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Técnico superior en higiene bucodental (Spain)

  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       1. We have examined the requirements under our national legal system and the result is our system is not directly or indirectly discriminatory on the basis of nationality or residence. 2.-There is no rule that establishes different requirements for foreigners

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
    • Public health
    • Protection of consumers and recipients of services

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       Public health: A dental hygienist is a professional specialised in providing dental healthcare. The dental hygienist makes dental health care possible for the entire population, especially children and older people. Testing: -The number of workshops on dental healthcare addressed to children in schools have increased. -The number of workshops addressed to pregnant women and the prevention of sexually transmitted diseases have increased. -The dental hygiene of disabled patients has improved. -Incorporation of dental hygienists to the Spanish National Health System. -The number of fluorisations and sealings have increased. -Presence of dental hygienists in multidisciplinary teams of dental specialists. Protection of consumers and recipients of services: Dental hygienists provide : 1.-Specific knowledge of oral health care education . 2.- High specialisation in prevention actions. 3.- The community benefits from their cooperation in epidemiological and statistical research concerning oral health care. 4.-Their experience in training programmes (specific of their profession) and in courses for multidisciplinary teams of scientific societies together with dentists. 5.-High effectiveness and efficiency in their assistential functions such as fluorations and sealant application. Testing: SURVEY ON ORAL HEALTH CARE IN SPAIN (DATA FROM 2010). ANALYSIS OF THE EVOLUTION OF ORAL HEALTH CARE FROM 1993 TO 2010: DATA ON INFANT CAVITIES. - The number of children with cavities in primary teeth (5 and 6 year olds) kept steady from 1993 to 2010. DATA ON CAVITIES IN YOUNGSTERS. - The number of 12-year-old children with cavities decreased by 40% and in 15 year olds it decreased by 25%. - In 12 and 15-year-old children the number of affected teeth was halved, from two affected teeth to one in 12 year olds and from four to two in 15 year olds. - This progression was kept until 2000, from then on data have been steady. DATA ON ADULTS. - In people aged between 35 and 44 cavities have been reduced by 36%. - In people older than 65 cavities have been reduced by 30%. THE GOALS SET FOR 2020 ARE: A higher presence of Dental Hygienists, with bigger competences for: - Improving and maximizing programmes of dental attention for children and young population, as well as improving prevention and oral health care. - Enhancing the importance of oral health in primary dentition. - Maximizing oral hygiene prevention programmes in schools focusing on a correct brushing and use of dental floss. - Increasing campaigns for promoting: The use of pit and fissure sealants in children at risk of suffering cavities and a greater control of plaque bacteria, together with tartar removal.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       CONTROL OF THE STATE : 1.-A minimum level of studies is set in order to practise the profession . 2.-Dental Hygienists are incorporated to the National Health System 3.- Professional intrusiveness is prosecuted. 4.- Patients’ safety is enhanced. CONTROL OF THE PROFESSIONAL ASSOCIATIONS : 1.- The ethics and patient relations rules are set. 2.-Patients and users' claims concerning malpractice are dealt with. 2.-Ongoing training for Dental Hygienists is developed. 3.- Insurance coverage is provided to protect the population against possible malpractice. Testing: -Increase in the number of penal sentences due to cases of professional intrusiveness. -Incorporation of Dental Hygienists to the National Health System’s range of activities.

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        1.- Decrease in the « DMFT » indices (decayed, missing, and filled teeth in permanent dentition). 2.-Decrease in the « DFT » indices ( decayed and filled teeth in primary dentition) 3.- Decrease of periodontal diseases. 4.- Increase in the number of multidisciplinary teams of dentists and DHs. 5.- Increase in the consumption of toothbrushes and dental floss.

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       - Yes. It is comparable to similar professions within the same sector (dental health), such as dentists. - Advances have been made but in a very slow way. It is necessary to bring dental health closer to the population, Dental Hygienists must be more present in the National Health System and in private clinics.

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       In order to improve the dental health of the population specialized professionals are necessary. Their training must be based on their specialization and ongoing training. Dental Hygienists deal with patients directly, with health as one of the main values of the human being. The protection of such a value makes countries create healthcare professionals who are specialised in the matter as a complement to other professions in the same field, as in this case, dentists. Having said this, we can point out some example cases which are common in the daily development of the profession and which show the healthcare interest of dental hygiene and its importance in the patients’ health. Some of these cases, if they ever took place, could end up with irreversible consequences if malpractice of the DH occurs. Therefore: 1.- The clinical report of patients must be perfectly known and understood. Especially in the case of patients following a medical treatment and whose defences are low, for instance, patients affected by cancer, transplants, medical complications and multi-pathologies. Depending on the treatment followed, secondary infections can occur when removing the pathogenic bacteria placed in the periodontal bags and therefore spreading into the blood flow and causing bacteremia with the possibility of leading to the patient’s death. 2.- The use of ultrasounds in the oral cleaning of patients with a pacemaker is not recommended due to the fact that ultrasound frequency prevents the correct functioning of the pacemaker in the event of heart failure, being thus a risk for the patient’s health. 3.- In patients treated with anticoagulation medication, this treatment must be suspended, because when suffering gingivitis (gum soreness), there could be a blood loss. Thus, clotting medication might be needed, but it cannot be applied by the dental hygienist. These are just some examples which prove that the competences and professional capacities of Dental Hygienists justify the complexity of the functions developed by these healthcare professionals. All this proves it would be necessary for these professionals to keep a highly skilled knowledge due to the importance of their service and direct contact with patients, especially children and senior citizens, which shows the interest of the dental hygienist profession for the health care sector.

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       The existence of different measures does not cause a cumulative effect in the professional activity of the Dental Hygienist. Therefore, the Spanish State assigns the control of the profession to several official bodies: the State, the Autonomous Communities and the Professional Associations, (for instance : it is the responsibility of the State the creation and regulation of the profession and setting the minimum qualification requirements. The Autonomous Communities recognise qualifications awarded by other States, as well as control and supervise the professional activity. The Professional Associations regulate the professional activity, and are in charge of the code of ethics, ongoing training and civil responsibility insurance).

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
    • Use of title protection

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       As explained above, scientific evidence proves the connection of systemic diseases with oral health . The welfare state of the population demands a higher number of highly skilled professionals. In the example cases mentioned above (patients affected by cancer, transplants, medical complications, multi-pathologies, the use of a pacemaker or anti-coagulation medication) professionals with a higher level of academic and practical qualifications, following an ongoing training scheme throughout their careers, are demanded.

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Maintain current system

       Explain where relevant:

       The reasons have been explained in the previous section.

    11. Any other comments?
       No further comments
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