Working within boundaries

Carmen’s story

Carmen is a dental hygienist with over 20 years of experience. She sees patients under direct access and often liaises with dentists to ensure her patients receive the most appropriate care.  

Patient history

Beatriz attends for a dental assessment with Carmen, her first in two years.  Beatriz thinks she may have lost a filling because she feels sharpness with her tongue and food keeps getting stuck. She points to the lower left posterior teeth. During the clinical examination, Carmen identifies two issues: 

1. Part of a composite filling has been lost on the lower left first molar (36) on the occluso-lingual surface exposing dentine and a sharp enamel ledge.  
2. A cavitation (ICDAS 5) on the lower left second premolar (35) distal surface exposing dentine indicative of caries. 

Carmen takes a pain history that identifies there is no pain or history of pain, it is simply annoying, indicating pulpitis is unlikely. Bitewing X-rays were taken in line with clinical guidance that confirm the clinical findings. 

Treatment options

Carmen is aware that a team approach is required. These include: 

1. Refer to a dentist or dental therapist for definitive care e.g. definitive restorations 
2. Place a temporary restoration on the 36 to enhance Beatriz’ comfort and refer to a dentist or dental therapist for definitive care. 

Professional scope

• Dental hygienists can identify dental caries and lost/broken restorations as part of a comprehensive oral health assessment including a clinical examination and radiographic assessment within their scope.  

• Dental hygienists can provide preventive advice for dental caries and can place temporary restorations within their scope.  

• Dental hygienists cannot provide definitive care plans for restorative management of dental caries so Carmen will need to refer to other dental team members.  

Personal scope

Carmen has the knowledge from her training to carry out the temporary restoration of tooth 36 including risks, benefits and complications. She has not had recent experience of this but she did cover it in a recent CPD course.  

In considering whether to place a temporary restoration, Carmen will need to make a judgement to decide what she feels she is competent to do. Reflecting on her own boundaries and limitations will help.  

Questions Carmen needs to ask herself are:

• Is the treatment clinically necessary? 
• Do the benefits outweigh the risks? 
• How long until the patient can receive definitive care? 
• How comfortable do I feel undertaking this procedure?
• Are there any factors about the case that make it more complicated?
• Do I feel able to manage complications if they occur? Would I like any support?  
  

Summary  

The dental hygienist’s role is essential for early detection of caries and lost restoration, demonstrating their responsibility to assess oral health, educate patients and work with the dental team by referring to a dentist or therapist when treatment is beyond their competence.  

By collaborating with a dentist, Carmen can ensure timely and appropriate treatment for her patient.  

This scenario highlights the importance of working as a team and providing holistic care to ensure patient safety.  See the table below for a framework to guide your decision making.

For further information, see the GDC’s Scope of practice guidelines.

Framework to guide decisions