DENTAL AUXILIARIES

Submitted by Fathima YasminGuided by Dr.Mahmood

Moothedath,Dr.Aseela,Dr.Aswathi

INDEX-INTRODUCTION-DEFINITION-CLASSIFICATION; OPERATING AUXILIARIES NON-OPERATING AUXILIARIES; CLINICAL AND LABORATORY-REVISED CLASSIFICATION; NON-OPERATING AUXILLIARIES: DENTAL SURGERY ASSISTANT DENTAL SECRETARY DENTAL LABORATORY TECHNICIAN DENTAL HEALTH EDUCATOR OPERATING AUXILIARIES: SCHOOL DENTAL NURSE DENTAL THERAPIST DENTAL HYGIENIST EXPANDED FUNCTION DENTAL AUXILIARY

-FRONTIER AUXILIARIES

-NEW AUXILIARY TYPE; DENTAL LICENTIATE DENTAL AIDE

-DEGREE OF SUPERVISION OF AUXILIARIES-AUXILIARIES IN PUBLIC PROGRAMS-EFFECTS OF AUXILIARIES ON DENTAL

EDUCATION-BENEFITS OF USING AUXILIARIES-IMPACT OF AUXILIARIES IN INDIAN SCENARIO-CONCLUSION-REFERENCE

The concept of 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 necessity to make it affordable and available to all.

Inorder to provide cost effective services and satisfy demands, the dedication of some responsibility to suitable trained paraprofessionals become inescapable in the dental field.

These new paraprofessionals recieve 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 training the patients

In Britain,they have been known as Dental Ancillaries.

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

WHO Classification 1) Non-operating auxiliaries

Clinical laboratory(Assist the dentist in his ( Assist the

professional clinical work ) in technical

laboratory procedures)

Revised classification 1) Non- operating ancillaries:

Dental surgery Dental secretary/ Dental laboratory Dental health

Assistant receptionist technician educator

2) operating ancillaries:

School dental Dental therapist Dental hygienist Expanded function

Nurse dental ancillaries

Non operating auxiliary Assist the dentist or dental hygienist in

treating patients Not legally permitted to treat patient

independently Also called as dental assistant,chair side dental

assistant, dental nurseDuties of dental assistant Reception of the patient Preparation of the patient for any treatment

he/she may need Preparation and provision of all necessary

facilities such as mouth washes and napkins Sterilization, care, and preperation of

instruments

Preparation and mixing of restorative materials including both filling and impression materials

Care of the patient after treatment until he/she leaves including clearing away of insruments and preparation of instruments for reuse

Preparation of surgery for the next patient

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

Assistancce with X-ray work and the processing and mounting of X-rays

Instructions of patient, where necessary , in the correct use of tooth brush

Aftercare of persons who have had general anaesthesia

With increased use of dental surgery assistant, a new concept had emerged in 1960’s, called the four handed dentisry

It is the art of seating both the dentist and dental assistant in such a way that both are with in easy reach of the the patient’s mouth.

Patient is in a fully supine position The assistant will hand the particular instrument that the

dentist need

And also perform additional tasks such as retraction, aspiritation...

The dentist can thus keep his hands and eyes in the field of operation and work with less fatigue and greater efficiency

A dental assistant is not required to be legally certified, registered or licenced or to have completed any particular duration of education

This is aperson who assist the dentist with his secretarial work and patient reception duties.

Fullfills the presciption provided by dentist regarding the extraoral construction and repair of oral applliances and bridge work

Also called as dental mechanic The formal training period covers as much as 2

years.

DUTIES: Casting of models from impressions made by the

dentist Include the fabrication of dentures, splints,

orthodontic appliance, inlays, crowns and special trays

Denturist : 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/registered Thier craft is called denturism ADA defines denturism as the fitting and dispensing

of dentures illegally to the public

This is the person who instructs in the prevention of dental disease and who may be permitted to apply preventive agents intraorally

In some countries, 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 school children. They are not allowed to undertake any intraoral procedures.

Dental nurse scheme was established in Wellington, New zealand in 1921 due to the extensive dental disease found in army recruits during first World war (1914-1918).

The man who influenced its formation was T.A Hunter, a founder of the New zealand dental association and a pioneer in the establishment of a dental school in New zealand. The name of school where they were trained was “The dominion training school for dental nurses”

The training extends to over a period of 2 years to cover both the reversible and irreversible procedures

Oral examination Prophylaxis Topical fluoride application Advice on dietary fluoride supplements Administration of local anesthetic Cavity preparation and placement of amalgam filling in

primary and permanent teeth 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

This is 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

DUTIES: Clinical caries diagnosis Technique of cavity preparation in decidous

and permanent teeth Material handling and restorative skills Vital pulpotomies under rubber dam in

decidous teeth and extraction of decidous teeth under local anaesthesia

In the U.K, they may work in the local authority and hospital services and they are required to carry out thier duties under the direction of a registered dentist

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

Work under the supervision of dentists In 1905, Fones trained Mrs. Irene Newmann in

the procedures of dental prophylaxis. In 1906, she become the first dental hygienist Dr.Alfred Civilion Fones is considered as

the father of dental hygiene

Duration of course was for a period of about seven months.

As per Indian Dental Act of 1948, a dental hygienist means a person not being a dentist or a medical practitioner, who scales, cleans or polishes teeth or give instructions in dental hygiene

In India, there are about 5-6 institutions where training is given

Cleaning of mouth and teeth with particular attention to calculus and stains

Topical application of Fluorides, sealants and other prophylactic solutions

Screening for preliminary examination of patients as individuals or in groups, such as 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

Referred to as expanded function dental assistant, expanded function dental hygienist, expanded function auxiliary, technotherapist, expanded duty dental auxiliary

They are mostly assistants or hygienists in some case with additional training. Hence the name expanded functions

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

Placing and removing rubber dams Placing and removing temporary restorations Placing and removing matrix bands Condensing and carving amalgam restoration in

previously prepared teeth Applying the final finish and polish to the

previously listed restorations

1) Certified dental assistant2) Preventive dental assistant3) Dental hygienist4) Dental hygienist5) Dental hygienist with expanded duties

Certified dental assistant

The training course is of 8 months duration. The assistant was taught traditional chairside duties The only intraoral duty was exposing radiographs

Preventive dental assistant

Course duration: 3-6 weeks They were permitted to: 1)Polish the coronal portions of teeth without

instrumentation 2)Take impressions for study models 3)Topically apply caries preventive agents 4)Place and remove rubber dams

Dental hygienist

Course duration: 8 months Permitted to : 1) Carry out scaling 2) Conduct a preliminary examination of

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

3) Provide a coplete prophylaxis including scaling, root planing and polishing of fillings

4) Apply and remove a periodontal pack 5) Apply fissure sealants

In developed countries, dentist remain in the urban centres and the number of areas too distant from public or private dental offices for the inhabitants to recieve regular comprensive care or emergency pain relief is very large

Nurses and former dental assistants can in such areas, provide valuable service with the minimum of training.

-simple dental prophylaxis can be performed -basic dental education can be provided -dental first aid can be renderd in cases with pain -patient can be referred to the nearest dentists -can organise fluoride rinse programs -can perform simple denture repairs

The expert committee on Auxiliary Dental Personnel of the WHO has suggested two new types of dental auxiliaries:

1) Dental licentiate 2) Dental aide

Dental licentiate: Semi-dependent operator Trained for 2 years Duties: -Dental prophylaxis -Cavity preparation and

filling of the primary and permanent teeth

-Extractions under local anaesthesia

-Drainage of dental abcesses

-Treatment of the most prevalent diseases of supporting tissues of the teeth

-Early recognition of more serious dental conditions

Dental aide Suggested in 1959 Training period extends from

4-6 months, followed by a period of field training under direct and constant supervision.

Duties: -Extraction of teeth

under local anesthesia -Control of hemorrhage -Recognition of dental

diseases important enough to justify transportation of patient to a center where proper dental care is available

ADA (1975) defined four degrees of supervision of Auxiliaries

1) General supervision:- The dentist have authorised the

procedures and they are being carried out, inaccordance with the diagnosis and treatment plan completed by the dentist

2) Indirect supervision:- The dentist is in the dental office,

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

3) Direct supervision:- The dentist is in dental

office,personally diagnosis the condition to be treated, personally authorises the procedure and before dismissal of the patient, evaluates the performance of the Dental Auxiliary.

4) Personal supervision:- The dentist is personally operating on

a patient and authorises the auxiliary to aid treatment by concurrently performing supportive procedures

Auxiliaries based programs have long been the backbone of public dental care in some countries

The oldest and best known is the New Zealand School dental nurse plan,introduced in 1921

As dental auxiliaries came to be accepted more and more by the dental profession, their numbers increased and individual dentists had to carry a greater responsibility for them.

Accordingly, it was realised in some countries that dental students should be trained to work with auxiliaries and begin to accept responsibility for them at an early stage in their undergraduate careers

With this, in 1961, the US public health service established dental auxiliaries utilisation (DAU)programme,which initiated the training of dental students in modern methods of working with dental surgery assistants and also the practice of four-handed dentistry

In the USA,Public Health Service announced a plan to make funds available for teaching dental students to work with, manage and supervise dental health team comprising both operating and non-operating auxiliaries. This is called TEAM programme

Facility for training the appropriate dental school supervisory staff in utilisation of Expanded Function Operating Dental Auxiliary(EFODA) was included in the programme

Some countries have an acute shortage of dentists and have no facilities for training the dentist. Under such situations, measures must be taken to provide even the most rudimentary dental care for the population

While concentrating on treating the consequences of dental disease, provisions can be made to include prevention and educational activities in public dental health programmes.

Dental services can be developed primarily on the basis of preventive approach, both for the community and the individual.

With rapid population growth and increasing demand for dental care, more and more dentists are required.

But unfortunately, this is an expensive process. Hence training an auxiliary is more economical, less time consuming and fewer burdens to the society

In general, this result in definite benefits to dentists, patients, auxiliaries and to whole community, financially, psychologically and ethically.

It is the essential that those people who plan and organise dental care services should be aware of the problems that might exist and are able to relate to their own particular situations.

Only with this can better utilisation of dental auxiliary be made and real dental care is available, eventually to all communities in the world

The only auxiliary personnels who exist in India are the dental surgery assistant, laboratory technician and dental hygienists

The most suitable types of auxiliary for the Indian set up will be school going dental nurse and Expanded Function of Dental Auxiliary(EFODA)

These auxiliaries will not only provide the basic dental care but also play an important role in prevention of dental diseases both for school going children and general public (underprivileged population)

School dental nurse will be extremely useful for lacking care of oral and dental problems among school going children who constitute about 40% of the total population.

Besides this, providing appropriate oral health care to school going children in younger age helps in preparing the children as better patient and development of positive attitude to oral health at a later part of the life. Thus such personnel will provide not only optimal dental care to the community but also enable to do so more economically and efficiently.

Certain parts of the task require top-level skill and knowledge and in dentistry, these are called professional services. Some other parts of the task require less skill and knowledge. These may safely and advantageously be delegated to auxiliary personnel.

The community benefits from this sort of division of labour are that, training time for professional personnel can be conserved, thereby saving the cost and man power to tackle the enormous untreated disease burden of the society.

These who do receive full training can make their best services available to a larger segment of population.

Hence, the training of dental auxiliaries, not only helps in tackling the major problem of the common dental diseases of the developing countries in particular, but also the philosophy of preventive dentistry can be practiced more efficiently in the countries suffering from financial crisis and lack of professional personnel

Preventive and Community Dentistry, Soben Peter(third edition)

Textbook of Preventive and Community Dentistry, S.S. Hiremath

Dentistry, Dental Practice and the Community- Brian.A.Burt, Stephen.A.Eklund

Textbook of Preventive Dentistry, Joseph John