Dental therapy at a turning point: entering the new era

Dental therapy is finally poised for success through training, regulation and clinical potential, says Cat Edney, but how can we take advantage of this opportunity most effectively?

Dental therapy in the UK is often described as an established profession, but the reality is that the model of practice we recognise today is still remarkably young. While dental therapists first appeared in the 1960s, the conditions needed for the profession to truly develop have only emerged within the last two decades.

For many years, dental therapists worked within tightly defined systems that limited where and how they could practise. Entry into general dental practice was not permitted until 2001, and even then therapists were required to work under the direction of a dentist. Although this structure ensured clinical oversight, it also created practical and cultural barriers that slowed the integration of therapists into everyday dental care.

One of the most persistent challenges was the difficulty many dentists experienced with the idea of referring treatment ‘down’ within the team. Dentistry has traditionally been organised around clear hierarchies, and the shift towards a more collaborative skill-mix model required a significant change in thinking.

Without widespread support or guidance on how best to integrate dental therapists into practice workflows, many clinicians were understandably cautious. Uncertainty around the therapist’s scope of practice, and the variation in confidence between individual clinicians working within that scope, meant that the potential of the profession was often not fully realised.

Direct access and prescription only medicines

The introduction of direct access in 2013, following recommendations from the Office of Fair Trading, marked a significant step forward. For the first time, dental hygienists and dental therapists were able to see patients directly, providing examinations and treatment within their scope without the need for a prior dental referral. The change recognised the training and capability of these clinicians, and opened the door to new models of care.

However, progress remained uneven.

One of the most frustrating barriers involved prescription-only medicines, particularly local anaesthetic. Dental therapists are fully trained to administer local anaesthetic as part of their scope of practice, yet historically they have not been permitted to prescribe it themselves. As a result, even when therapists were providing care directly to patients, a dentist was often still required to prescribe certain medicines in order for treatment to proceed.

Patient group directions provided a partial solution, allowing therapists to administer medicines within agreed protocols, but these systems were complex to implement and often difficult to sustain in NHS settings. In practice, this meant that while dental therapists could carry out the majority of treatment independently, small legislative barriers continued to restrict the efficiency of care.

NHS complications

The NHS system presented further complications. Until recently, dental therapists were unable to open or close a course of treatment within NHS dentistry, even when they were the clinician delivering that care. It was not until 2022 that this administrative limitation was removed in England, enabling therapists and hygienists to take greater ownership of patient care pathways.

The final and perhaps most important change arrived at the end of 2024, when legislative exemptions allowed dental therapists access to the medicines required to practise fully within their scope. After many years of advocacy from clinicians and professional bodies, the profession finally achieved a regulatory framework that supports modern dental team working.

For the first time, dental therapists in England and Wales can practise without supervision, see patients directly, and deliver treatment without unnecessary prescribing barriers. While this may appear to be a technical legislative shift, its impact on clinical practice is profound.

What we are now witnessing is the beginning of a profession practising in the way it was always intended to.

Dental therapists bring a unique blend of preventive, periodontal and restorative skills that are increasingly aligned with the needs of modern dentistry. As patient populations grow and expectations of care evolve, the ability to deliver prevention-focused treatment efficiently and collaboratively has never been more important. The integration of dental therapists within practice teams allows care to be organised around skills and patient need, rather than professional title alone.

The future of dental therapy

Looking ahead, the growth of dental therapy is likely to be shaped by three key developments.

The first is a continued shift towards prevention-led models of care. Dental therapists are uniquely positioned to support this transition, combining restorative treatment with periodontal management and patient education in a way that keeps prevention at the centre of the patient journey.

The second is the increasing sophistication of team-based dentistry. As practices adopt digital diagnostics, enhanced periodontal protocols and minimally invasive approaches, the contribution of every clinician within the team becomes more important. Dental therapists are particularly well placed within these models, often acting as the link between diagnosis, prevention and ongoing maintenance.

The third is a gradual cultural shift within the profession itself. As more dentists work alongside dental therapists and see the benefits of collaborative care, confidence in skill-mix models continues to grow. This shift cannot be forced by legislation alone; it develops through experience, trust and shared clinical success.

Remaining barriers

Of course, challenges remain. NHS systems across parts of the UK still present barriers to the full utilisation of dental therapists, and widespread understanding of the profession’s capabilities continues to develop. But the direction of travel is clear.

After many years in which structural limitations slowed progress, the dental therapy profession now finds itself in a position where its training, regulatory framework and clinical potential are finally aligned. Rather than asking whether dental therapists should play a greater role in the delivery of care, the conversation is increasingly focused on how practices and health systems can best harness the skills already available within their teams.

For a profession that has spent decades waiting for the systems around it to evolve, this moment represents not simply progress, but opportunity. The coming years will likely see dental therapists contributing more visibly and more confidently to the delivery of modern dental care, helping practices meet the growing demands of prevention, access and long-term oral health management.

Dental therapy may have been introduced many decades ago, but in many ways its most important chapter is only just beginning.

Catch up with Cat’s previous columns:

• How is dental therapy utilised differently around the world?
• Building a shared care model for the modern dental practice
• Dental therapy in 2026: a profession coming into its own
• Does GDC working patterns data show an identity crisis for DCPs?
• What does new scope of practice guidance mean for dental therapists?

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