NZ Dental Therapy REX cheat sheet

Scope of practice: a dental therapist works under the New Zealand Health Practitioners Competence Assurance Act 2003 and the Dental Council scope; treatment of children and adolescents is core, and treatment of adults requires the prescribed additional qualification or delegation.

Informed consent is a process, not a signature: the patient (or guardian for a minor) must receive the nature, risks, benefits, alternatives and consequences of declining, in language they understand, before treatment starts.

Code of Practice obligations: put patient interests first, obtain informed consent, maintain competence through continuing professional development, protect patient privacy under the Privacy Act 2020, and report colleagues only when patient safety requires it.

Mandatory reporting: concerns about a health practitioner's competence or conduct go to the Health and Disability Commissioner or the relevant authority; child protection concerns go to Oranga Tamariki under the Children's Act 2014.

Health and Disability Commissioner Code of Rights: Right 4 (services of an appropriate standard), Right 6 (information), Right 7 (choice and consent), Right 10 (complaints) are the rights most often cited in dental complaints.

Record keeping: clinical records must be contemporaneous, legible, signed or authenticated, retained for at least 10 years from the last entry (or until age 25 for a child), and released only with consent or legal authority.

Delegation rule: a dental therapist may perform only tasks within their scope or validly delegated by a dentist who retains overall responsibility; accepting a task outside scope is a professional breach, not a favour.

Cultural safety: under the Health Practitioners Competence Assurance Act, practitioners must recognise the Treaty of Waitangi and provide culturally safe care, including whānau involvement where the patient wishes it.

Hand hygiene is the single most effective measure: use the WHO 5 Moments, alcohol-based hand rub for visibly clean hands, and soap and water when hands are visibly soiled or after contact with body fluids.

Personal protective equipment sequence: don gloves last and remove them first; change gloves between patients and after touching contaminated surfaces; masks and eye protection are required whenever splash or aerosol is anticipated.

Instrument reprocessing: pre-clean, then clean (ultrasonic or washer-disinfector), inspect, package, and autoclave at 134–137 °C for the validated cycle; monitor every load with chemical indicators and periodically with biological spores.

Critical items (surgical, periodontal, hand instruments) must be sterile at point of use; semi-critical items (mirrors, impression trays) require at least high-level disinfection or sterilisation; non-critical surfaces require detergent and disinfectant.

Sharps safety: never recap by hand, place sharps immediately in a puncture-resistant container filled no more than three-quarters, and report needlestick injuries immediately for post-exposure prophylaxis assessment.

Surface and equipment: barriers on handles, light switches and suction; wipe surfaces with a TGA-listed disinfectant at the correct contact time; suction lines flushed with disinfectant at the start and end of each session.

Waste segregation: sharps in rigid containers, infectious clinical waste in yellow bags, amalgam waste in sealed containers with mercury suppressant, and general waste separate; amalgam separators are required on suction systems.

Transmission-based precautions: for known or suspected airborne infection (for example measles or tuberculosis) use a fit-checked P2/N95 respirator and isolate; for droplet or contact infections add the relevant precautions to standard precautions.

Assessment sequence: history (chief complaint, medical, dental, social, medications, allergies), extraoral examination, intraoral soft tissue examination, then hard tissue charting and periodontal assessment.

Risk assessment drives recall: caries risk factors include high sugar frequency, poor plaque control, dry mouth, enamel defects, previous caries and socioeconomic factors; high risk warrants shorter recall and fluoride varnish at least twice yearly.

Periodontal charting in children: record plaque and bleeding on probing, probing depths where cooperation allows, and note eruption stages; do not over-diagnose adult periodontitis in the mixed dentition.

Radiographic selection is based on clinical need (ALARA): bitewings for approximal caries, periapicals for suspected periapical pathology, and panoramic views for developmental or eruption anomalies; do not take routine films without indication.

Differential diagnosis: distinguish caries from enamel hypoplasia, fluorosis, molar-incisor hypomineralisation and staining; a white or brown lesion that does not cavitate may be developmental rather than active caries.

Treatment plan hierarchy: stabilise pain and infection first, then preventive and behavioural measures, then restorative care, then review; involve the caregiver in agreeing goals and the recall interval.

Special considerations: congenital cardiac conditions requiring antibiotic prophylaxis, bleeding disorders, immunosuppression and bisphosphonate history change the plan and may require dentist referral.

Referral triggers: suspected oral cancer, non-healing ulcer over two weeks, unexplained bleeding, trismus, paraesthesia, or pathology beyond scope of practice require urgent dentist or specialist referral.

Fluoride varnish: 22,600 ppm fluoride applied to dried tooth surfaces at least twice yearly for children at caries risk; avoid on ulcerated mucosa or asthma requiring hospitalisation history, and record application.

Toothpaste fluoride concentration by age: use a smear of 1000 ppm from first tooth eruption, a pea-sized amount of 1000 ppm from age 2, and consider 1350–1500 ppm for children at elevated risk from age 6.

Dietary advice targets frequency, not just amount: limit sugar-containing food and drinks to mealtimes, avoid sweetened drinks in bottles and at bedtime, and note that dried fruit and juice are cariogenic.

Fissure sealants: place on permanent molars with deep pits and fissures, especially where caries risk is high; sealants are indicated for early non-cavitated lesions to arrest progression.

Oral hygiene instruction: demonstrate brushing twice daily with a soft brush, supervise children under 8, and introduce interdental cleaning when contacts form; use disclosing agents to show plaque.

Community water fluoridation is the most cost-effective population measure; know the local fluoridation status and adjust individual fluoride advice accordingly.

Motivational interviewing beats lecturing: use open questions, reflective listening and agenda setting with the child and caregiver to build a specific, achievable behaviour-change plan.

Smoking and vaping cessation: brief advice (ask, advise, assist) is within scope; refer to Quitline for pharmacotherapy, and note vaping is not a safe alternative for oral health.

Local anaesthetic maximum doses: lidocaine 2% with adrenaline 1:80,000 is limited to 4.4 mg/kg (about 7 mg/kg with adrenaline in some guidance); calculate by body weight before infiltrating a child.

Inferior alveolar nerve block landmarks: coronoid notch, pterygomandibular raphe and occlusal plane; insert with the barrel parallel to the occlusal plane and aspirate before depositing solution.

Rubber dam isolation is standard for restorative work and endodontics; choose a clamp that fits the tooth, verify seal, and consider alternative isolation if the patient cannot tolerate it.

Cavity preparation principles: remove infected dentine, preserve sound enamel margins, use minimal intervention where possible, and place a well-adapted restoration with correct contour and contact.

Restorative materials: glass ionomer releases fluoride and suits primary teeth and high-risk patients; composite needs good moisture control; amalgam is now restricted under the Minamata Convention.

Pulpotomy and pulpectomy in primary molars: indicated for reversible pulpitis with vital radicular pulp; a non-restorable tooth, furcation involvement or excessive mobility indicates extraction.

Extraction in the primary dentition: assess root resorption and the developing successor; space maintenance may be required when a primary molar is lost early to prevent arch collapse.

Record what was done, tooth notation (FDI two-digit), material, anaesthetic used and volume, and post-operative instructions given.

Medical emergency readiness: know the location of oxygen, suction, adrenaline and a defibrillator; the adult adrenaline dose for anaphylaxis is 0.5 mg IM (0.01 mg/kg in children, maximum 0.5 mg).

Syncope management: lay the patient flat, raise the legs, ensure airway patency and give oxygen if needed; do not sit the patient upright during recovery.

Asthma: position upright, use the patient's reliever inhaler with a spacer, give oxygen and call emergency services if there is no improvement.

Adverse event reporting: report incidents and near misses through the practice incident system without blame; open disclosure to the patient or family is required under the Code of Rights Right 6.

Infection control audits, radiographic quality audits and record audits are quality-improvement tools; a clinical audit cycle is define standard, measure, compare, implement change, re-measure.

Consent and capacity: for a child under 16, assess competence; a mature minor may consent to their own care, and refusal by a competent minor must be respected and escalated appropriately.

Equipment safety: check autoclave cycles daily, log water quality and compressor maintenance, and remove faulty handpieces from service immediately.

Radiation safety: use the shortest exposure time, collimate the beam, stand behind a protective barrier, and never hold the receptor for a patient.

Teach-back confirms understanding: ask the patient or caregiver to explain the plan in their own words rather than asking "do you understand?".

Use plain language and avoid jargon; when a technical term is unavoidable (for example fissure sealant), define it once in the patient's own frame of reference.

Child-friendly communication uses the tell-show-do technique: explain the step, demonstrate on a model or finger, then perform it.

Interpreters: use a professional interpreter, not a family member, for consent discussions where language is a barrier; document the interpreter's involvement.

Behaviour guidance for anxious children includes positive reinforcement, distraction and voice control; restraint or sedation requires specific consent and training.

Whānau-centred care: offer to include family in discussions and respect tikanga around touching the head, food and modesty where relevant.

Breaking bad news: use a structured approach (prepare, establish what the patient knows, share information in chunks, respond to emotion, agree next steps) and allow silence.

Complaints are handled openly: acknowledge the concern, investigate, explain, apologise where appropriate, and record the outcome and any system change.