DENTAL AUXILIARY-HOW THE DENTISTS ARE BEING ASSISTED

WHO Definition (1958)

• A dental auxiliary can be defined as ‘A person who is given responsibilities by a dentist so that he or she can help the dentists render dental care, but who is not himself or herself qualified with a dental degree’.

• In U.K the corresponding generic term is used called “Dental Ancillary”

CLASSIFICATION OF DENTAL AUXILIARIES:

REVISED CLASSIFICATION

• NON OPERATING AUXILIARIES

1) Dental surgery assistant

2)Dental secretary/ receptionist

3)Dental laboratory technician

4) Dental health educator

• OPERATING AUXILIARIES

1)School dental nurse (New Zealand type)

2)Dental therapist

3) Dental hygienist

4) Expanded function dental auxiliaries

• NEW TYPES OF DENTAL MANPOWER

1) Dental licentiate

2)Dental aides

3)Community dental health coordinator

4)Oral preventive assistant

NON OPERATING DENTAL AUXILIARY

1)DENTAL SURGERY ASSISTANT

-Dental assistants are an invaluable part of the dental care team.

– Enhancing the efficiency of the dentist in the delivery of oral health care and

– Increasingly influencing the productivity of the dental office through

-Sound management

-Effective communication skills, and

– Promotion of patient education.

HISTORY OF DENTAL ASSISSTANT:

• After the the introduction of anaesthesia in dentistry after 1850 is one of the reasons for dentists requiring the In 1885, Dr. Edmund Kells of New Orleans hired the first woman dental assistant to replace his male “helper”.

• Dr.Kells then realized that the “lady in attendance” could be helpful in office duties, as well as in facilitating dental health care delivery for women.

DUTIES

– Reception of patient.

– Preparation of the patient for any treatment he or she may need.

– Preparation and provision of all necessary facilities, such as mouthwashes, napkins.

– Sterilization care and preparation of instruments.

– Preparation and mixing of restorative materials including tooth filling and impression materials.

– Care of patients after treatment until he or she leaves, including clearing away of instrument and preparation of instruments for reuse.

– Preparation of the surgery for the next patient.

– Presentation of documents to the surgeon for his completion and filling of this.

– Assistance with extra work and processing and mounting of x-rays.

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

– Aftercare of persons who have had general anaesthesia.

2)DENTAL SECRETARY / RECEPTIONIST:

• This is a person who assists the dentist with his secretarial work and patient reception duties.

3)DENTAL LABORATORY TECHNICIAN

• The dental technician, whose main function is the fabrication of appliances, should work according to the prescriptions and under the supervision of the fully qualified dentist.

 Functions

– The casting of models from impressions of patients’ mouths.

– The construction of appliances based on these models from the dentists prescription.

– The treatment of metals and of plastic materials used in construction of these appliances.

– The construction of splints used in faciomaxilliary surgery.

– The construction of orthodontic appliances to the dentist prescription.

– The keeping of dental stores.

DENTURIST

• Denturist is a tem applied to those dental laboratory technicians who are permitted to fabricate denturedirectly for patient without dentist’s prescription

• Introduced in 1883 in Germany.

4)DENTAL HEALTH EDUCATOR

• In few countries duties of some dental surgery assistants have been extended to allow them to carry out certain preventive procedures.

OPERATING AUXILIARY.

1)THE NEW ZEALAND SCHOOL DENTAL NURSE

• The New Zealand school dental nurse plan was introduced in 1921

• During World War I (1914-1918) extensive dental disease were observed in army recruits and dentists were in short supply.

• Hence in 1921 first training school for dental nurse was opened in wellington, New Zealand.

• This school started by Sir Thomas Hunter, a founder of the New Zealand dental association

• In 1923, 29 dental nurses were graduated from the wellington school

• The dental nurse is employed only by the government.

• The dental service offered to children begins at the age of two and one-half years.

• When child reaches the age of thirteen he is discharged from the services of dental nurs

• The Dental Nurse name was retained in Manitoba, and in Saskatchewan and other federal regions, the term Dental Therapist or Saskatchewan dental nurse was used.’
• In United Kingdom, the first operating auxiliaries based in the New Zealand school dental nurse model were graduated in 1962.They are generally known as ‘New Cross’ auxiliaries’ because the one training school in located in the New Cross area of south London.

Functions of School Dental Nurse

• General

• Maintaining a specific group of approximately 500 children in sound dental health and free from dental defects by examining and treating them at six monthly intervals.

• Teaching the principles of oral hygiene, using modern teaching and publicity methods, and gaining the interest and cooperation of the children and their parents in this matter.

• Specific

• Examining patients and charting the dental condition(diagnosis)

• Performing prophylaxis.

• Placing fillings in both permanent and deciduous dentition.

• Extracting teeth under local anesthesia.

• Making topical application of preventive medicaments.

2)DENTAL THERAPIST

• These ancillaries, earlier called dental dressers, were employed in the school dental service in parts of Great Britain.

• Their training and employment were opposed by the dental profession and the scheme was abandoned in 1925.

• Dental therapist is more conserved term than dental nurse as they work under direct supervision dentists .

• They are like school dental nurse but their role is quite different, they are not permitted to diagnose and plan dental care. They are  permitted to work based on the written treatment plan by the dentist.

• The training of therapists is for a period of 2 years including the clinical training.

• They can perform all functions as a school dental nurse, but are not allowed to perform endodontic procedures and interpretation of xrays.

3)DENTAL HYGIENIST

DUTIES

• Scaling and polishing teeth
• Applying flourides and other preventive agents
• Educating patients to practice sound dental habits
• Diagnostic data collection
• Desensitization of teeth after scaling and polishing
• Radiograph
• Bleaching of teeth
• Occlusal splints
• Sealant placements
• Preventive appoinmnets
• Photography
•  Scaling and polishing

EXPANDED FUNCTIONS DENTAL

AUXILIARIES (EFDA)

• The expanded-function dental auxiliary (EFDA) or expanded-duty dental auxiliary (EDDA) is a more recent development in operating auxiliaries in the United States and Canada.

• In 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

• The personnel could be trained to perform the desired services within considerably shorter periods of training than required for dental practitioners.

• One such study was done in the Division of Dental Health of the Philadelphia Department of Public Health; they termed them as ‘Dental Technotherapists’.

• DUTIES UNDERTAKEN BY EXPANDED

FUNCTION DENTAL AUXILIRY

– Applying topical fluorides

– Applying desensitizing agent

– Applying pit and fissure sealants

– Placing, carving and polishing amalgam restoration

– Placing and finishing composite restoration

– Placing and removing matrix band

– Placing and removing rubber dam

– Monitoring nitrous oxide use

– Taking impression for study casts

– Exposing and developing radiographs

– Removing sutures

– Removing and replacing ligature wires on orthodontic

appliances.

• NEW TYPES OF DENTAL AUXILIARIES

1)Dental licentiate

2)Dental aides

DENTAL LICENTIATE

• Dental licentiate is the semi independent operator trained for 2 years to perform.

• Duties undertaken by dental licentiate,

– Oral prophylaxis.

– Cavity preparation and filling of primary and permanent teeth.

– Extraction under local anaesthesia.

– Draining of dental abscesses.

– Treatment of most prevalent diseases of supporting tissues of the teeth.

– Early recognition of more serious dental conditions.

DENTAL AIDE

• They perform duties which include, elementary first aid procedures for the relief of pain, including

– Extraction of teeth under local anaesthesia,

– Control of haemorrhage, and

– Recognition of dental disease important enough tojustify transportation of the patent to a centre where proper dental care is available.

• The formal training extends from 4-6 months, followed by a period of field training under direct and constant supervision.

• FRONTIER AUXILIARIES

Include capable lay people,  nurses & former dental  assistants with minimal training.

 FUNCTIONS:

• Dental prophylaxis
• Dental Health Education
• Relief of pain
•  Referral
• Fluoride Rinse programs
• Simple denture repairs

• DEGREES OF SUPERVISION

• Auxiliaries of all types operate under varying degrees of supervision by dentists

• In 1975, American Dental Association (ADA) defined four degrees of supervision of auxiliaries

as :

– General supervision

– Direct supervision

– Indirect supervision

– Personal supervision

1. General supervision:

– The dentist is not required to be in the dental office when the procedures are being performed by the auxiliary, but has personally diagnosed the condition to be treated, has personally authorized the procedures, and will evaluate the performance of the allied dental

personnel.

2. Indirect supervision:

– The dentist is in dental office, authorizes the procedure and remains in the dental office while the procedures are being performed by the auxiliary.

3. Direct supervision:

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

4. Personal supervision:

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

REFERENCES

1)PETER S ;DENTAL AUXILIARIES;TEXT BOOK OF PREVENTIVE AND COMMUNITY DENTISTRY;5TH EDITION

2)HIREMATH SS; DENTAL AUXILIARIES;TEXT BOOK OF PREVENTIVE AND COMMUNITY DENTISTRY:2ND EDITION