Practice Resources for Denturists

This section describes the standards to which denturists are expected to practice in British Columbia.

Denturist Practice

The practice of denturism means:

• provision of professional services, as permitted by the regulations, which encompass evaluation, pre-treatment, treatment, and post-treatment of a
• professional administration of clinical, laboratory, and business practices related to the practice of denturism.

Standards of Practice

A registrant must demonstrate, at all times, a level of knowledge which ensures the adequate protection of the public. Areas of requisite knowledge include:

• ethics and responsibilities
  • demonstrate a knowledge of the Health Professions Act, the regulations and College of Oral Health Professionals bylaws;
  • communicate the responsibilities of a professional to patients, peers, members of the public, and other professionals.
• principles of business
  • demonstrate knowledge of general business practices including principles of accounting, record keeping, basic tax law, basic lease information, basic proprietary and corporate implications on practice, personnel management, and insurance requirements.
• principles of communication
  • demonstrate the ability to communicate in both written and oral forms with patients requiring basic information, peers, other professionals, and staff.
• general and bio-sciences
  • describe basic principles of chemistry, biology, psychology, general anatomy, physiology, kinesiology, pharmacology, histology, embryology;
  • describe advanced principles in head, neck and oral anatomy; head, neck and oral physiology; gnathology; gerontology; psychology; periodontology; pathology; and microbiology.
• removable dental prosthetic sciences
  • describe the theoretical basis of prosthetic care;
  • demonstrate the tasks required to complete clinical and laboratory requirements of practice including documentation, treatment planning, and selection of appropriate dental materials.
• principles of critical analysis
  • demonstrate skill in self-evaluation, problem solving, self-reflection, and constructive criticism.
• clinical skills
  • demonstrate tasks related to the clinical practice of denturism.
• laboratory skills
  • demonstrate tasks related to the laboratory practice of denturism.
• patient management skills
  • demonstrate skill in managing patients from differing socio-economic, cultural, and generational backgrounds;
  • manage the referral of patients to appropriate health care providers as required;
  • document each interaction with patients and other health care providers;
  • maintain complete patient patient records.
• treatment planning
  • demonstrate the ability to prepare different treatment plans for a patient;
  • estimate and explain the potential for success based on proposed differing treatments.
• sterilization and infection control
  • demonstrate aseptic techniques and environmental controls to ensure adequate hygienic environment.

This section contains the College code of ethics. This code forms part of the bylaws, but is presented separately in this section due to its importance to all registrants. 

General

Every registrant is charged with the duty to uphold the honour and dignity of the profession of denturism and to adhere strictly to the principles set forth in this code.

The profession is given the privilege of self-governance under the Act and, accordingly, registrants must understand the Act, the regulations, and the bylaws and must strictly observe or perform their duties and obligations thereunder.

To uphold and advance the honour and dignity of the profession and its high standards of ethical conduct, registrants must:

• be honest and impartial in serving their patients, the public and their profession;
• strive to increase the competence and status of their profession;
• use their knowledge and skill to improve the health and well-being of their patients and the public; and
• respect the dignity and professional status of, and professional relationships with, their colleagues.

Duty to the Public

The duty of the registrants to the public includes:

• educating the public in the promotion of oral and removable prosthodontic health, but presentations for such purposes must be in accordance with generally accepted professional standards and must not contravene these bylaws with respect to marketing or professional services;
• providing leadership in community activities whose purpose is to improve the health and well being of the individual and the community;
• publicizing any advance or discovery in any branch of removable prosthetic science in journals and professional publication; and
• not making any statement or declaration or sign any certificate or any other document, or induce or permit a patient to sign any certificate or document which they know or ought to know to be untrue, misleading, or otherwise improper.

Duty to Patients

The duty of registrants to patients includes:

• maintaining patient confidentiality except as may be necessary to divulge such information as contained elsewhere in these bylaws or in connection with investigations by the inquiry committee under section 33 of the Act, or except to the extent the patient has expressly agreed that the registrant may release specific information;
• consulting and providing treatment to any member of the public or, if they are unavailable, to make alternate arrangements;
• maintaining their knowledge of denturism; and
• rendering treatment only in accordance with current professional standards, except that a registrant may use experimental methods and materials in treatment provided such methods and materials:
  • are within the bounds of accepted scientific criteria for well designed experiments, such as the human experimental protocol established by the University of British Columbia, for research and other studies involving human subjects in effect from time to time;
  • have been approved in writing by the College;
  • are used in accordance with the requirements set forth in that approval; and
  • are explained to patients as being experimental and the range and possible results and problems of the experiment are conveyed.

Registrants may treat patients only when they are qualified by training or experience to carry out the treatment plan. Registrants must always be willing to check their diagnosis, treatment, and prognosis by consultation with fellow practitioners or specialist in the field of dentistry or medicine pertaining to the case under consideration. Registrants must be willing to refer a patient when advisable.

Registrants must protect the health of their patients at all times by not delegating or referring any duty or procedure to a person who is not qualified to perform such duty or procedure by skill or training, or by licensure if required under the Act, the regulations or these bylaws, and by not condoning or being a party to such delegations or referrals. Registrants must ensure the actions of all personnel within their employ or control comply with the Act, the regulations, and these bylaws.

Registrants must keep adequate records of all clinical findings, diagnosis and treatment with respect to each of their patients. When a registrant who is presently treating a patient requests records for another registrant who has formerly treated the patient, the registrant must make copies of those records available to the attending registrant only where the patient has instructed that the records be transmitted and has given his/her consent for their release.

A registrant who is providing service to the former patient of another registrant should make every effort to obtain a copy of the patient’s records from the previous registrant.

Duty to the Profession

The duty of registrants to the profession includes:

• supporting and providing advancement of the profession; and
• providing the highest standard of care and accepting full responsibility for treatments provided.

Duty to Colleagues

Registrants should not:

• comment or pass judgement on the qualifications of, or procedures rendered by, other registrants unless
  • such comment is in the best interests of the patient’s health and well being;
  • the registrant has been subpoenaed as a witness and is testifying under oath.
• compete for patients or professional services by methods which would adversely affect the honour, dignity, or credibility of the profession; or
• compare their professional competence to that of other registrants.

In the event of a consultation, registrants should render only the treatment which was specifically requested.

Read the Denturist Association of Canada document here. >>

Read the summary document here. >>

On February 24, 2020, the Ministry of Health announced amendments to the regulations (scope of practice statements) for dental hygienists, dental technicians, denturists and dentists. One significant change that may affect the provision of services provided by denturists is the amended definition of prescription.

The Denturists Regulation now defines a prescription as “an authorization, issued by a person who is authorized under the Act to prescribe a partial denture or overdenture, to dispense a partial denture or overdenture for use by a named individual”.

What is an authorization?

An authorization is permission or authority to do something.

Who is authorized to prescribe a partial denture or overdenture?

Dentists are authorized under the Health Professions Act to prescribe a partial denture or overdenture as part of the patient’s treatment plan. The dentist and denturist must work collaboratively to ensure the treatment options are appropriate.

Prescription Guidance

1.    Prescriptions for dispensing a partial denture or overdenture to a patient may be written or verbal.

The authorization can be provided by a written prescription from the dentist for the patient or over the phone following the collaborative care discussions between the dentist and the denturist.

2.    Prescriptions must be based on collaborative discussion and decision- making amongst the patient and the oral healthcare team.

The decision to prescribe a partial denture or overdenture will be based on collaborative discussion and decision-making amongst the patient, the denturist and the dentist. This process will serve to enhance collaborative care amongst the entire dental team. Collaborative care includes pre-treatment assessment of the patient and review of the patient’s medical record by all parties, and determination through discussion between the denturist and dentist of the patient’s needs for and expectation of the partial or overdenture. The denturist and the dentist each must take responsibility according to their scope of practice.

If the prescription requires a dental technician to assist with the development of a partial denture or overdenture, the dental technician must review the prescription and be included in the discussion with the rest of the oral healthcare team and the patient.

3.    Oral healthcare providers must have the education, knowledge and skills to authorize and fill the prescription.

When a dentist creates a prescription, they must only authorize or request procedures with which they are familiar. This ensures that they are aware that the authorization or request is reasonable under the prevailing conditions, and that they would be able to assist with the management of circumstances that may occur during the completion of the prescription. If they are unfamiliar with the procedures or conditions potentially addressed by the prescription, the dentist should refer the patient to a practitioner with experience providing that service.

When a denturist receives a prescription, they must confirm that they understand the content of the prescription, and that they have the education, training, acquired skills, equipment and materials to undertake that portion of the work or treatment for which they will be responsible. If a denturist does not have the required competencies, they should refer the patient to another practitioner with experience providing that service.

4.    Denturists must examine the patient to ensure they are in suitable condition for treatment.

The denturist must examine the patient to ensure they are in suitable condition for the treatment to be undertaken. Where circumstances appear to be unsuitable for placement of a prosthesis, a discussion with the prescribing dentist is necessary. For example:

• teeth that appear to have been inadequately prepared to receive a partial denture;
• the presence of mobile teeth that have not been stabilized; or
• inflamed oral tissues that have not been sufficiently prepared for receipt of a removable prosthesis.

A dentist may choose to issue a prescription for a given patient to cover a specific timeframe (e.g. three to six months). If this is the case, it is expected that the denturist will review, update and document the patient’s medical status as well as revisit and determine the need for the partial denture or overdenture prior to dispensing. The denturist must engage the prescribing dentist in discussion should any changes be required.

5.    Patient records must include thorough documentation of those discussions and decisions, including the authorization by the dentist.

It is expected the patient’s treatment record will include:

• The name of the denturist and dentist involved in the treatment.
• The type of denture being prescribed.
• The reason and/or rationale for the need to prescribe the partial denture or overdenture.
• Documentation about the prescription. If the dentist provides a verbal prescription, the denturist must document this in the patient record and sign it. If the dentist has provided a written prescription for the patient, a signed copy must be included in the patient’s record.
• Any modifications to the prescription, whether written or verbal.

Reference documents:

• Ministerial Order M041 with amendments to regulations for Dental Hygienists, Dental Technicians, Dentists and Denturists (February 24, 2020)
• Health Professions Act: Denturists Regulation

On February 24, 2020, the Ministry of Health announced amendments to the regulations (scope of practice statements) for denturists. One significant change that may affect the provision of services by denturists is the definition of fit, specifically implant overdentures.

It is important to note that the guidance is to be referenced alongside the denturist regulations and interpretive guidance for the definition of prescription. These three documents make up the standards, limits and conditions for implant overdentures to ensure high quality practice and protection of the public.

The Denturist Regulation now defines fit as “means to perform any non-surgical intra-oral procedure related to dispensing a denture, including the making of impressions”.

What is an overdenture?

An overdenture means a dental prosthesis that replaces natural teeth, is removable by the patient and is (a) attached to or supported by implants, or (b) attached to, supported by or covers retained roots or natural teeth.

A registrant in the course of practising denturism may dispense or fit an overdenture but only for the purpose of implementing a prescription.

Implant Overdenture Guidance

1. To provide an implant overdenture, the denturist will work in collaboration with the oral health care team. These members may include but are not limited to a denturist, dentist, dental lab technician or hygienist.
2. The denturist shall have knowledge of the principles of the osseointegration process and the prosthetic phases of treatment in order that the standards of practice and professional responsibility are maintained.
3. The denturist would perform the procedures required for the dispensing of an implant overdenture in accordance with all appropriate and reasonable practice standards.
4. The denturist is able to unscrew and place healing caps, abutments and implant bars if there is no need to cut into the tissue.

Educational Requirements

1. Prior to performing any implant procedures, denturists involved in implant overdenture fabrication shall take comprehensive courses which are recognized by the British Columbia College of Oral Health Professionals and
   1. conducted by persons who have had formal training and experience performing implant services and procedures;
   2. one that has a participation component; and
   3. one that teaches methods that have been shown to be successful as a result of investigative basic science and by long term scientific studies.
2. It is recommended that denturists complete a recognized radiographic pattern recognition

Professional Records

Denturist records should include:

1. Names of the members of the implant oral health care team
2. Copies of all related correspondence
3. Prosthodontic notes which should include the procedures performed as well as
   • implant manufacturer;
   • number, location, size and type of implants;
   • size and type of abutment used;
   • type of overdenture fabricated;
   • type of connection (locator, implant bar);
   • all components placed in the patient’s

Professional Responsibilities

1. The denturist must recognize the need to refer the patient to an oral health care team member on the first signs of abnormalities.
2. It is the joint responsibility of the dentist and denturist to use components which have been approved by Health Prosthetic components used by the denturist must be compatible with the implants and appropriate techniques must be used to restore those implants.
3. The denturist should educate the patient on denture and implant maintenance and aftercare.