public health dentistry

1. DENTAL MANPOWER
1

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

3. Introduction
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)
3

4. 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.
4

5. DENTIST
A dentist is a person licensed to practice dentistry
under the law of the appropriate state, province,
territory, or nation.
5

6. 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
6

7. 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.
7

8. 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
8

9. 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)
9

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.
10

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.
11

12. OPERATING 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.
12

13. REVISED CLASSIFICATION
NON OPERATING AUXILIARIES
Dental surgery assistant
Dental secretary/ receptionist
Dental laboratory technician
Dental health educator
13

14. OPERATING AUXILIARIES
School dental nurse (New Zealand type)
Dental therapist
Dental hygienist
Expanded function dental auxiliaries
14

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.
15

16. 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
16

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.
17

18. The dentist can thus keep his hands
and eyes in the field of operation and work with
less fatigue and greater efficiency.
18

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.
19

20. • 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.
20

21. • Instruction of the patient, where necessary, in the
correct use of the toothbrush.
• Aftercare of person who have had general
anaesthetics.
21

22. DENTAL
SECRETARY/RECEPTIONIST
Person who assists the dentist with the
secretarial work and patient reception duties.
22

23. 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.
23

24. 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.
24

25. Duties
Casting of models from impressions made by the
dentist.
Fabrication of dentures, splints, orthodontic
appliances, inlays, crowns and special trays.
25

26. 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
26

27. 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.
27

28. • The candidate must have passed at least
matriculation examination of a recognised
university taking science subject or an equivalent
recognised qualification.
28

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’.
29

30. 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.
30

31. 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.
31

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
32

33. They are, however, not allowed to undertake any
intraoral procedures
33

34. SCHOOL DENTAL NURSE34
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
35

36. 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.
36

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.
37

38. DUTIES:
• 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
38

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.
39

40. 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
40

41. Duties;
• 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.
41

42. EXPANDED 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.
42

43. DUTIES:
• 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
43

44. Four levels of training and qualification were
recognised,
• Certified dental assistant
• Preventive dental assistant
• Dental hygienist
• Dental hygienist with expanded duties
44

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
45

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
46

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
47

48. Dental 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
48

49. • 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
49

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.
50

51. Duties
• Simple dental prophylaxis
• Basic dental health education
• Dental first aid
• Organise fluoride rinse program
• Perform simple dental repair
51

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
52

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
53

54. • Drainage of dental abscesses.
• Treatment of the most prevalent diseases
supporting tissues of the teeth
• Early recognition of more serious dental
conditions.
54

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.
55

56. These new auxiliaries are particularly useful in
some countries, having acute dentist shortage,
with no facilities for training dentists.
56

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
57

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
58

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
59

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.
60

61. Personal supervision
The dentist is personally operating on a
patient and authorizes the auxiliary to aid
treatment by concurrently performing
supportive procedures
61

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.
62

63. 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
63

64. 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
64

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.
65

66. REFERENCES
 Essentials of public health dentistry 5th
edition- Soben Peter
66

67. 67