Dental therapists join forces to improve care in general anaesthesia settings

Anyone working in NHS dentistry now is acutely aware of the pressures facing our services. Waiting lists for patients needing treatment under general anaesthesia (GA) are lengthy, demand continues to grow, and specialist capacity is stretched.

The delays have real consequences for patients, from families waiting months for their child to be seen, to adult patients with complex needs who depend on specialist care.

The increasing prevalence of dental decay and these long waiting lists for GA procedures highlight the need to fully utilise the dental workforce, including dental therapists, within their scope of practice. Maximising the expertise of dental therapists and their skill mix to improve patient care is timely and important.  

I'm proud to share a new joint statement developed by four leading professional organisations: the British Society of Paediatric Dentistry (BSPD), the British Association of Dental Therapists (BADT), the British Society of Special Care Dentistry (BSSCD), and the Society for the Advancement of Anaesthesia in Dentistry (SAAD).

With the support of the General Dental Council (GDC), the statement addresses the question that has called for a clear answer for some time: what is the role of dental therapists in general anaesthetic settings, and how should that role be governed?

Clearing up a misconception

For many years, dental therapists were not permitted to work in GA settings due to restrictions on their permitted duties. Those restrictions fell away well over a decade ago, yet practice across the profession never fully reflected that change. Many services, commissioners and clinicians remained unaware that the position had shifted.

The reality is, there is nothing in the GDC's Scope of Practice guidance or the Safe Practitioner Framework preventing dental therapists from working in GA environments, within their defined scope of practice.

That gap between what is permitted and what is widely understood to be permitted matters. It has meant that a skilled and willing part of our workforce has been underutilised at precisely the time services need to make best use of every member of the dental team.

What the statement sets out

The joint statement is practical, clearly defining what dental therapists can and cannot do in GA settings. Restorative care, extractions of primary teeth and placement of preformed crowns all fall within scope. Complex procedures, including surgical extractions involving bone removal, endodontic treatment in adult teeth, and advanced radiographic interpretation, remain the responsibility of dentists, specialists and consultants.

Supervision requirements are addressed with equal clarity. For paediatric patients, supervision must be immediate and robust, with the supervising clinician physically present in the operating theatre or immediately available in an adjacent theatre and able to intervene without delay. For adult special care patients, the requirements are more stringent; dental therapists must never operate independently, and a suitably qualified dentist, specialist or consultant must be present throughout the procedure. In more complex or best interest cases, where the treatment plan may not be known in advance, a second dentist should also be available to agree the treatment plan and step in for unplanned events.

The statement also addresses training, competency, governance and indemnity. Dental therapists working in GA settings must have completed mandatory training in GA protocols, medical emergencies including immediate life support for both adults and children, consent processes and relevant clinical skills including airway management and surgical safety checklists. Competency must be assessed regularly through workplace-based evaluations and clinical logbooks. Services must have clear governance frameworks, documented supervision arrangements, audit trails and appropriate indemnity in place. Indemnity arrangements must be specific to the setting, whether NHS, subcontracted or private.

Why this matters for patients

Working in community dental services, I see the consequences of unmet dental need every day. Children in pain, families who have waited far longer than they should, and adults with complex needs whose care is delayed by overstretched services. We have a responsibility to make better use of our workforce, within safe and well-governed frameworks, where we can.

When dental therapists work within their scope in GA settings under appropriate supervision, consultants can oversee multiple GA lists, theatre time is used more efficiently, and more patients receive timely care. Importantly, this also supports dental therapists in developing, using and enhancing their skills across a wider range of settings, within a supportive environment. The clinical risk, where the framework set out in this statement is properly followed, is low. The benefit to patients is clear.

A collaborative approach

This statement did not come together quickly or easily. It required sustained discussion between organisations with different memberships, different clinical contexts and, at times, different starting points. The fact that we arrived at a consensus position, supported by the GDC, reflects a shared commitment to patient safety and to providing the profession with the clarity it needs.

Those undertaking or responsible for the provision of care by dental therapists under general anaesthetic should read the full statement and the supporting documentation from each organisation to ensure a comprehensive understanding of the framework. This material is publicly accessible without any membership requirement, because it should be available to every registrant who needs it.

I'm proud to have been part of this important step in a much broader conversation about workforce in dentistry. I hope that with the support of the GDC, it gives practitioners and services the confidence to move forward.