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Expanding the Scope of Dental Hygiene and Therapy in the UK

As a proactive and passionate dental hygienist and therapist, I have always had huge ambitions for my profession. Over the last few years, I have seen the potential for our role to expand, not only in established dental practice but also as independent clinicians.

I believe that the direct access model provides the greatest opportunity for both for hygienists and therapists to capitalise on utilising our full scope of practice and skills, whilst providing a convenient and effective way for patients to receive improved access to dental care.

That belief was one of the key reasons I started my own direct access business, London Hygienist. Additionally, alongside my own business, I also work in two extremely busy multi-disciplinary practices which provide perspective on the more traditional hygienist and therapist working environments.

Perhaps serendipitously, messaging around preventative health and the links between oral health and systemic health have received vast amounts of press coverage in the last year, which has led to a huge boost in new direct access patients seeking advice and treatment. I think the fact that patients trust us with these questions and concerns, and look to us to provide solutions, is a testament to our relationships with them and the great work we all do. It is clear that times are changing fast for our profession.

Looking outside the UK, those changes have already occurred. I grew up in Canada and have always been aware of the North American independent hygiene model, where a significant emphasis on prevention is accepted as a large part of good dental care and where it is the norm for hygienists to operate their own high street practices. Interested to hear more about how this works for our Canadian colleagues in practice, and to explore how this model might fit into our post-Covid oral health landscape, I recently interviewed Julie DiNardo, lead hygienist and founder of Gleam Smile Centre, located in Hamilton, Ontario, Canada.

How did the independent hygienist and therapist model come about in Canada?

Over the last few decades, the profession of dental hygiene has undergone a gradual transition to how we practice today in Ontario, Canada. The biggest change came in 2007 with the modification of legislation which allowed qualifying registered dental hygienists to work independently from a licensed dentist. This seal of independent practice would open accessibility to the public so that they could receive preventive oral health care as an alternative to the traditional dental clinic.

How did you start your clinic and what were some of the challenges you faced?

The biggest challenges faced when opening was the mindset of our community. I was one of very first in Ontario to open an independent practice at a time when no one really understood that independent dental hygiene practices existed or what they did. This meant a lot of public education through public speaking, community events, joining business groups, as well as educating my fellow dental colleagues on how I practice.

As in any business, much time and research went into the planning stages of opening, from thinking of a name to registering it for a business license, to speaking to an accountant and bank manager as well as looking for the perfect location. It's all a part of any business and professional people of their respective industries are there to help you along the way.

How do you work alongside the rest of the dental team and other healthcare professionals?

Being totally independent means that I have no licensed dentist in my practice, so a working plan is developed between myself and the dentist I choose to refer to. A patient can expect individualised care focusing on the prevention of disease. Treatment of bacterial infections affecting the oral tissues and teeth and the reason behind why this infection is happening is what we prioritize our focus on. I have developed a circle of health professionals from different occupations that I can refer to and get advice from when I am uncertain of how to proceed.

We have found that integrating this model of care into our community works and it is the best career decision I have made. I would encourage anyone who is looking to make a difference in oral health to investigate this model of practice.

We know that there is increasing awareness amongst the public about the link between oral health and better overall health, something I know you are very passionate about. How do you approach this in your practice?

We understand that infection in the oral cavity affects the systemic health of an individual, and that ill health can come from bacterial dysbiosis. Along with their oral health, we therefore look at every patient holistically, including their general health and medications. Educating my patients on the benefits of having a healthy oral microbiome and how ridding the cause of infection would benefit their health is something that holds a lot of value to them.

In our practice we choose to use a high strength, long-lasting, 10% chlorhexidine antimicrobial coating to rid the oral cavity of pathogens and reset the oral microbiome. The product name is Prevora, supplied by a Canadian company called CHX Technologies. Many of my patients with comorbidities benefit from having the Prevora applications. Prevora lowers the oral bacteria to help the body's innate immune system to ultimately heal diseased tissue. We have worked hard to educate our patients on the existence and benefits of this working model so it is great to see that momentum and enthusiasm for this treatment is growing fast.

My patients are healthier and happier knowing they have reduced the inflammatory process within their bodies and significantly lowered their risk of dental decay, both of which are a cause from bacterial infections. Prevora has an important role in making that happen.

Every day that I go into work, my goal is to make a difference in the health of each of my patients by using quality treatments and surrounding myself with like-minded practitioners who believe that the health of a patient also includes the health of the oral cavity.


Whilst making the leap to working as an independent hygienist and therapist may not be for everyone, from my own experience and from listening to Julie’s journey, the emphasis on prevention will be a crucial factor in expanding our scope of practice.

For any industry to stay dynamic we must embrace change and we are no different. Our industry is ready for a shake up. I passionately believe that, as hygienists and therapists, we can help lead the way to better oral health care and improved access to dental care.


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