remedy with the dentist
• Select, arrange and customize teeth for aesthetic results by prescription
• Make, repair, reline, replace or furnish full or partial dentures and, for that purpose, carry out nonsurgical intraoral procedures including the taking of impressions and occlusal registrations that are necessary, by prescription (CDAA, 2014)

Dental Therapist

Dental therapists are unique members of allied oral health care workers in Canada. Unlike, for instance, dental hygienists and assistants, dental therapists may be employed by federal or provincial governments to provide oral health care services in rural and remote communities. These oral health professionals, however, are still registered and regulated by the provincial regulatory authorities in certain jurisdictions, such as British Columbia.

Dental therapists are primary health care professionals who are trained to perform basic clinical and dental treatment and preventative services within a variety of practice settings.  As members of a multidisciplinary health team, dental therapists may provide restorative dental treatment services, as well as perform disease prevention and oral health promotion.

At present there are about 300 dental therapists practising in Canada; most practise in Saskatchewan; some positions exist in the three northern territories, and less than 50 dental therapists are distributed throughout the rest of Canada with the exception of Ontario and Quebec. In some provinces dental therapists are directly employed by Health Canada or by one of the territorial governments and trained to provide oral health services to Inuit and First Nations people in rural and remote communities. In some provinces, like Saskatchewan and Manitoba, dental therapists may also be privately employed as part of dental practices.

Receptionists and Business Staff

Receptionists maintain the dental team's schedules and allow the office to run smoothly. The receptionist is usually the first point of contact and may often provide clients general information about appointments and billings (CDA, 2014).

It is helpful to ensure that the responsibilities for billings (direct to patient or insurance plan) and dealing with practice finances (banking, ordering inventory, etc.) are often shared among more than one staff member. It should also be noted that front desk business personnel are preferable but not necessary to operate a dental practice.

Your Associate Dentist

The associate dentist is your professional colleague. It is important to treat your associate with respect, openness and trust. To establish a healthy working relationship with your associate be sure to consider the following points:

• Confirm that you have a valid employment contract for your associate before he or she starts working with you.
• Discuss and negotiate as equals on issues such as hours of work, vacation time, attendance at courses, clinical practices, etc.
• Within the limits of personal scope, the associate should be allowed freedom in clinical decisions.
• It is reasonable to expect improvement over time for new graduates. It is completely unacceptable to impose production quotas or billing targets on an associate.
• Respect that associates are accountable for their own patient charts, treatment notes and billing practices even as a contracted member of your practice.
• Support your associate to consult or refer patients as they believe is necessary to ensure the best possible care for the patient.

As a practice leader, whether principal or associate, it is important that you work to create a supportive and professional work environment.

All members of your dental office team must be treated with fairness and respect. As a leader in your practice, it is your responsibility to ensure that bullying or harassing behaviour is not tolerated by any staff member. Use the following strategies to foster healthy and positive relationships with your staff members and allied oral health care colleagues:

1. Be inclusive.
2. Demonstrate appreciation.
3. Communicate openly, honestly and often with the team.
4. Create written job descriptions and office policies.
5. Invite input from your team whenever possible, for example, on administrative issues.
6. Provide timely and constructive feedback.
7. Hold annual written performance reviews and have employment contracts for all positions.
8. Encourage continuing education for your staff to upgrade their skills whenever possible.
9. Maintain appropriate and professional personal boundaries with all staff.

Helpful Links and Resources

Canadian Dental Association: Your Dental Health Care Team Fact Sheet

Each member on your dental health care team plays an important role. This fact sheet developed by the Canadian Dental Association provides a brief overview of the roles and responsibilities possessed by allied oral health care professionals and support staff.