Scope of Practice guidance

In determining your own scope of practice, it may help to consider it in two parts.

Firstly, by your professional title, which establishes the formal boundaries of your role and reflects your training, qualifications, and skills at the point of registration.

Secondly, by your experience, ongoing learning, and any additional training undertaken in practice.

Together, these factors influence how your capabilities develop over time, enabling you to extend what you can do safely and competently.

The table below details the differences in both parts:

Your scope of practice is influenced by a range of factors.

For example, you may have qualified under one professional title in another country but are registered under a different title here in the United Kingdom.

Alternatively, you might work in a setting where the care you provide is more specialised or limited in scope.

Your personal scope of practice is shaped by both your practical experience and your ability to reflect on whether your underpinning knowledge is sufficient to support safe practice.

There may be situations where your employer, or your colleagues in the dental team, encourage you to undertake additional tasks or new procedures. If you do not feel you have the knowledge, skills, or experience needed to carry out these tasks safely and effectively, you should not undertake them until you have gained more experience or completed further training. It is not appropriate for another member of the team to override or insist otherwise. You must use your professional judgement to recognise and work within the limits of your own competence, and to seek further training or decline to proceed where this is necessary to ensure patient safety.

Youssef trained as a dentist in Syria; he relocated to the United Kingdom and was able to register as a dental therapist under a now-closed pathway. When practising in Syria, Youssef felt very confident in diagnosing pulpal issues and extirpating a tooth when indicated, to relieve the patient from pain.

He is now working in a high street practice in the UK.  One day, an 11-year-old patient presents with pain in a permanent molar. Youssef is the only clinician on site that day and, after careful assessment, using a number of diagnostic tools, concludes that there is likely some kind of pulpal involvement. Although he is trained and experienced in procedures such as extirpation in Syria, he is registered and indemnified in the UK as a dental therapist.

Youssef recalls the Guidance on Scope of Practice and, in particular, Section 2.5 which states that “Dental therapists do not undertake […] procedures associated with the pulp in the adult dentition...”  He understands the boundaries associated with his professional title and makes the appropriate referral to a registered dentist to ensure the patient receives safe and effective care.

Zara is a registered dental nurse at a private clinic. She wants to expand her role to support the dental hygienists in providing patients with oral health advice. After researching how she could do this, she finds a Certificate in Oral Health Education that will give her the knowledge and skills to advise patients confidently and competently.

When she puts this to her manager, they suggest to her that the dental hygienists could provide her with onsite training instead. Zara is concerned that, because the dental hygienists have not worked as dental nurses or educators, they may not fully recognise her existing skills, provide appropriate feedback, or offer clear guidance on how to critically understand and tailor advice for patients within the scope of a dental nurse.

After reviewing the Guidance on Scope of Practice, specifically Section 1.9, Zara realises that not all advanced skills require formal courses and can sometimes be developed through workplace training. However, because the skills she wants to gain are more complex, she feels that an accredited course designed for dental nurses is the best way to develop them safely and competently. She discusses this with her manager at her development meeting, referencing the guidance, and they agree the Certificate in Oral Health Education is appropriate. They also consider other ways that this new skill might be used, such as Zara providing oral health care workshops at their nearby residential care home.

Carys is a dental therapist and dental hygienist who has just started a new role at a dental clinic that often provides clear aligner orthodontic care. The practice owner has suggested that, as part of her new role, Carys will be trained by one of the orthodontists in several new skills, including interproximal reduction and placing and removing orthodontic attachments.

Carys feels nervous about this because she knows that performing orthodontic procedures falls outside her professional scope of practice. The practice owner, however, argues that these are technical tasks rather than full orthodontic treatment and Carys will utilise skills that she already possesses, albeit applied in a different way.

Carys reflects carefully on each task, evaluating her training and competence.

First, she considers interproximal reduction. While she agrees that her current skills are technically similar – she is experienced at removing enamel for restorations – she recognises that she does not fully understand the procedure. She considers the potential consequences of making an error and asks herself if she could confidently explain all possible adverse events to patients. She also reflects on whether she understands how insufficient or excessive reduction might affect the orthodontic treatment plan, and how to correct it if it goes wrong? Ultimately, Carys concludes that interproximal reduction is best left to a competent dentist or specialist orthodontist, whose training covers not only the technical procedure but also understanding and managing all possible outcomes.

Next, Carys considers the placement of orthodontic attachments. Like interproximal reduction, she feels confident in her technical ability to work with adhesive materials. What she feels she is missing, however, is the broader understanding of the procedure beyond the technical task required. She worries that incorrect placement could lead to inappropriate tooth movement, something she cannot safely and competently manage. If she were responsible for such an outcome, which would cause patient harm, she would be unable to independently correct it. She recognises that carrying out this task would not be in the best interests of patients.

Finally, Carys considers the removal of orthodontic attachments. She feels confident in her ability to manage plaque-retentive factors and has a thorough understanding of this aspect of patient care. She reflects on the potential impact of performing this procedure, concluding that it would not affect the orthodontic treatment outcome in a way significantly different from minor issues such as attachment breakage or inconsistent aligner wear.

After discussing her considerations with both the practice manager and the orthodontist, Carys decides to accept the offer of on-the-job training and mentoring, but only for the removal of orthodontic composite attachments. She also ensures that her professional indemnity insurance is updated to reflect this expansion of her scope of practice.

Risk assessment and your scope of practice are inextricably linked, because safe decision‑making depends on recognising your limits, your competence, and the boundaries of your professional role. Registered dental professionals should recognise that unexpected situations, including emergencies, can arise at any time. You must be prepared to respond appropriately within your scope of practice. This makes undertaking risk assessments a key part of safe and effective care.

GDC guidance and standards set out that patient wellbeing is paramount for all dental professionals. This is particularly important to keep in mind when unexpected situations arise. Patient wellbeing should guide your assessment of risk, helping you to balance the patient’s immediate needs with the delivery of safe and appropriate care. This involves making careful and defensible clinical judgements when evaluating risk and deciding whether treatment is necessary and, if so, what form it should take.

Effective risk assessment also relies on self-reflection and a clear awareness of your own competence and scope of practice before providing care. Taking time to evaluate these factors supports safer decision-making and reduces the likelihood of harm.

Questions to ask yourself before undertaking a task as a dental professional, include:

• Is this care in the patient’s best interests, and is it the most appropriate option in their current circumstances?
• Is it reasonably foreseeable that, once commenced, the task could prove more complex than expected and fall outside my competence or scope of practice?
• If a task progresses beyond my skill level or competence, what steps can I take to ensure the patient’s best interests are maintained? Do I have a clear plan for a quick and safe referral pathway?

Risk assessment also includes recognising external pressures. If you are encouraged to undertake a task you feel unsure about, it is important to prioritise patient safety and professional responsibility. All actions must remain within your level of competence.

Case Study: Risk Assessment

Malik is a dental therapist working in a dental hospital. He has noticed that dentists are often referring paediatric patients to him without considering the complexity of the treatment they need. Over the past month, three patients have been referred to Malik who, after reviewing their radiographs, require restorative treatment on permanent teeth where there is a risk of pulpal involvement.

At today’s staff meeting, Malik plans to run a short workshop about the scope of practice of a dental therapist, particularly in situations where there is a risk to the pulp.

To make sure his information is accurate, Malik refers to the Guidance on Scope of Practice. He will first talk about Section 2.5, which sets out the limits of the dental therapist’s role. He will explain that if it appears, either clinically or on radiographs, that treating a permanent tooth is likely to involve the pulp, the patient should be referred to a dentist.

Malik will then discuss the use of risk assessment in cases where caries may be more extensive than initially anticipated and, regardless of the dental therapist’s best efforts, pulpal involvement may occur. He will emphasise that a dental therapist should not begin treatment on a permanent tooth where pulpal involvement can be reasonably anticipated, and such cases should be referred to a dentist. However, if pulpal exposure occurs unexpectedly during treatment, the dental therapist must carry out an appropriate risk assessment.

He will stress that the main priority for a dental therapist, as with all dental professionals, is the patient’s wellbeing.

In a dental hospital setting, this would usually involve escalation to a dentist for further management. Where immediate dental support is unavailable, such as in a primary care setting, the dental therapist should exercise clinical judgement to provide appropriate interim management, for example by placing a temporising restoration to alleviate pain and maintain function until definitive care can be delivered.

Malik believes that explaining this clearly will help his dentist colleagues better understand what dental therapists can and cannot do, and the care they are able to provide.