Effective delegation in the workplace

Media item: article

Date published: 12 January 2008

Subject: management and delegation

This page records the media item. The original article is the property of its publisher and is not reproduced here.

Delegation in a dental practice is not a management choice

The general business literature treats delegation as a matter of judgement: what a manager should hand over, to whom, and how much oversight to keep.

In a dental practice, most of that judgement is removed by law. Who may do what is set by registration division and approved scope of practice under the National Law, and a practitioner who works outside their scope commits a breach of their registration regardless of how competent they are or who instructed them.

This is one of the most consistently misunderstood things about dentistry, and it is genuinely useful to a patient trying to work out who is treating them.

Who is registered, and what each division may do

The Dental Board of Australia registers five divisions of dental practitioner. Only these people may provide dental treatment.

Dentists have the broadest scope. A dentist may examine, diagnose, plan and carry out the full range of general dental treatment, prescribe within their competence, and take and interpret radiographs.

Dental specialists are dentists with an approved postgraduate qualification who hold specialist registration in one of the recognised specialties. Specialist registration is a separate entry on the register and the specialist titles are protected by law — a general dentist may not call themselves an orthodontist or a periodontist, however much of that work they do.

Oral health therapists hold dual qualification as dental hygienist and dental therapist. Their scope covers preventive care, periodontal treatment, and — depending on their qualification and the structured professional relationship they work in — restorative treatment for children and adolescents, and often adults. The difference between a therapist and a hygienist is set out separately.

Dental hygienists provide preventive and periodontal care: assessment, scaling, root surface debridement, oral hygiene instruction, fluoride and sealants, and radiographs within their scope. What a hygienist actually does is a common question.

Dental therapists provide examination, preventive and restorative care principally for children and adolescents, within their scope.

Dental prosthetists are independently registered practitioners who provide removable dentures and mouthguards directly to the public, without referral. Their registration numbers begin with the ADP prefix rather than DEN.

The structured professional relationship

Hygienists, therapists and oral health therapists work within a structured professional relationship with a dentist. This is a formal registration requirement, not an office arrangement.

What it does not mean: that a dentist must stand over them, check every step, or repeat their examination. These are independently registered practitioners exercising their own clinical judgement and carrying their own accountability, indemnity and continuing professional development obligations.

What it does mean: there is a defined referral and consultation pathway to a dentist for anything outside their scope, and a documented relationship rather than an ad hoc one. The patient must be able to access a dentist when the treatment requires one.

This is why a hygienist appointment is a legitimate appointment in its own right, and equally why a hygienist will refer you to a dentist rather than treat a cavity they find.

Who is NOT registered — and this is the part that matters

The following people work in Australian dental practices and are not registered dental practitioners:

Dental assistants (dental nurses). They are not registered by any national board. They assist chairside, prepare instruments, manage infection control and take notes. Many hold a Certificate III or IV, and some have completed additional training — for instance in radiography or oral health education — but none of that constitutes registration. A dental assistant may not diagnose, may not treat, and may not decide what treatment you need.

Dental technicians. They make crowns, bridges, dentures and appliances in a laboratory, often to a very high level of skill. Dental technicians are not registered by the Dental Board of Australia and, critically, do not treat patients. A dental technician working directly in a patient's mouth is practising outside any lawful scope. (A dental prosthetist is a different, registered profession and does see patients directly.)

Practice managers, receptionists and treatment coordinators. They are not clinicians. A treatment coordinator may explain a plan and its cost; they cannot create or alter one, and they should not be the person who convinces you to accept it.

Practice owners who are not practitioners. As covered elsewhere in this collection, Australian law permits non-dentist ownership. An owner has no clinical authority over an individual practitioner's decisions.

What this means when you are in the chair

The honest translation of all this for a patient:

The person who diagnoses your problem and plans your treatment must be a dentist, a dental specialist, or a practitioner working within their own registered scope. It cannot be an assistant, a technician, a coordinator or an owner.
You are entitled to know the name and registration division of anyone who treats you — ours are listed — and to look them up free on the AHPRA public register at ahpra.gov.au.
A practitioner cannot be instructed to exceed their scope, by an employer or by anybody else. If they are asked to, refusing is the correct action and the National Law protects it.
"Supervised" does not mean unqualified. Registered hygienists and therapists are qualified practitioners — the difference between a clean by a dentist and by a hygienist is a matter of role, not standard. It is the unregistered roles that are the boundary worth knowing.

The genuine version of delegation in a dental practice

Within those legal limits, delegation does real work, and it is one of the clearest arguments for a multi-practitioner practice:

Preventive and periodontal care delegated to hygienists and oral health therapists — practitioners whose entire training is in exactly that — usually produces better periodontal outcomes and longer appointment times than the same work squeezed into a general dentist's day.
Complex work referred to a registered specialist rather than attempted by a generalist reaching the edge of their competence. Knowing when to refer is itself a professional obligation, not an admission of limitation.
Administrative and infection-control work handled by trained non-clinical staff, freeing clinical time for clinical decisions.

None of this changes who is accountable. Under the National Law, accountability sits with the individual registered practitioner who provided the care. It cannot be delegated at all.

Common questions

Which thirteen specialties are they, actually?

The Dental Board lists them, and the list is closed — the thirteen are “approved by the Australian Health Workforce Ministerial Council”:

dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial surgery, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry), and special needs dentistry.

That is the whole of it. If a description you have been given is not on that list, it is not a recognised specialty, however professional it sounds — and that includes several terms in common marketing use. ‘Cosmetic dentistry’ is not there. Neither is ‘implant dentistry’, and neither is ‘orofacial pain’.

A practitioner may lawfully do that work and do it well. What they may not do is borrow a title. Dentists and Registered Specialists explains the distinction.

How much training sits behind a specialist entry on the register?

More than the postgraduate qualification alone. The Board requires every applicant for specialist registration to hold a qualification in the specialty and to have “completed a minimum of two years general dental practice” — which “may be achieved by experience outside Australia, subject to assessment and approval by the Board” — and to have “met all other requirements for general registration as a dentist.”

So the pathway is: qualify as a dentist, register, practise generally for at least two years, complete an approved specialist qualification, then apply for a second registration entry. Nobody arrives at a specialist title straight from a degree.

For applicants qualified overseas, the Board and the Dental Council (New Zealand) jointly developed ‘Entry-level competencies for dental specialties’, one purpose of which is “to assist the Board in the assessment of overseas applications for specialist registration”.

Can someone be registered here but limited to a narrower scope than an Australian-trained colleague?

Yes, and it is recorded. The Board states that it “may impose conditions on your registration if this is required to make your occupation equivalent to an Australian occupation”, giving the trans-Tasman example directly: “the scope of practice for an occupation may be narrower in New Zealand than in Australia, and the Board may impose conditions on your Australian registration to ensure that you only do work equivalent to the work you perform under your New Zealand registration.” It may also impose conditions matching those already on a New Zealand registration.

This is the part people do not think to check. The AHPRA register is not only a yes-or-no on registration — it carries the division, any specialist entry, and any conditions attached. A registration with conditions is still a valid registration; it simply describes a narrower permitted scope, and you can read it yourself in a minute.

Does the list of recognised specialties ever change?

Rarely, and it has. The Board published a revised list of recognised dental specialties, specialist titles and definitions taking effect 1 October 2017, following consultation and approval by the Ministerial Council. The changes were described as “minor technical changes to the specialities of oral medicine, oral pathology and forensic odontology”, made to “align the specialist titles with international nomenclature and/or better reflect the nature of work undertaken by dentists within the existing specialty”.

Why this is worth knowing as a reader: an older article, directory entry or referral letter may name a title in a form that no longer matches the register exactly. That is usually a dating artefact rather than a false claim — but the register, not the letterhead, is what is current.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration, division and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information about registration and scope of practice in Australia. It is not a diagnosis, a treatment plan or legal advice. Third-party published content is not reproduced.

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