The psychological support role of the Dental Care Professional (DCP)

 L. Davies NEBDN cert in dental nursing, BDA cert in Oral Health Education, NEBDN cert in Dental Sedation, BDA Cert in Dental Radiography, NEBDN cert in Special Care Dental Nursing, City in Guilds cert PTTLS, Certificate in CBT for Dental Anxiety*
*Sedation Nurse Lead / Senior Dental Nurse, Hertfordshire Special Care Dental Service, Hertfordshire Special Care Dental Service, Hertfordshire Community NHS Trust, Sandridge Gate Business Centre, Ronsons Way, St Albans, Herts, AL4 9XR
*Correspondence to: Lisa Davies
Email: lisa.andrews3@nhs.net
Davies L. The psychological support role of the Dental Care Professional (DCP). SAAD Dig. 2024: 40(1): 58-59

Anaesthetics in dentistry commenced after 1850 and women were often used to chaperone female patients. This was predominantly the job of the wives and daughters of dentists and included chairside duties. Over time this developed into a role for male 'dental assistants' and served as an apprenticeship, with such individuals often progressing to become dentists.¹

Towards the end of the nineteenth century, concerns were raised nationally regarding the dental health of the population. This prompted action to improve dental health, starting with children. From 1912, medical treatment in schools was free. The NHS was not even thought about at this point however, the role of dental nurses was about to begin. Training was then discussed with the local authorities.

Internationally, other countries, notably Germany, had started to employ dental nurses to assist dentists. This introduced the concept of the dental nurse as a distinct role, although it was still a predominantly male career choice. This changed at the start of WWI, when there was a shortage of men, and women were then trained as dental nurses.

In the early 1900s, a list of duties was drawn up and a conference was held by Dr Sidney Barwise and Mr Norman Bennett, members of the British Dental Association (BDA), to discuss the proposals. By May 1917, Dr Barwise reported that the first dental dressers (the predecessors of dental nurses) had completed a six-month training course which was endorsed by the BDA. Records show that the first nurses to complete the course did so in 1920.

The dental nurse’s role has changed dramatically over the years and increasingly dental nurses are recognised for their vital role as part of the dental team. Commencing in July 2008, dental nurses were required to be registered with the General Dental Council (GDC) and were independently recognised as dental care professionals with a specific scope of practice.

Input into the daily running of the clinical environment and care of the patient is vital. One of the additional qualifications dental nurses can pursue is in sedation. The sedation nurse is highly trained and supports both the dentist and the patient. The patient will often rely on the dental nurse to offer emotional support which is essential to successful sedation.

I have been involved in the provision of conscious sedation in dentistry for over 20 years and have witnessed the role of the sedation nurse change over time. With the publication of the Clinical Guide for Dental Anxiety Management 2023² the value of psychological support in the management of dental anxiety is being recognised academically. As many experienced dental sedation nurses know, anxious patients often turn to the nurse for emotional support. A short conversation to get to know the individual at the beginning of their patient journey can make a big difference to the effectiveness of the sedation. For example, remembering something the patient has mentioned at their pre- assessment makes them feel more secure, valued and comfortable. This builds trust and rapport and can mean a smoother visit for the patient and the dental team.

My interest in the psychological support of the patient led me to embark on a Cognitive Behavioural Therapy (CBT) distance learning course at King’s College London. The course was designed by Dr Jennifer Hare and Professor Tim Newton and is specifically aimed at the dental team. As part of a service development programme, I completed the course with the sedationist from my team so that we could offer anxiety management to our dentally-anxious patients, in addition to more conventional treatment adjuncts, such as conscious sedation.

We developed a pathway where patients can be referred for anxiety management. Initially patients are sent an MDAS (Modified Dental Anxiety Score)3 which gives an indication of the depth of their anxiety and areas that are most worrying to them. We have found that the process usually takes up to six or eight visits if the patient is co-operative and wants to make changes in their thoughts and behaviours concerning dentistry.

I have found that making a simple phone call in the first instance for a short discussion, can be helpful. This is used as a fact-finding session and ice breaker. A telephone conversation can be less intimidating for the patient as opposed to a face-to-face appointment. As a nurse, I find patients are more willing to speak freely and provide an insight into their concerns. We discuss specific and general concerns, how they can maintain control during the appointment and choosing a hand signal or safe word that will ensure treatment is paused or stopped. We encourage patients to bring a blanket or soft toy from home as a comforter and to think about playing music. Often patients choose to wear earphones or earbuds, although we ensure only one ear is covered to maintain communication.

The next couple of sessions are in person, with the nurse alone, often in a non-clinical room should the severity of the patient’s anxiety dictate. After discussion with the dentist, relaxation techniques, desensitisation and / or acclimatisation are considered, as appropriate to the individual. The patient is encouraged to practise the relaxation at home, and it is fundamentally important the patient engages with the process. Usually within the first two to three meetings a good rapport and an element of trust is starting to form. By around the fourth session, I introduce the dentist as ‘my friend’, which helps the patient trust the dentist and enables me to take the role of the patient’s advocate.

Having a foundation in sedation is helpful when treating patients with dental anxiety, as sedation forms part of the continuum of anxiety management. It is important that this continuity of care for the patient (where the dental nurse remains with the patient throughout their journey, regardless of whether they have anxiety management alone or progress to conscious sedation) is not underestimated. There are several sedation courses available, including the national course provided by SAAD, which provide sedation knowledge and skills.

Utilising dental nurses in dental nurse-led clinics is a cost-effective way to treat anxious patients, providing a more holistic approach and empowering patients to take responsibility for their own healthcare. This is a model that can work equally well in the community, in hospital and in general dental practice. Knowing the foundations of sedation and anxiety management is essential, but gaining hands-on experience is invaluable. Seeing patients who have always had their treatment with sedation, gain the confidence to move away from pharmacological support by utilising the anxiety management strategies that I have taught them, is a rewarding part of my job.

The role of a dental nurse has evolved into much more than a job, rather a career. More educational opportunities and training are available leading to increased responsibility for dental nurses and autonomy when working with patients. Dental nurses are more respected as members of the dental community and the skillset we offer is recognised. I look forward to seeing how the role of the dental nurse will change going forwards, and I hope we can encourage more young people to consider it as an occupation.

References 

1. Reed, D. The history of dental nursing. BDJ Team 2021; 8: 48–51.

2. NHS Digital. Clinical guide for dental anxiety management 2023. Online information available at https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/

3. Humphris G, Morrison T, Lindsay S J. The Modified Dental Anxiety Scale: UK norms and evidence for validity. Comm Dent Health. 1995; 12: 143-50.