CATEGORY 100 AUSTRALASIAN DENTIST ORAL HEALTH What if the biggest challenge facing Australia’s oral health workforce isn’t what our practitioners can do, but what our system actually allows them to do? “Scope of practice” has become a familiar phrase in dentistry. We debate professional boundaries, education, competencies and who should be able to perform particular procedures. These are important conversations. Patient safety must always remain central. But perhaps we are asking the wrong question. Rather than asking simply: “What is this practitioner allowed to do?” perhaps we should be asking: “How can we safely and effectively use the skills, education and expertise of the workforce we already have? And how do we build the skills of the workforce to better meet the needs of the community they serve?” The distinction matters. The Dental Board of Australia is clear that an individual practitioner’s scope of practice is influenced by their education, training and competence. Practitioners are responsible for understanding their own scope and only undertaking treatment for which they are appropriately educated, trained and competent. The Australian Dental Council provides tertiary education providers with the ‘professional competencies for the newly qualified dental practitioner’, which broadly describe each registration division’s professional scope of practice and influence program curriculum to ensure graduates can demonstrate competency across each domain. However, there can be a considerable gap between what a practitioner is educated, trained, and competent to do, what their employer permits them to do, and what they actually do in practice. That gap is scope of practice utilisation. Australia has a diverse oral health workforce comprising dentists, dental prosthetists, dental hygienists, dental specialists, dental therapists and oral health therapists. The workforce has grown substantially, with 29,119 registered dental practitioners reported from the March 2026 Dental Board of Australia registrant data report, up from 21,657 registered dental practitioners 10 years ago. However, the composition of our workforce has remained fairly static, with almost three-quarters of the total dental practitioner workforce being dentists and around one-fifth of the workforce being an oral health practitioner (dental hygienist, dental therapist or oral health therapist). Yet workforce numbers alone do not tell us whether we are making the best use of that capacity. Consider a hypothetical dental team where a patient presents with active periodontal disease, high caries risk and restorative needs. Does the dentist need to personally deliver every component of that patient’s care? Perhaps not. A model where the dentist can provide more advanced restorative and surgical care, while an appropriately educated and competent oral health practitioner focuses on preventive care, periodontal management, oral health education, restorative care and maintenance, may allow the entire team to work more effectively. This isn’t about replacing one practitioner with another. It is about matching the right practitioner to the right task, for the right patient, at the right time. And this principle should apply to dentists too. We sometimes talk about scope of practice as though underutilisation is an issue that only affects allied dental practitioners. But imagine a public dental service where a dentist spends a substantial proportion of their clinical time undertaking routine procedures that could safely and appropriately be delivered by another member of the dental team. At the same time, patients requiring more complex care may be waiting. That isn’t necessarily a problem with the dentist’s scope. It may be a problem with workforce design. The same question applies across private practice. If a dental hygienist, dental therapist or oral health therapist has the education and competence to undertake a particular aspect of care, but organisational structures, historical assumptions or workplace policies prevent them from doing so, we have created unused workforce capacity. And unused capacity matters. Australia’s current dental workforce planning recognises not only workforce supply and demand, but also scenarios involving unmet public-sector demand and unutilised clinical hours. The challenge, therefore, isn’t simply to train more practitioners. It is to design systems that make better use of the practitioners we already have. This requires a shift in thinking. Instead of starting traditional models, we could start with patient needs. What does this patient require? What skills are required to provide that care? Which member of the team has the appropriate education, competence and experience? What can each practitioner contribute? This approach also recognises something important: scope of practice is not necessarily a fixed list attached to a professional title. Two practitioners within the same registration division may have different individual scopes depending on their education, training, experience and competence. The result isn’t a hierarchy of professions. It is a team built around complementary expertise. Perhaps we should be asking a more fundamental question: Are we using every member of Australia’s oral health workforce to their full potential? If the answer is no, then we may not have a scope of practice problem. We may have a scope of practice utilisation problem. And perhaps solving that problem could be one of the most important opportunities we have to build a more sustainable, collaborative and patientcentred dental workforce. u We don’t have a scope of practice problem. We have a scope of practice utilisation problem By William Carlson-Jones BOralHlth GCertOralHlthSc (Adel) GCertEdStud (Higher Ed) (Syd) MBA (Accounting) (S.Cross) FHEA PhD Candidate (Qld) Lecturer – Sydney Dental School Faculty of Medicine and Health, University of Sydney
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