Dental Manpower PDF

DENTAL MANPOWER CONTENTS 1. INTRODUCTION 2. DENTIST 3. DENTAL AUXILIARIES 4. FRONTIER AUXILIARIES 5. NEW AUXILIARY TYPES 6. DEGREES OF SUPERVISION OF AUXILIARIES 7. DENTAL MANPOWER 8. SUMMARY 9. CONCLUSION 10. REFERENCES INTRODUCTION MANPOWER The supply of dental care available in a given area and t...

DENTAL MANPOWER CONTENTS 1. INTRODUCTION 2. DENTIST 3. DENTAL AUXILIARIES 4. FRONTIER AUXILIARIES 5. NEW AUXILIARY TYPES 6. DEGREES OF SUPERVISION OF AUXILIARIES 7. DENTAL MANPOWER 8. SUMMARY 9. CONCLUSION 10. REFERENCES INTRODUCTION MANPOWER The supply of dental care available in a given area and to a certain extent also the demand for dental care are linked with the number of people in the dental profession and the way they make use of the time. The dentist themselves of course at the most important people to consider but in order to go watch the total output we must also consider the auxiliaries 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. Dental Needs,Resources and Objectives.Dunning INTRODUCTION WHO Definition (1958) -Auxiliary is a technical worker in a certain field with less than full professional training. 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’. -Slack (1960) The duties undertaken by dental ancillaries range from simple tasks such as sorting instruments to relatively complex procedures which form part of the treatment of patients. INTRODUCTION In U.K the corresponding generic term is used called “Dental Ancillary” The word auxiliary means being helpful, subsidiary; whereas ancillary means subservient, subordinate. DENTIST A dentist is a person licensed to practice dentistry under the law of the appropriate state, province, territory, or nation. Qualifications :1. completion of an approved period of professional education in an approved institution. 2. demonstration of competence DENTIST DUTIES They are legally entitled to treat patients independently To prescribe certain drugs To employ and supervise auxiliary personnel. REGISTRATION OF DENTISTS Dentists must be registered Pass the dental written and practical board exams Registered with the PRC DENTAL AUXILLARIES 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. DENTAL AUXILLARIES CLASSIFICATION Revised Classification Slack GL, Burt BA (1981 Dental Auxillaries WHO1967 Operating Non -Operating Operating Non Operating School Dental Nurse Dental Surgey Assistant Dental therapist Dental Secretary Dental Hygienist Lab Technician EFDA Heath Educator Clinical Laboratory DENTAL SURGERY ASSISTANT HISTORY OF DENTAL ASSISSTANT: The introduction of anaesthesia in dentistry after 1850 is one of the reasons for dentists requiring the presence of an dental assistant and to act as a helper one for female patient. In 1885, Dr. Edmund Kells of New Orleans hired the first woman dental assistant to replace his male "helper". This aptly-named "lady in attendance" made it acceptable for a respectable woman to seek dental treatment DENTAL SURGERY ASSISTANT 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. By 1890, he routinely employed women as both chair side and secretarial assistants. In 1921, Juliette A. Southard organized dental assistants into the Educational and Efficiency Society. American Dental Assistants Association (ADAA) DENTAL SURGERY ASSISTANT A curriculum committee was organized in 1930 to develop courses and to provide training By 1943, the ADAA had determined that sound preparation was key to successful dental assisting practice In 1944, the Certification Committee was established to promote standards and to craft a certification examination for dental assistants. The Certifying Board of the ADAA was formed in 1948 Dental Assisting National Board (DANB), joined the National Commission for Health Certifying Agencies in 1979. 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. 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. Dental assistant Chair side dental assistant Dental nurse DENTAL SURGERY ASSISTANT Duties of dental assistant 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 preparation 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 FOUR HANDED DENTISTRY Introduction Principles Basic tenets Motion Economy Zones of Activity Strategies to ensure effective fourhanded dentistry FOUR HANDED DENTISTRY 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. The assistant will hand the particular instrument that the dentist need 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 PRINCIPLES 1. Any sort of operation being done in a seated position. 2. Utilizing the skills if the dental assistant is skilled. 3. Organising every component of the practice. 4. Simplifying all tasks to the maximum. Basic tenets of four-handed dentistry 1. To minimize unnecessary motion, equipment’s must be ergonomically designed. 2. Both the operating team and the patient should be comfortably seated 3. Practice of motion economy should be done. 4. Pre-set cassettes/trays are utilized. 5. The dentist assigns all legally delegable duties to qualified auxiliaries based on the state’s guidelines. 6. Treatment Plan of the patient is designed in advance in a logical sequence. Principles of Motion Economy Motion economy refers to the manner in which human energy can be conserved while performing a task. The objective in all areas of the dental office, clinical, business or laboratory setting,should be to minimize the number and magnitude of motions and conserve energy while working. Classification of Motion Motions can be classified into five categories according to the length of the motion The four zones are: a) Operator’s zone, b) Assistant’s zone, c) Transfer zone, d) Static zone. The operator changes position depending upon the dental arch and tooth being treated. Strategies to ensure effective fourhanded dentistry: a) Teamwork: For effective application of true four handed dentistry each member of the dental team must assume personal as well as team responsibilities. The team must be aware of each other’s needs, recognize the need to reposition the patient and operating team, as necessary, to reduce strain, improve access and visibility, and reduce unnecessary movement by transferring instruments only within the transfer zone. Strategies to ensure effective fourhanded dentistry: B) Strategies for the Operator: For basic dental procedures, a standardised routine must be followed involving a nonverbal signal during exchange of instruments and when necessary a distinct verbal direction to communicate. The dentist/ operator must be willing to accept input from the assistant as it is noted that chair positions need to be adjusted. Strategies to ensure effective fourhanded dentistry: C) Strategies for the Dental Assistant: The clinical assistant must develop a thorough understanding of the procedure, recognize the patient’s needs, anticipate the operator’s need, and recognize any change in the procedure. During the procedure the assistant should be seated as close to the patient as possible with legs parallel to the long axis of the patient’s body. The assistant must be alert to changes in position of the dentist and determine a non verbal signal to indicate to him or her that chair positioning needs to be improved. SIX HANDED DENTISTRY DENTAL SECRETARY/RECEPTIONIST This is a person who assist the dentist with his secretarial work and patient reception duties. DENTAL LABORATORY TECHNICIAN 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. Eligibility-Matriculation,Minimum 15 years ,Medically fit 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 Their craft is called denturism ADA defines denturism as the fitting and dispensing of dentures illegally to the public DENTAL HEALTH EDUCATOR 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. The DHE has three areas of responsibility and activity: patient relations staff relations community-wide education OPERATING AUXILLARIES SCHOOL DENTAL NURSE DENTAL THERAPIST DENTAL HYGIENIST EFDA SCHOOL DENTAL NURSE 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. 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 DUTIES OF SCHOOL DENTAL NURSE 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 DENTAL THERAPIST 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 DENTAL HYGIENIST 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. Dr.Alfred Civilion Fones-father of dental hygiene EXPANDED FUNCTION DENTAL AUXILIARY(EFDA) 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 DUTIES OF EFDA 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 Four level of training and qualification Certified dental assistant Preventive dental assistant Dental hygienist 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: 24 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 FRONTIER AUXILIARIES 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 NEW AUXILIARY TYPES 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 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 DEGREE OF SUPERVISION OF AUXILIARIES 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 SUMMARY A dentist is a person licensed to practice dentistry under the law of the appropriate state, province, territory, or nation 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. 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 WHO CLASSIFICATION 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. 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. This classification is particularly useful in that it draws a distinction between operating and non – operating auxiliaries. SUMMARY REVISED CLASSIFICATION Slack GL, Burt BA (1981) NON OPERATING AUXILIARIES Dental surgery assistant Dental secretary/ receptionist Dental laboratory technician Dental health educator OPERATING AUXILIARIES School dental nurse (New Zealand type) Dental therapist Dental hygienist Expanded function dental auxiliaries NEW TYPES OF DENTAL MANPOWER Dental licentiate Dental aides REFERENCES Preventive and Community Dentistry, Soben Peter(Sixth 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 Yadav S, Rawal G. The current status of dental graduates in India. Pan Afr Med J. 2016;23:22. Published 2016 Feb 1. doi:10.11604/pamj.2016.23.22.7381 Jaiswal, Ashish K.; Srinivas, Pachava; Suresh, Sanikommu (2014). Dental manpower in India: changing trends since 1920. International Dental Journal, 64(4), 213 –218. Dalai DR, Bhaskar DJ, Agali CR, Gupta V, Singh N, Bumb SS. Four Handed Dentistry: An Indispensable Part for Efficient Clinical Practice. Int J Adv Health Sci. 2014; 1(1): 16-20 Vundavalli, Sudhakar (2014). Dental manpower planning in India: current scenario and future projections for the year 2020. International Dental Journal, 64(2), 62–67.