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DENTAL MANPOWER

2 CONTENTS• INTRODUCTION• DENTIST• DENTAL AUXILIARIES• FRONTIER AUXILIARIES• NEW AUXILIARY TYPES• DEGREES OF SUPERVISION OF AUXILIARIES• DENTAL MANPOWER IN INDIA• CONCLUSION• REFERENCES

3Introduction

The vision of the dental team is one of various people in dentistry with different • Roles• Functions• Period of training all working together

to treat patients. Health care systems depend not only

upon infrastructure and resources, but also on the availability of skilled human resources.

(Parkash H. Dental Workforce Issues: A Global Concern. Journal of Dental Education 2006,70;11, 22-26)

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Dental auxiliary is generic term for all persons who assist the dentists in training patients.

Repetition without shift of attention makes for speed and accuracy.

Reason for division of labor also lies in the different levels of knowledge attainable within one field by persons of differing aptitude and opportunity for training.

5 DENTIST

A dentist is a person licensed to practice dentistry under the law of the appropriate state, province, territory, or nation.

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These laws ensure that to become licensed, a prospective dentist must satisfy certain qualifications such as,

1. completion of an approved period of professional education in an approved institution.

2. demonstration of competence

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Dentists are concerned with the prevention and control of the diseases of the oral cavity and the treatment of unfavorable conditions resulting from these diseases, from trauma or from inherent malformations.

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They are legally entitled to treat patients independently, to prescribe certain drugs and to employ and supervise auxiliary personnel.

Dentists must be registered Registration is the process by which,

qualified individuals are listed on an official roster, maintained by a government or non-governmental agency

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After being trained for 4 years, followed by one year of paid rotating internship, the student is conferred the degree of Bachelor in Dental Surgery (BDS)

The student has to register with the Dental Council of India (DCI)through State Dental Council.

He/she can then practice dentistry or can pursue post graduation in speciality of his/her choice of subject, leading to a masters degree- Master of Dental Surgery(MDS)

10 DENTAL AUXILIARY A dental auxiliary is a person who is given

the responsibility by a dentist so that he or she can help the dentist render dental care, but who is not himself or herself qualified with a dental degree.

The duties undertaken by dental auxiliaries range from simple tasks such as sorting instruments to relatively complex procedures which form part of the treatment of patients.

11 CLASSIFICATION BY WHO (1967)

NON OPERATING AUXILIARIES a) CLINICAL - a person who assists the

dentist in his clinical work but does not carry out any independent procedures in the oral cavity.

b) LABORATORY - a person who assist the professional (dentist) by carrying out certain technical laboratory procedures.

12OPERATING AUXILIARIES

This is a person who, not being a

professional is permitted to carry out certain treatment procedures in the mouth under the direction and supervision of a professional.

13 REVISED CLASSIFICATIONNON OPERATING AUXILIARIES

Dental surgery assistant Dental secretary/ receptionist Dental laboratory technician Dental health educator

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OPERATING AUXILIARIES School dental nurse (New Zealand type) Dental therapist Dental hygienist Expanded function dental auxiliaries

15 DENTAL SURGERY ASSISTANT

A non operating auxiliary who assists the dentist or dental hygienist in treating patients, but who is not legally permitted to treat patient independently.

A dental assistant may only work under the supervision of a licensed dentist carrying out duties prescribed by the dentist or by a dental hygienist employed by the dentist.

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This category of auxiliary personnel has been called by various names in different countries.

Commonly used ones include• Dental assistant• Chair side dental assistant• Dental nurse

17 Four handed dentistry

The term four handed dentistry is given to the art of seating both the dentist and the dental assistant in such a way that both are within easy reach of the patient’s mouth.

The patient is in fully supine position. The assistant will hand the dentist, the

particular instrument he needs. She will also perform additional tasks such

as retraction or aspiration.

18 The dentist can thus keep his hands and eyes in the field of operation and work

with less fatigue and greater efficiency.

19 The duties of the dental assistant are• Reception of the patient.• Preparation of the patient for any treatment

he or she may need.• Preparation and provision of all necessary

facilities such as mouthwashes and napkins.• Sterilization, care and preparation of

instruments.• Preparation and mixing of restorative

materials including both filling and impression materials.

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• Care of the patient after treatment until he or she leaves, including cleaning away of instrument and preparation of instruments for reuse.

• Preparation of the surgery for the next patient.

• Presentation of documents to the dental surgeon for his completion and filling of these.

• Assistance with x-ray work and the processing and mounting of x-rays.

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• Instruction of the patient, where necessary, in the correct use of the toothbrush.

• Aftercare of person who have had general anaesthetics.

22 DENTAL SECRETARY/RECEPTIONIST

Person who assists the dentist with the secretarial work and patient reception duties.

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DENTAL LABORATORY TECHNICIAN

Non operating auxiliary who fulfils the prescription providing the dentist regarding the extra oral appliance and bridge work.

Also knows as dental mechanics. As per the Indian Dentist Act of 1948, dental

mechanic is a person who makes or repairs dentures and dental appliances.

In some countries they have not been considered as auxiliary because, in these places , their work is mostly performed in commercial laboratories and not in the dental practice setting.

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Dental laboratory technician receive their training through apprenticeship which is associated with formal training at a dental school or technical college.

The formal training period covers two years.

25 Duties Casting of models from impressions made

by the dentist. Fabrication of dentures, splints, orthodontic

appliances, inlays, crowns and special trays.

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Dental mechanic is a person, who makes or repairs dental appliances and dentures including inlay, crown and bridge work. He shall restrict his activities to purely mechanical laboratory work at the instance of the registered dental surgeon. He shall not do any chair side work

-The Dental Council of India

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The Dental Council of India has prescribed that,

• The course of studies should extend over a period of two academic years and lead to the qualification of dental mechanic certificate.

• The candidate should be at least 15 years of age at the time of admission or within 3 months of it and should be medically fit.

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• The candidate must have passed at least matriculation examination of a recognised university taking science subject or an equivalent recognised qualification.

29 Denturist

It is a term applied to those dental laboratory technicians who are permitted to fabricate dentures directly for patients without a dentist’s prescription.

They may be licensed or registered. The desire for autonomy among dental

laboratory technicians led to the formation of ‘denturists’.

Their craft is called ‘denturism’.

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According to that, if the patient is in need of a denture, the process of fabricating a denture, from the impression onwards, is done by the technician in direct relationship with the patient.

The ADA defines ‘denturism’ as the fitting and dispensing of dentures illegally to the public.

Several countries have allowed laboratory technician to work directly with the public.

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The ADA has vigorously opposed the denturist movement at the political level.

The Association’s principal argument is that denturists are unqualified to treat patients and that poor quality care and even actual harm could result to patients.

The WHO Expert Committee on Auxiliary Dental Personnel(1959) has recommended that only qualified dentists may work directly on patients.

32 DENTAL HEALTH EDUCATOR This is a person who instruct in the prevention

of dental diseases and who may also be permitted to apply preventive agent intra orally

In a few countries , the duties of some dental surgery assistant have been extended to allow them to carry out certain preventive procedures

In Sweden, two additional weeks of training are given, which auxiliaries are allowed to conduct fluoride mouthrinsing programs to group of school children

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They are, however, not allowed to undertake any intraoral procedures

34 SCHOOL DENTAL NURSE Operating auxiliary, who is permitted to

diagnose dental disease and to plan and carry out certain specified preventive and treatment measure, including some operative procedures in the treatment of dental caries and periodontal diseases in defined groups of people, usually school children.

35 Duties Oral examination Prophylaxis Topical fluoride application Advice on dietary fluoride supplements Administration of local anaesthetic Cavity preparation and placement of

amalgam filling in primary and permanent teeth

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Pulp capping Extraction of primary teeth Individual patient instruction in tooth

brushing and oral hygiene Classroom and parent- teacher dental health

education Referral of patient to private practitioners

for more complex services, such as extraction of permanent teeth, restoration of fractured permanent incisors and orthodontic treatment.

37 DENTAL THERAPIST This is an operating auxiliary, who is

permitted to carry out to the prescription of a supervising dentist ,certain specified preventive and treatment measures including the preparation of cavities and restoration of teeth.

38DUTIES:• Clinical caries diagnosis• Cavity preparation in deciduous and

permanent teeth• Vital pulpotomies under rubber dam in

deciduous teeth• Extraction of deciduous teeth under local

anaesthesia

39 DENTAL HYGIENIST A dental hygienist is an operating auxiliary

licensed and registered to practice dental hygiene under the laws of the appropriate state, province, territory or nation.

The dental hygienist works under the supervision of dentists.

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Dental hygienist is a person, not being a dentist or medical practitioner; who does oral prophylaxis, give instructions in oral hygiene & preventive dentistry, assists the dental surgeon in chair side work and manages the office. He/she shall work under the supervision of the dental surgeon

-The Dental Council of India

41Duties;• Cleaning of mouths and teeth with

particular attention to calculus and stains.• Topical application of fluorides, sealants

and other prophylactic solutions. • Screening or preliminary examination of

patients as individuals or in groups, such as school children or industrial employees , so that they may be referred to a dentist for treatment.

• Instruction in oral hygiene.

42EXPANDED FUNCTION DENTAL AUXILLIARY

An EFDA is a dental assistant or a dental hygienist in some cases, who has received further training in duties related to the direct treatment of patients, though still working under the direct supervision of a dentist.

43DUTIES:• Placing and removing rubber dams• Placing and removing temporary

restorations• Placing and removing matrix bands• Condensing and carving amalgam

restoration in previously prepared teeth• Placing of acrylic restorations in

previously prepared teeth.• Applying the final finish and polish to the

previously listed restorations

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Four levels of training and qualification were recognised,

• Certified dental assistant • Preventive dental assistant• Dental hygienist• Dental hygienist with expanded duties

45 Certified dental assistant

Training course is of 8 month duration Assistant was tough traditional chair side

duties Only intraoral duty was exposing the

radiograph

46 Preventive dental assistant The trainee had to be a certified dental

assistant Full time courses were of 3-6 weeks length They are permitted to• Polish the coronal portion of the teeth

without instrumentation• Make impressions for study model• Topically applied caries preventive agent• Place and remove rubber dams• Maintain patient oral hygiene

47 Dental hygienist 8 month training program allowed them to,• Carryout scaling• Conduct a preliminary examination of the

oral cavity including taking a case history a periodontal examination and recording clinical findings

• Provide a complete prophylaxis including scaling root planing and polishing of fillings

• Apply and remove a periodontal pack• Apply fissure sealant

48Dental hygienist with expanded duties

Training of 4 months duration was given to dental hygienist who had at least 1 years practical experience

They were allowed to carryout • Removing sutures• Placing, finishing, and polishing

restorations of amalgam and resin• Placing and removing matrix bands• Placing cavity liners

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• Retracting gingiva for impression making

• Fitting and removing orthodontic bands• Separating of teeth prior to banding by

a dentist• Cementing temporary crowns previously

fitted by dentist• Placing temporary fillings

50 FRONTIER AUXILIARIES

In developed countries, dentists remain in the urban centres and a large numbers of areas are too distant from public or private dental offices for the inhabitants to receive regular comprehensive care for emergency pain relief.

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Duties• Simple dental prophylaxis• Basic dental health education• Dental first aid• Organise fluoride rinse program• Perform simple dental repair

52 NEW AUXILIARY TYPES

The expert committee on auxiliary dental personnel of WHO (1959) has suggested 2 new type of dental auxiliaries

• The dental licentiate• The dental aide

53 Dental licentiate

He is a semi independent operator, trained for 2 years to perform

• Dental prophylaxis• Cavity preparations and fillings of primary

and permanent teeth• Extractions under local anaesthesia

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• Drainage of dental abscesses.• Treatment of the most prevalent

diseases supporting tissues of the teeth• Early recognition of more serious dental

conditions.

55 Dental aide

This type of auxiliary personnel performs duties which include, elementary first-aid procedures for the relief of pain, including:

• Extraction of teeth under local anaesthesia• Control of haemorrhage• Recognition of dental disease which is

important enough to justify transportation of the patient to a centre where proper dental care is available.

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These new auxiliaries are particularly useful in some countries, having acute dentist shortage, with no facilities for training dentists.

57 DEGREES OF SUPERVISION OF AUXILIARIES ADA (1975) defined four degrees of

supervision of auxiliaries, with the assumption that ultimate responsibility was assumed by the licensed dentist.

• General supervision• Indirect supervision• Direct supervision• Personal supervision

58 General supervision The dentist has authorized the procedures

and they are being carried out in accordance with the diagnosis and treatment plan completed by the dentist

59 Indirect supervision The dentist is in the dental office,

authorizes the procedure and remains in the dental office while the procedures are being performed by the auxiliary

60 Direct supervision

The dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure and before dismissal of the patient, evaluates the performance of the dental auxiliary.

61 Personal supervision

The dentist is personally operating on a patient and authorizes the auxiliary to aid treatment by concurrently performing supportive procedures

62 DENTAL MANPOWER IN INDIA India has about 298 dental institutions,

producing 25,000to 30,000 BDS graduates every year.

In 2004, the dentist to population ratio was 1:30,000.

But with a significant geographic imbalance among dental colleges, there has been a great variation in the dentist to population ratio in rural and urban areas.

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India (in 2004) had one dentist for 10,000 persons in urban areas and about 2.5 lakh persons in rural areas.

Almost three- fourths of the total number of dentists are clustered in the urban areas, which houses only one-fourth of the country’s population.

This is in great contrast to the physician population ratio, which was 1:2,400 in 2000 and 1:1,855 in 2004

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In 1990 there were 3,000 registered hygienists and 5,000 laboratory technicians in India.

This implies that the service of one hygienist was available to 7 dentists, and one laboratory technician renders service to four dentists, whereas it should ideally be a 1:1 .ratio

65 CONCLUSION The practice of dentistry involves a personal

relationship between the dentists, dental auxiliaries and the patients.

Both dentist and auxiliary personnel try to emphasize health education, to correct misconceptions and to attack apathy about dental health.

Because of their unique privileges granted to them, the members of the dental profession have the responsibility of providing a high standard of service to their patients and they should assume their duties freely and voluntarily.

66 REFERENCES

Essentials of public health dentistry 5th edition- Soben Peter

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