Part 2 book “Textbook of preventive and community dentistry” has contents: Dental auxiliaries, school dental health, payment for dental care, ethical issues, dentists act and association, prevention of oral diseases, primary preventive services, fluorides in caries prevention, applied biostatistics and research methodology, behavioural sciences,… and other contents.
CHAPTER 14 Dental Auxiliaries Social forces are the principal determinants of the structure and process of health services The types of dental personnel in a society are a part of the structure: Their number and distribution are part of the process The concept of the dental team encompasses the various providers of dental care who have different roles, functions and periods of training and who combine to treat patients With increasing health consciousness the demand for dental care increases among the public There was a necessity to make it affordable and available to all In order to provide cost effective services and satisfy demand, the dedication of some responsibility to suitably trained para-professionals became inescapable in the dental field These new para-professionals receive a less rigorous training of a shorter duration compared to the dentist They were expected to perform well demarcated tasks efficiently Dental auxiliary is a generic term for all persons who assist the dentist in treating the patients In Britain, they have been known as “dental ancillaries”.1 Definition A dental auxiliary or ancillary is a person who is given 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.3 CLASSIFICATION WHO Classification3 Non-Operating Auxiliary a b Clinical: This is a person who assists the professional in his clinical work but does not carry out any independent procedures in the oral cavity Laboratory: This is a person who assists the professional by carrying out certain technical laboratory procedures Operating Auxiliary 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 Revised Classification Non-operating ancillaries Dental surgery assistant Dental secretary/receptionist Dental laboratory technician Dental health educator Operating ancillaries School dental nurse Dental therapist Dental hygienist Expanded function dental ancillaries Dental Surgery Assistant The employment of women as dental assistants was started in the USA more than a century ago Dr C Edmund Kells of New Orleans employed a woman as a “lady in attendance” in 1885, so that unaccompanied female patients could come to his clinic This practice became popular.4 The assistants started helping the dentist in his business office as well as by chair The utilisation improved during World War II due to acute shortage of professionals to meet the demands of the armed forces The dental assistants now assist the dentist in performing certain tasks which are non-technical in nature and not require any or much training The dentist thus can concentrate and devote full attention to care of patient In fact, at many places including India, the assistant gets on-the-job training from the dentist he serves The duties of the dental surgery assistants are as follows: a Reception of the patient b Preparation of the patient for any treatment he or she may need c Preparation and provision of all necessary facilities such as mouthwashes and napkins d Sterilization care and preparation of instruments e f g h i j k Preparation and mixing of restorative materials including both fillings and impression materials Care of the patient after treatment until he or she leaves, including clearing away of instruments and preparation of instruments for reuse Preparation of the surgery for next patient Presentation of documents to the surgeon for his completion and filing of these Assistance with X-ray work and the processing and mounting of Xrays Instruction of the patient, where necessary, in the correct use of the toothbrush After care of persons who have had general anaesthetic Dental Secretary/Receptionist This is a person who assists the dentist with his secretarial work and patient reception duties Dental Laboratory Technician A non-operating auxiliary who fulfills the prescriptions provided by dentists regarding the extra oral construction and repair of oral appliances and bridgework This category of personnel have also been known as dental mechanics The functions of dental technician in addition to the casting of models from impression made by dentists, include the fabrication of dentures, splints, orthodontic appliances, inlays, crowns and special trays Denturist is a term applied to those dental lab technicians who are permitted in some states in the US and elsewhere 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 has led to the formation of “denturists” Their craft is called ‘denturism’ That is, 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.2 Several countries have allowed laboratory technicians to work directly with the public Tasmania, a state in Australia, was the first place where technicians were legally permitted to provide a prosthetic service Denmark uses the term ‘Denturist’ to describe a special category of dental technician who sits at an examination, to enable him to prescribe, make and fit removable dentures without supervision In the state of Maine, denturists are permitted to make impressions and fit dentures but only under the direction of a dentist The ADA has vigorously opposed the denturists movement at the political level The Association’s principal argument is that denturists are unqualified to treat patients and the poor-quality care and even actual harm could result to patients.5 The Dental Health Educator This is a person who instructs in the prevention of dental disease and who may also be permitted to apply preventive agents intraorally In a few countries, the duties of some dental surgery assistants have been extended to allow them to carry out certain preventive procedures In Sweden, two additional weeks of training are given, after which ancillaries are allowed to conduct fluoride mouthrinsing programmes to groups of schoolchildren They are, however, not allowed to undertake any intraoral procedures School Dental Nurse School dental nurse is a person 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 disease in defined groups of people, usually schoolchildren Interest to improve dental conditions among children in New Zealand became evident in 1905 Treatment of children was particularly difficult on account of the distance which often separated small communities The Dental Nurse Scheme was established in Wellington, New Zealand in 1921 due to extensive dental diseases found in army recruits during World War 1914– 1918 The man who influenced its formation was TA Hunter, a pioneer in the establishment of a dental school in New Zealand The name of the school was ‘the dominion training school for dental nurses’ The training was for a period of two years to cover both reversible and irreversible procedures Upon completion of training, each school dental nurse is assigned to a school where she is employed by the government to provide regular dental care of between 450 and 700 children School dental nurse is accepted as a member of the school They are expected to provide care for the children at nearly 6-month intervals They are under general supervision of a district principal dental officer The duties of the school dental nurses as listed by the New Zealand Department of Health Division includes: a Oral examination b Prophylaxis c Topical fluoride application d Advice on dietary fluoride supplements e Administration of local anaesthesia f Cavity preparation and placement of amalgam filling in primary and permanent teeth g Pulp capping h Extraction of primary teeth i Individual patient instruction in tooth brushing and oral hygiene j Classroom and parent – teacher dental health education k Referral of patient to private practitioners for more complex services, such as extraction of permanent teeth, restoration of fractured permanent incisors and orthodontic treatment The Dental Therapist This is a person 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.1 In the United Kingdom, they came into being because of a shortage of dentists to work in the school dental service They are likened to New Zealand type school dental nurse but, they are not permitted to diagnose and plan dental care The operative procedures they are entitled to carry out are similar to those of the New Zealand school dental nurses, including the administration of local infiltration analgesia The training of dental therapists is for about a period of two years involving both the reversible and irreversible procedures The functions of a therapist vary Their training includes clinical caries diagnosis, technique of cavity preparation in deciduous and permanent teeth, material handling and restorative skills, vital pulpotomies under rubber dam in deciduous teeth and extraction of deciduous teeth under local anaesthesia They have a little training in interpretation of X-rays They are not trained to provide enodontic care The dental therapists are widely used in the public dental service Apart from Australia and the United Kingdom, other countries using the services of therapists include Hong Kong, Singapore, Vietnam and Tanzania.2 Dental Hygienist Earlier, the Ohio college of dental surgery had developed a program for hygienists and assistants in 1910, but it had to be discontinued due to pressure from the dentists The duration of training is 1–2 years As per the Indian Dentist Act of 1948, a dental hygienist means a person not being a dentist or a medical practitioner, who scales, cleans or polishes teeth, or gives instructions in dental hygiene 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 hygienists work under the supervision of dentists The usual functions of dental hygienists are: a Cleaning of mouths and teeth with particular attention to calculus and stains b Topical application of fluorides, sealants, and other prophylactic solutions c Screening or preliminary examination of patients as individuals or in d e group (school children or industrial employees) so that they may be referred to dentists for treatment Instruction in oral hygiene Resource work in the field of dental health Expanded Functions Dental Auxiliary They have been referred to as expanded function dental assistant, expanded function dental hygienist, expanded function auxiliary, technotherapist, expanded duty dental auxiliary 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 direct supervision of a dentist They are allowed to carry out reversible procedures that is which could be either corrected or redone without undue harm to the patient’s health They not prepare cavities or make decision as to pulp protection after caries has been excavated, but work alongside the dentist and take over routine restorative procedures, as soon as the cavity preparation and base have been completed.3 Duties of dental assistant in extended function Retraction of gingiva Impressions for cast restoration, space maintainers, orthodontic appliances Etching of teeth Determine root length and fitting of trial endodontic filling points Pit and fissure sealants Duties of dental hygienist in extended function Retraction of gingiva Impressions for cast restoration, space maintainers, orthodontic appliances Temporary stabilization procedures Debridement of the periodontal surgical site Suture placement In 1958, WHO introduced two new types of auxiliaries Dental Licentiate: He is a semiindependent operator trained for years Their dental knowledge and skill are equivalent to New Zealand dental nurse They work under a wider variety of conditions and for all age Their functions include dental prophylaxis, cavity preparation and fillings of primary and permanent teeth, extraction under local anaesthesia, drainage of dental abscesses, treatment of prevalent diseases of supporting tissues, early recognition of serious conditions They are responsible to the chief of the regional or local health service Their service would probably occur in rural or frontier areas and so, supervision and control would probably be remote Dental aide: Among native populations the dental aides provide elementary first aid procedures for the relief of pain, including extraction of teeth under local anesthesia, control of haemorrhage, recognition of dental disease They would operate only within a salaried health organization and be under supervision, the closer the better, particularly at first The formal training extends from to months, followed by a period of field training under direct and constant supervision Frontier auxiliaries: They include capable lay people, in particular nurses and former dental assistants with minimum training Their functions include dental prophylaxis, dental health education, relief of pain, referral, fluoride rinse program, simple denture repairs Future developments: Predicting the future is a thankless task at best, and the task of attempting to predict future developments in dental care is more thankless than most Rate of population growth, types of healthcare systems that evolve, economic developments, consumers demands, and legislative action will all be major factors in shaping the future of the dental care system Within dentistry, the growth of specialists, the ability to increase productivity in the dental office, and the apparent growing restlessness of auxiliary groups will all exert their influences The demands of society mean that the cherished autonomy of the dental profession may be curtailed to some extent ... Government of India constituted a school health committee to assess the standards of health and nutrition and also assigned the task of suggesting ways and means to improve the health status of school... documentation and evaluation Lack of co-ordination between • Different schemes and health programmes within the health department • Health department and outside agencies particularly the education department... aware of need and effectiveness of preventive dentistry practice that can be accomplished within a school environment Parents and community leaders are not committed to oral health Public health officials