P a g e | 2

Certificate This is to certify that the subject seminar on Role of Dental Auxiliaries in Dental health by Batch B of Final BDS (January 2015 batch) submitted is a bonafide work done under my guidance and supervision.

Date:

Signature of Faculty Department of Public Health Manipal College of Dental Sciences Manipal P a g e | 3

Internal Examiner External Examiner P a g e | 4

Contents Introduction...... 4 Classification by W.H.O (1967)...... 5 Degrees of Supervision...... 6 (A) Non-Operating Dental Auxiliaries...... 9 1. Dental Receptionist...... 9 2. ...... 13 Educational and licensing requirements in U.S...... 13 Earnings and salary...... 14 3. Dental Health Educator...... 15 4. ...... 19 (B) Operating Auxiliaries...... 23 1. School Dental Nurse...... 23 2. ...... 27 3. Expanded Functions/Duties of Operating Dental Auxiliaries (EFDA OR EDDA)..29 Frontier Auxiliaries...... 31 Dental Manpower in India...... 34 Conclusion...... 40 References...... 41 P a g e | 5

Introduction

A dental auxiliary is a person who is given responsibility by a so that he/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. P a g e | 6

Classification by W.H.O (1967)

1) Non Operating Auxiliaries  Clinical – This is a person who assists the professional (dentist) 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.

2) 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. REVISED CLASSIFICATION 1) Non Operating Auxiliaries  Dental surgery assistant  Dental secretary/receptionist  Dental laboratory technician  Dental health educator

2) Operating Auxiliaries  School dental nurse   Dental Hygienist  Expanded function dental auxiliaries P a g e | 7

Degrees of Supervision

ADA (1975) defined four degrees of supervision of auxiliaries, with the assumption that ultimate responsibility was assumed by licensed dentist.

1. GENERAL SUPERVISION:

The dentist has authorized the procedures and they are being carried out in accordance with the diagnosis and treatment plan completed by dentist. The supervisor provides continuing or individual assignments by indicating generally what is to be done, limitations, quality and quantity expected, deadlines and priorities. Additional, specific instructions are given for new, difficult, or unusual assignments. The employee uses initiative in carrying out recurring assignments. The supervisor assures that the work is technically accurate and in compliance with instructions or established procedures.

2. DIRECT SUPERVISION:

It is a term that is used to refer to situations in which a supervisor is present at all times. The supervisor oversees activities as they occur and provides constant direction, feedback, and assistance. For some types of workplaces, direct supervision is required for safety and health reasons. In others, it may be strongly recommended to make a workplace run P a g e | 8 more smoothly. : 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

One example of a workplace in which direct supervision is required is in a medical practice. Technicians may need direct supervision for performing certain types of procedures. While they are authorized to do these procedures, they cannot do them without being monitored by a doctor. For example, a dentist may be required to supervise a dental hygienist during certain types of dental procedures. Likewise, a veterinarian must be present for some procedures performed by a veterinary technician.

Another setting in which direct supervision is used is prisons and jails. In a facility that uses this approach to managing inmates, people are incarcerated in “pods,” which consist of cells that surround a public day area. A corrections officer works in the day area, not a private office or secured area, interacting directly with inmates when they are out of their cells. This allows for rapid intervention in the event that problems develop and it also provides a mechanism for monitoring behavior to offer rewards for good behavior.

3. INDIRECT SUPERVISION:

Indirect supervision is characterized by some form of authority over the work of employees not under direct supervision. In other words, the "supervisor" who provides indirect supervision is responsible for the work, but not for the worker. The descriptions above were written in relation to the employee under direct supervision; the following subsections describe persons with responsibility for exercising indirect supervision. The dentist is in the dental office, authorizes the procedures P a g e | 9 and remains in the dental office while the procedures are being performed by the auxiliary.

4. PERSONAL SUPERVISION: The dentist is personally operating on a patient and authorizes the auxiliary to aid treatment by concurrently performing supportive procedures. P a g e | 10

(A) Non-Operating Dental Auxiliaries

1. Dental Receptionist

PRIMARY RESPONSIBILITIES Responsible for administering the day-to-day activities of the business office, including: maintenance of the records of patients, scheduling of patients, accounts receivable, maintaining appearance and order of dental office, presentation of financial treatment plan options, and recall/recare system. SPECIFIC DUTIES

o Reception Management o Manage day-to-day operations of dental office o Open and close dental office according to office protocol o Review the office for a neat, professional appearance and make necessary changes o Check the daily schedule for accuracy and post it in all treatment rooms o Answer and respond to telephone calls with professionalism o Review supplies for reception and provide order to Doctor. o Maintain petty cash o Patient Management o Maintain a professional reception area; organize patient education materials, etc. o Greet and welcome patients and visitors to the practice P a g e | 11 o Check in patients according to office protocol, verifying and updating patient information o Manage recall and inactive patient system o Oversee patient relations & handle patient complaints, under the doctor’s indirect supervision o Help explain office policy to patients o Confirm the next day’s appointments according to protocol and patient preferences o Schedule patients for efficient use of doctor and staff time o Check patient quick-fill list to try to fill in cancellation and no- show appointment times o Collect payment from patients at the time of treatment o Make follow-up appointments as needed o Prepare financial treatment plans and present plan options to patient at end of their appointment o Assist in the treatment room as needed o Records Management o Gather and accurately record insurance information from patients o See that records are stored securely. o Accurately file patient information o Arrange patient charts and radiographs for the next day’s appointments o Track cases and referrals to and from other doctors o Insurance o Update insurance information on all patients at all times o Submit treatment plans for predetermination of benefits o Prepare claim forms for patients with dental insurance o Organize supporting materials for claim forms, such as radiographs or written narratives, as directed by the doctor. o Mail or electronically submit claim forms from office o Assist in the resolution of problems with third-party payers o Inventory Management P a g e | 12 o Monitor inventory and order dental office supplies as needed o Monitor and make sure all dental office equipment is working properly

Office Participation o Be an active participant in staff meetings o Perform other tasks as assigned by the doctor. o Accounts Receivable Management o Enter patient financial activity in computer o Maintain accounts receivable activity o Prepare bank deposits o Prepare statements o Follow-up insurance claims o Follow-up delinquent accounts o Arrange payment schedule with patients o Billing o Prepare billing statements promptly and accurately mail billing statements as directed by the doctor. o Prepare and mail overdue account letters as directed by the doctor. o Telephone patients with accounts overdue o Post checks received each day o Manage patient financial accounts o Correspondence o Sort, organize, and distribute mail o Prepare and send out new patient and referral thank-you letters as directed by doctor. o Prepare and send out continuing care notices as directed by the doctor. o Prepare and send out correspondence as directed by the doctor. o Marketing and Public Relations Management o May assist with the design of marketing and promotional materials (print and electronic) P a g e | 13

o May assist with dental office advertising/recruiting ads for new staff o May assist with dental office facility management PERSONNEL REQUIREMENTS

o Education/Experience o High school diploma o 2 years office experience desired o Legible handwriting for notations in charts o Interpersonal o Good interpersonal skills to maintain effective rapport with patients, , other staff members and community o Effective verbal skills to communicate with patients and staff o Team player o Able to adapt to office policy improvements (office is constantly striving for improved customer care/service) o Conflict resolution experience o Customer service or patient relations experience o Quick response/accurate data entry to present treatment plans to patients in a short time frame o Communicate all concerns to the doctor.

2. Dental assistant

Dental Assistants assist the dental operator (dentist or other treating dental auxiliary) in providing more efficient dental treatment, by preparing the patient for treatment, sterilizing instruments, passing P a g e | 14 instruments during the procedure, holding suction devices, exposing dental radiographs, taking impressions, and fabricating provisional crowns. Dental operators can focus more time on the procedure; the dental assistant then effectively becomes the operator's extra hands.

Educational and licensing requirements in U.S.

In some states, dental assistants can work in the field without a college degree, while in other states; dental assistants must be licensed or registered.

Dental assistants are required to meet the minimum certification to work in the field. There are many things that dental assistants must consider while working in the field and arguably the most important is infection control.

The Commission on Dental Accreditation of the American Dental Association accredits dental assisting school programs, of which there are over 200 in the United States. To become a Certified Dental Assistant, or CDA, dental assistants must take the DANB (Dental Assisting National Board) CDA examination after they have completed an accredited dental assisting program, or have at least two years of on- the-job training as a dental assistant. Some dentists are willing to pay a dental assistant-in-training that has a good attitude and work ethic.

Expanded duties dental assistants or Expanded Functions Dental Assistants, as they are known as in some states, may work one on one with the patient performing restorations after the doctor has removed decay. Ideally a dental assistant should have both administrative and clinical skills although it's still acceptable to have one or the other. Duties may also include seating and preparing the patient, charting, mixing dental materials, providing patient education and post-operative P a g e | 15 instructions. They also keep track with inventory control and ordering supplies.

In the UK, Registered Dental nurses are prohibited from carrying out any form of direct dental treatment on the patient, including teeth whitening procedures, under the GDC scope of practice.

Dental nurses found to be carrying out dental procedures are liable to be removed from the statutory GDC register.

However, in the Republic of Ireland, other parts of the UK, and parts of North America, it is often dental nurses (and teeth whitening technicians) who carry out teeth whitening procedures rather than dentists. This practice mainly occurs in clinics focusing solely on laser teeth whitening. In Ireland, registration as a dental nurse with The Irish Dental Council is voluntary; however, nurses who are registered and who carry out teeth whitening may face disciplinary action if caught.

In Australia, a formal qualification is not required to work as a dental assistant. However, this is usually preferred by most dentists to ensure that their staff has enough background knowledge about dentistry. Australian dental assistants are not required to be registered with the Australian Dental Association.

Earnings and salary

Dental assistants are currently listed by the US Bureau of Labor Statistics as a healthcare support occupation, and therefore do not earn the same salary as dentists. Their median salary in the US was $33,470 annually, or $16.09 per hour, in 2010.[2] Salary ranges vary widely by state and by major metropolitan area. The lowest-paying state, West P a g e | 16

Virginia, pays its lowest-earning dental assistants around $18,490 per year, while the highest-paying state, Alaska, pays its top earners around $56,760 annually. The lowest-earning dental assistants in Santa Fe, NM, earn around $17,950 per year, while the highest earners in San Francisco, CA earn around $59,370 per year.

3. Dental Health Educator This is the person who instructs in the prevention of dental diseases and who may also be permitted to apply preventive agents intra orally. 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, additional weeks of training are given, after which auxiliaries are allowed to conduct fluoride nourishing programs to group of school children. They are, however, not allowed to undertake any intra oral procedures. Few responsibilities of a dental health educator are: a) Assessing Individual and Community Needs. This means that a health educator needs to determine the health needs and concerns of a specific population or person. Besides this the health educator also needs to perform a capacity assessment to find ways to empower the community and identify skills and resources they have to help solve problems. The health educator is responsible for helping others in a community to help themselves. Another aspect of this is for educators to collect and analyze data from their specific populations and use this to determine priority areas where health education programs need to be placed. b) Plan Health Education Strategies, Interventions and Programs. This part takes place after the needs of a population have been assessed. It P a g e | 17 involves recruiting stakeholders to help develop and support an effective health program. Goals and objectives must be developed specific to the proposed health ed. Program. After the goals and objectives are set up then interventions can be developed. These interventions and strategies must be fitting to the needs of that community and atmosphere. They should raise awareness and plan strategies and programs that will meet the objectives. By using the Rule of Sufficiency health educators can determine how and if their strategies are sufficiently forceful and efficient enough to help objectives and goals be met. c) Implement Health Education Strategies, Interventions and Programs. After assessing all the needs and planning the programs and interventions it is time for the health educator to implement the health education program into the target population. They are first responsible for understanding the people in the population and know how to get people to participate in the program, what time the program should be held, what kind of assistance is needed or what extent of understanding the people have for the health issue being acknowledged. Health educators should be comfortable using a variety of educational methods to help present their program. Then if problems are discovered during the implementation they should be addressed and objectives and goals might need to be revised. When implementing an educational program the health educator is also responsible for dressing professionally and adhering to the Code of Ethics. d) Conduct Evaluation and Research Related to Health Education. This responsibility for health educators focuses on evaluating the worth of a P a g e | 18 program and if it is successful in meeting its desired goals and objectives. For an evaluation to be effective the health educator must have made realistic objectives back when they were planning their program. Otherwise the program may not be able to meet its expected goals and could therefore be terminated. Data collected and analyzed on a program should reflect how it is holding up and progressing and what things might need to be modified in the future. The program will also develop based on its research and new information that it generates, the health educator is responsible for interpreting and conducting research and using the results to improve their program

e) Administer Health Education Strategies, Interventions and Programs. This responsibility of the health educator is to coordinate and administer the performance of a program. Health educators must facilitate coordination with personnel and programs. They need to make sure that personnel and members of their program have an equal understanding and knowledge of their education program. Sometimes the educator is required to coordinate activities between their program and other similar programs within a community. f) Serve as a Health Education Resource Person. A health educator is also responsible for being a resource person. This means that they must have the skills to access and acquire health information and resources when called upon by clients or associates. They must know how and where to retrieve information. But besides this they must also be able to establish effective relationships with others and be able to communicate information regarding health in an effective, nonthreatening way. P a g e | 19

g) Communicate and Advocate for Health and Health Education. Basically this means that the health educator has the responsibility to communicate effectively to clients, associates or whomever else the information necessary to improve and protect their health. Good communication is an essential tool for health educators. Besides relaying and translating information they must also advocate and support their profession and be promoters of health. Health educators can be called upon to instruct and communicate health needs to individuals and groups. They need to support, initiate and abide by rules and procedures that will enhance the health of a target population. P a g e | 20

4. Dental Technician The Art and Science of Dental Technology Dental laboratory technology is the art and science of manufacturing corrective devices and replacements for natural teeth. There is a skilled professional behind the scene, working on the written order or prescription of the dentist, who manufactures the restoration or device. This is the dental laboratory technician. Each restoration the technician makes will be different and each must simulate the function of the natural teeth. But, beyond that, the technician’s great challenge is to capture and recreate both the perfection and the imperfection of natural teeth. History of the Dental Laboratory Technician As the art and science of dentistry continued to develop, special processes and skills were developed in manufacturing prosthetic devices. Since these processes and skills were in demand by other dentists, the practice of sending out laboratory work to those possessing the processes began. Dr. W. H. Stowe opened the first dental laboratory in Boston in 1887. The establishment of the commercial dental laboratory led quickly to the training of apprentices and thus the dental laboratory technician The Necessary Skills Good candidates for careers in dental technology usually possess good eye-hand coordination and color perception, dexterity in using small instruments, the patience to attend to minute detail and an interest in learning the underlying material science. P a g e | 21

The Work Setting Most dental technicians are employed in commercial dental laboratories. Commercial dental laboratories are often very small, having only two or three employees. There are also, however, some very large labs with over 100 employees. Some private dental offices have their own laboratory. Military services still train and employ a number of dental technicians. Schools teaching dental technology offer some teaching positions for experienced technicians. CAD/CAM Dentistry, (Computer-Aided Design and Computer-Aided Manufacturing in Dentistry), is an area of Dentistry utilizing CAD/CAM technologies to produce dental restorations.

Getting Started Many dental laboratories – larger ones in particular – offer positions for trainees. Persons hired at the entry level may rapidly progress to being productive employees, performing a limited range of laboratory procedures. Another route to a career in dental laboratory technology is by completing one of the two-year or four-year degrees in dental technology offered through educational programs. Download the current list of U.S. schools offering dental laboratory technology programs: U.S. Dental Lab Schools These courses provide students with broad-based theory and an introduction to laboratory procedures across the various dental technology specialties. P a g e | 22

A graduate may expect to be hired at a salary not significantly higher than that of a paid trainee, but should be able to progress far more rapidly to a professional level. Country Qualifications required India  Diploma for 2 academic years (D.D.T-diploma in dental technology)

 Candidate must have passed at least matriculation examination of a recognized university. United kingdom  Registered with GDC  Completion of a course approved by GDC such as:

1) BTEC National Diploma in Dental Technology (or) 2) BSc (Hon) degree in Dental Technology United States of America  Education and training through a two-year program at a community college, vocational school, technical college, university or .

 Graduates of these programs receive either an associate degree or a certificate (certified by National Board for Certification in Dental Laboratory Technology)

 Few programs offer a four-year baccalaureate program in dental technology. New Zealand & Australia  The profession of dental technology is registered under the Health Practitioners Competence Assurance Act 2004

 Graduates with a Bachelor of Dental Technology (BDentTech) P a g e | 23

degree are automatically entitled to register with the Dental Technicians Board in order to practice as Registered Dental Technicians.

 Opportunities for postgraduate study for the Postgraduate Diploma in Dental Technology (PGDipDentTech), and the Master of Dental Technology (MDentTech) and Doctor of Philosophy (PhD) degrees. P a g e | 24

The Professional Dental Technician

Most states set no minimum qualifications for persons to be employed as dental technicians. However, the industry encourages standards for the benefit of the dental patient. New materials, techniques and equipment are regularly introduced to dental technology and technicians must continue their education through training courses and seminars. Technicians who have at least five years of education and/or experience in dental technology are encouraged to distinguish themselves by taking the examinations to be Certified Dental Technicians (CDTs) in different areas. Since certification is voluntary in most states, it represents not only compliance with established standards, but also a personal commitment to quality and professionalism. P a g e | 25

The Future of Dental Laboratory Technology Dentistry and dental laboratory technology have been, are and will continue to be ever-changing interrelated fields of endeavor. Both health and aesthetics will continue to be driving forces in the continuing development of dentistry. As we move onward further into the 21st century, we see a period of true promise and steady growth in dentistry and dental laboratory sales. There will be no decline in the demand for dental services, rather the demand will grow. P a g e | 26

(B) Operating Auxiliaries

1. School Dental Nurse

This is an operating Dental Auxiliary, who is permitted to diagnose dental disease and to plan and carry out certain specified preventive and treatment measures, including some operative procedures in the treatment of dental caries and periodontal disease in defined group of individuals, especially school children. Interest in an organized plan to improve dental conditions among children in New Zealand first became evident in 1905. Treatment of these children was particularly difficult on account of the distance, which often separated small communities. Also, Dentists were in short supply during World War I (1914-18) and treatment of young children was not as accepted an area of dental practice at that time. The School Dental nurse Scheme was established in Wellington, New Zealand in 1921 due to extensive dental disease found in army recruits during World War I. the man who influenced its formation was T. A. Hunter, a founder of New Zealand Dental Association and a pioneer in the establishment of a dental school in New Zealand. The name of the school where they were trained was “The Dominion Training School for Dental Nurse.” The training extends to over a period of two years to cover both reversible and irreversible procedures. P a g e | 27

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 for between 450 and 700 children. Each school which takes more than 100 children has its own dental clinic. When a school dental Nurse is assigned to a school, she is accepted as a member of the staff in the same was as are the teachers. In New Zealand, the dental school nurse is predominantly in the school- based salaried service and is expected to provide care for the children at nearly 6-month intervals. They are under general supervision of a district principal dental officer. The dental nurse inspector who is delegated certain responsibilities visits these school dental clinics about twice as often as the principal officer.

Duties: . Oral examination. . Prophylaxis. . Topical fluoride application. . Advice on dietary fluoride supplements. . Administration of local anesthetics. . 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. P a g e | 28

Additional skills a nurse could develop in their career include:

 Further skills in oral health education and oral health promotion

 Assisting in the treatment of patients who are under conscious sedation

 Further skills in assisting in the treatment of patients with special needs

 Intra-oral photography

 Shade taking

 Place rubber dam

 Measuring and recording plaque indices

 Pouring , casting and trimming study models

 Removing sutures after the wound has been checked by a dentist

 Applying fluoride varnish as part of a programme which is overseen by a consultant in dental public health or a registered specialist in dental public health

 Constructing occlusal registration rims and special trays

 Repairing the acrylic component of removable appliances

 Tracing cephalographs P a g e | 29

Because of this system works well in New Zealand it does not mean that it would work for any other country because New Zealand is a small country and one with advanced social services. Operating auxiliaries with functions similar to those of the New Zealand School Dental Nurse are employed in a number of other countries, many of which have started their own training schools. In Saskatchewan, a Canadian province and the only place in North America where someone other than a dentist may legally drill and fill the teeth, the nurses receive direct supervision during the first two months and then work with a more experienced dental nurse for the third month. If the performance is found to be satisfactory, then they work without direct supervision. The dentist does the initial examination and meets each nurse at least once a week. Dental Nurses are presumed to provide care at less cost than dentists. They are less expensive to train than the dentists and their salaries are similar to those of physical therapists and school teachers. P a g e | 30

2. Dental Hygienist Dental hygienist is an individual who has completed an accredited dental hygiene education program and an individual who has been licensed by the state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist are based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations but always include at a minimum scaling and polishing of teeth. Tasks performed are-:

 Educate and council children and adults on dental health and plaque control, oral hygiene and nutrition

 Patient screening procedures, such as assessment of oral health conditions, review of health history, oral cancer screening ,head and neck inspection and dental charting and taking blood pressure and pulse

 Removing deposits and stains from the teeth by scaling and root planning

 Giving LA for dental procedures

 Assist in prevention and control of dental carries

 Select and use appropriate fluoride treatment and polish tooth restorations

 Taking and developing dental radiographs P a g e | 31

 Making impression of patients mouth for construction of study casts and mouth guards

 Apply and remove periodontal packs

 Instruct patient o how to look after their teeth and mouth after operation

 Assist in management of periodontal diseases

 Teaching patients appropriate oral hygiene practices

 Performing documentation and management activities

 Applying preventive materials to the teeth e.g. fluoride , sealants P a g e | 32

3. Expanded Functions/Duties of Operating Dental Auxiliaries (EFDA OR EDDA) This is a person who is permitted to carry out certain specified treatment and preventive measures including reversible procedures under the direct supervision of a dentist. An efda is a dental assistant or a hygienist in some cases, who has received further training in duties related to direct treatment of the patient though still working under the direct supervision of a dentist. It excludes diagnosis, treatment planning, cutting of hard and soft tissues and prescribing drugs. They are allowed reversible procedures that are procedures that could be repeated by the dentist without any harm to the patient if the work performed by auxiliary is of unacceptable quality. Procedures permitted are:-

 Placing rubber dam

 Restoration of a teeth in which cavities have been prepared by the dentist with amalgam and other plastic filling materials

 Taking radiographs

 Taking impression

 Topical application of fluoride

 Making of study models

 Making of impression trays

 Casting and polishing of inlays and dentures

 Placing and removing matrix bands P a g e | 33

 Removing sutures

 Monitoring of nitrous oxide

 Removing and replacing ligature wires on orthodontic appliances

 Applying pit and fissure sealants and desensitizing agents REGISTERED RESTORATIVE ASSISTANT IN EXTENDED FUNCTIONS May perform any duties that a dental assistant may perform Perform following duties under direct supervision;-

 Cord retraction of gingiva during impression

 Taking impression on cast restoration

 Formulating indirect patterns for endodontic post and core castings

 Fitting trial endodontic filling points

 Drying canals previously opened by the dentist

 Testing pulp vitality

 Removing excess cement from subgingival tooth surface with a hard instrument

 Fitting and cementing stainless steel crowns

 Placing class 1 3 and 5 non metallic restorations

 Taking face bow transfers and bite registration P a g e | 34

 Taking final impressions for tooth borne removable prosthesis P a g e | 35

Frontier Auxiliaries

It refers to the community of nurses and former dental assistants who are provided training to work in rural areas which are distant to public or private dental clinics.

 In developed countries dentists remain in urban areas and are too distant making it difficult for inhabitants to receive regular comprehensive care or emergency pain relief. They are trained to provide services like: 1. Simple dental procedures 2. Basic dental health education 3. Organizing fluoride rinse programs 4. Simple denture repairs 5. First aid can be rendered in case with pain In 1981, 1 week training program was conducted for frontier auxiliaries in Alaskan communities, 40 or more miles away from the nearest dentist. 2 years later case reports from the community showed that large no of simple dental health problems had been solved and references had been made to urban dentists for elective work. NEW AUXILIARY TYPES Expert committee on auxiliary dental personnel of who (1959) suggested 2 new types of dental auxiliaries P a g e | 36

1. The DENTAL LICENTIATE: He is a semi-independent operator trained for 2 years.

 They are responsible to the chief of regional or local health service.

 Their services occur in rural or frontier areas and hence the supervision and control would probably be remote. Duties performed by them include:

 Dental prophylaxis

 Cavity preparation and fillings of primary and permanent teeth

 Extractions under local anesthesia

 Drainage of dental abscesses

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

 Early recognition of more serious dental conditions.

2. THE DENTAL AIDE

 This type dental auxiliary is of even briefer training period who would perform functions similar to those of the medical corpsmen now seen in military services

 Training of sterilization procedures is of utmost importance

 They operate only within a salaried health organization and be under close supervision at first P a g e | 37

 Formal training extends from 4-6 months followed by a period of field training under direct and constant supervision.

 They are useful in some countries having shortage, with no facilities for training dentists. Their duties include

 Elementary first aid procedures for relief of pain

 Extraction of teeth under local anesthesia

 Control of hemorrhage

 Recognition of dental disease which is important enough to justify transportation of the patient to a center where proper dental care is available. P a g e | 38

Dental Manpower in India

 Each country evolves a pattern of medical including dental care which is suitable to its social conditions, economic system, political ideology and experience.  Patterns show variation from country to country and from time to time.  Pattern of practicing dentistry may be organized in different ways, the most common being solo practice in which dentist is a private practitioner setting up his own clinic, and employing assistants as and when required. He may have an honorary or part-time attachment at a government, semi- governmental or public trust health facility. Sometimes a newly passed graduate maybe working as an assistant to get experience. A small number of dentists may be employed fulltime in one of the organizations mentioned above.  The concept of group practice or polyclinics envisages a group of medical/ dental practitioners coming together and setting up a common facility. They may be organized as partners in a common endeavors and share the cost of maintenance of the premises. They are responsible for the technical work individually.  Group practice may develop into a big organization consisting of various specialties in medicine and/ or dentistry. There are many advantages of such a big organization –  Increase in quality and continuity of care,  Patient convenience to have different services available at one place,  Economical as the common expenses are shared without duplication, P a g e | 39

 Same benefits are derived by the patients and the providers of the service.  Development of dental practice along this line has been seen in many places across India.  Due to extreme shortage of dentists in India in the pre- independence period as noted by the Bhore Committee, suggestions were made by the committee on of which was to train the dental hygienists.  The Mudaliar Committee in 1959 also recommended training of dentists, dental hygienists and dental mechanics.

P a g e | 40

 India is diverse in geography, culture and religion. It is predominantly a rural nation as 72% population lives in rural areas.

 Health of its population depends on:

Health care delivery system-  It is based on the principle of health for all through primary health care approach which is foundation of rural health care. According to national family health survey conducted by ministry; 1/3rd population is in urban area and 2/3rd in rural. The poor mainly are concentrated in the rural areas esp. in the north, and mainly practice agriculture (according to World Bank). They are less literate and have less access to oral health care facilities, subsequently suffering most from oral diseases.  Health care system is affected by infrastructure deficiency and variation in quality of services provided. Since independence, India never had oral health status data and this proved a great problem for Indian policy makers in assessment of oral health services.  Integrated network is present to provide different levels of care to population-  Dental college/medical college(tertiary care)  District hospital  Primary health centre  Subcentre(rural dispensary)  Rural health has around 1,36,815 subcentres, around 26,952 primary health centres and 3708 community health centres. P a g e | 41 P a g e | 42

Socio-demographic profile-  Includes socioeconomic status, literacy rates, infant and maternal mortality rates, human development index etc.  Oral health care delivered through primary health care infrastructure is of limited resources and dental manpower.  India produces about 18,000 dentists per annum. Dentist population ratio in urban areas is 1:10000 and in rural is about 1; 2,50,000. This distribution of dentists is grossly uneven indicating that about 90% dentists are in urban areas and only 10% in rural areas (for the 72% population). In most states, dentists are not posted at community and primary health centers. Government establishments cater to a small population, majority treated by private setups. Shortage of equipment and materials and facilities result in minimal curative services.  Accessibility is also a serious problem in dentistry. The major missing link causing this serious problem is absence of primary health care approach in dentistry, reasons being geographic P a g e | 43 imbalance in distribution of dental colleges, variation in dentist population ratio. It is difficult for poor urban and rural people to get emergency care. Community oriented health programs are seldom implemented. Reasons for contradiction are geographic variation, uneven dentist population ratio, poor specialist: generalist ratio, poor dentist: auxiliary ratio and low priority to oral health.

P a g e | 44

Conclusion

India is the 7th largest country in the world. Need of the hour is to develop an effective dental care delivery system which is equitably distributed, with a well – qualified , dedicated work force for which these levels of supervision are a must. P a g e | 45

References

Soben Peter, Essentials of Public Health Dentistry 5th Ed, Arya Publications, Chapter 19, Pg- 476-485 CM Marya, Textbook of Public Health Dentistry, Jaypee Publications, Chapter 17, Pg- 213-219 Nicola Ursula Zitzmann, Edgar Hagmann andRoland Weiger. (18 JUN 2007). Clinical Oral Implants Research. Available: http://onlinelibrary.wiley.com/doi/10.1111/j.1600- 0501.2007.01435.x/abstract. Last accessed 11th October 2014. Dental technician/dental technologist Retrieved from http://www.nhscareers.nhs.uk/explore-by-career/dental-team/careers-in- the-dental-team/dental-techniciandental-technologist/