• Degree of Supervision
• Classification of auxiliaries
• Functions of auxiliaries
• Function and Training
• 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
3. • Newer types of auxiliaries
– Dental licentiate
– Dental aides
– Community dental health coordinator
– Oral preventive assistant
– Advanced dental hygiene practitioner
• Evolutionary process of dental health services
• Development of Dental Profession
• Benefits of auxiliaries
• Impact on Indian scenario
• The vision of the dental team is one of various
people in dentistry with different
– Period of training all working together to treat
• 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)
5. • 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.
6. 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’.
• 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
7. • In U.K the corresponding generic term is used
called “Dental Ancillary”
• The word auxiliary means being helpful,
subsidiary; whereas ancillary means subservient,
8. 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
– General supervision
– Direct supervision
– Indirect supervision
– Personal supervision
9. 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 the dentists.
– The dentist is not required to be in the dental office
when the procedures are being performed by the allied
but has personally diagnosed the condition to be
has personally authorized the procedures, and
will evaluate the performance of the allied dental
10. 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.
– The dentist is in the dental office, has personally diagnosed the
condition to be treated, authorizes the procedures and remains
in the dental office while the procedures are being performed
by the allied dental personnel, and will evaluate the
performance of the allied dental personnel.
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
11. CLASSIFICATION OF DENTAL
• Dental auxiliaries may be classified according
To the training they have received,
The task they are expected to undertake, and
The legal restrictions placed upon them.
• While different titles have been given to groups of auxiliaries
classified in this way, terminology is not consistent from one
country to another.
• Therefore, unless standard definitions are provided of what
constitutes a dentist, a dental therapist, or any other dental
health worker, national and international statistics cannot be
comparable and meaningful.
• Standardization of definitions of health worker has been initiated
International Labour Organization and by the conference conducted
by the World Health Organisation in New Delhi in 1967 11
12. 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
b) LABORATORY - a person who assist the professional (dentist) by
carrying out certain technical laboratory procedures.
• 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.
13. REVISED CLASSIFICATION
Slack GL, Burt BA (1981)
NON OPERATING AUXILIARIES
• Dental surgery assistant
• Dental secretary/ receptionist
• Dental laboratory technician
• Dental health educator
• School dental nurse (New Zealand type)
• Dental therapist
• Dental hygienist
• Expanded function dental auxiliaries
NEW TYPES OF DENTAL MANPOWER
• Dental licentiate
• Dental aides
• Community dental health coordinator
• Oral preventive assistant
• Advanced dental hygiene practitioner 13
• A dentist is a person licensed to practice
dentistry under the law of the appropriate
state, province, territory or nation.
16. • These laws ensure that to become licensed, a
prospective dentist must satisfy certain
qualifications such as:
– Completion of an approved period of professional
education in an approved institution.
– Demonstration of competence
– Evidence of satisfactory personal qualities.
• Legally entitled to treat patients independently,
to prescribe certain drugs and to employ and
supervise auxiliary personnel.
• Dentists must be both licensed and registered.
17. DEVELOPMENT OF THE DENTAL
• Dental diseases have always afflicted human health.
• The first written evidence on dentistry is by Pierre
Fauchard in 1728.
• Even the well known dentist G.V. Black had possessed a
formal education of dentistry in just 20 months.
• Baltimore college of dental surgery (1840) was the first
dental college in world. Later known as University of
• First journal of dentistry was ‘The American Journal of
• The first Organization was named ‘The American Society
of Dental Surgeons’.
• The first census was in 1850 in the US which showed a
dentist: population ratio of 1:8000 (compare it with 1900
having a ratio of 1:2562 and in 1980 it was 1:1348). 17
18. DENTAL PROFESSION IN INDIA
• Dr. Rafiuddin Ahmed started the first dental
college in Calcutta in 1920.
• At the time of independence, there were only 2
– Lahore and Bombay, and there were 19 private
institutions such as
– Nair dental college (Bombay) and The Calcutta college.
• Presently, there are about 240 dental colleges in
19. • The World Health Organisation recommends a 1:
7500 dentist to population ratio whereas the
dentist to population ratio in India is as low as
(World Health Organization: Recent advances in oral health. In Technical
Report Series-826. World Health Organization; 1992:1-37.)
• In 2004, India had one dentist for 10,000 persons
in urban areas and about 2.5 lakh persons in rural
(India Ministry of Health and Family Welfare and Dental Council of India. Status of
dental colleges for admission to BDS course. At:http://mohfw.nic.in/Adental.html.)
• Almost three-fourths of the total number of
dentists were clustered in urban areas, which
house only one-fourth of the country's population.
(Tandon S: Challenges to the Oral Health Workforce in India.
J Dent Education 2004, 68:29-33.)
20. Non – Operating Auxiliary.
• Dental surgery assistant
• Dental secretary / receptionist
• Dental laboratory technician
• Dental health educator
21. 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.
22. 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
helperone for female patient.
• In 1885, Dr. Edmund Kells of New Orleans hired
the first woman dental assistant to replace his
• He has generally been credited as the founder of
the dental assisting profession.
• This aptly-named "lady in attendance" made it
acceptable for a respectable woman to seek
dental treatment without her husband or a
maiden aunt present in the office. 22
23. • Dr. Kells then realized that the "lady in
attendance" could be helpful in office duties, as
well as in facilitating dental health care delivery
• By 1890, he routinely employed women as both
chair side and secretarial assistants. Although
subsequent years brought many women into
the dental practice for treatment, the
employment of women as dental assistants was
still not widely accepted by many dentists.
24. • It was thought that "the female's very form and structure
unfits her for the duties of dentistry" and "women's
inferiority and lack of mechanicability" caused her to be
relegated to the background of dental health care delivery.
Many years passed before dentists realized the true worth
of and potential scope of practice of the "lady in
• In 1921, Juliette A. Southard organized dental assistants
into the Educational and Efficiency Society.
• This organization later became the American Dental
Assistants Association (ADAA).
• A curriculum committee was organized in 1930 to develop
courses and to provide training in writing educational
guidelines for dental assistants.
• By 1943, the ADAA had determined that sound
preparation was key to successful dental assisting practice.
25. • A high school diploma had to be earned before
membership could be granted in this organization.
• 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
to credential dental assistants who passed the
• This board, now known as the Dental Assisting National
Board (DANB), joined the National Commission for
Health Certifying Agencies in 1979.
26. DUTIES ASSIGNED TO DENTAL ASSISTANTS
• The expert committee on auxiliary dental personnel of the World
Health Organisation lists following 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,
– Sterilization care and preparation of instruments.
– Preparation and mixing of restorative materials including tooth filling and
– 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
– Assistance with extra work and processing and mounting of x-rays.
– Instruction of the patient, where necessary, in the correct use of the
– Aftercare of persons who have had general anaesthesia.
• (Auxiliary Dental Personnel. World health Organization. Technical
report series. No. 163) 26
27. TRAINING OF DENTAL ASSISTANT
• Is done to assist the dentist by providing an extra pair of hands to
enable him to work more effectively and speedily.
– Length of training
• Is directly related to the degree of development of the area.
• In developed areas where
– The dentist have been trained in efficient use of chair side assistants.
– Areas where there is an adequate number of suitable recruits.
• The candidates are expected to have had a secondary education and a
formal course of training of one year’s duration is required.
• The formal course should include :
– The importance of ethical behavior
– Principles and methods of sterilization
– Preparation of filling and impression materials
– Care and maintenance of instruments and light equipments
– First aid
– Basic knowledge of dental nomenclature
– The use and compilation of appropriate documents and records.
• (Auxiliary Dental Personnel. World health Organization. Technical
report series. No. 163) 27
28. • There is still great variability in the utilization of
dental assistance from office to office and from
country to country.
• Some dental assistant are in fact merely
receptionists with a added duty of sterilising
instruments and replacing them in a cabinet.
• Other dental assistant relived of receptionist
duties stay constantly on chair side, called as
chair side dental assistant or dental surgery
29. • Four Handed Dentistry is given to the art of
seating both the dentist and dental assistant
in such a way that both are within easy reach
of the patient’s mouth.
• Perform additional tasks such as retraction or
• The dentist can thus keep his hands and eyes
in the field of operation and work with less
fatigue and greater efficiency.
30. • RESULTS TO BE EXPECTED WITH THE HELP OF DENTAL
1. More dental-care services can be provided through use of a trained assistant
because she conserves the dentist's time by performing the numerous tasks
incident to routine dental treatment, which the dentist would otherwise
have to perform himself.
2. Quality of services is also improved because the dentist is under less physical
and mental strain.
3. Better control of the patient is possible through the influence of an assistant.
4. The necessary armamentarium is as near as the dentist's hand. He can work
from the seated position during the entire treatment procedure, and be less
5. Provision of more services results in greater patient turn-over, which brings
6. The resultant increase in the number of patients treated, reduces the
incidence of caries through early detection and treatment, and makes
available to the dentist more time for providing preventive treatment.
7. Also, the appointment periods are shorter, resulting in less pain and
discomfort to the patient.
31. DENTAL SECRETARY / RECEPTIONIST:
• This is a person who assists the dentist with his secretarial
work and patient reception duties.
• 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
• Dental laboratory technology is both a science and an art.
Since each dental patient's needs are different, the duties
of a dental laboratory technician are comprehensive and
• Although dental technicians seldom work directly with
patients, except under the direction of a licensed dentist,
they are valuable members of the dental care team.
32. History of dental laboratory technician
• In the past the dentist himself undertook on his own
laboratory work. Later due to increased burden of patient,
dentists started teaching laboratory work to technician and
later retaining him as employer in office.
• Under these conditions the quality of training varied with
the ability of the dentists.
• In many countries, like India and US, course for dental
laboratory technician is for 2 years while in some country,
like United Kingdom it is for 3 to 5 years on part time basis.
• Dental laboratory technician may be employed by
– dentists in private or public health practices; they may be
– self employed and accept work from dentists in the area or
– may be employed by commercial laboratory established by
other dental technicians
33. • Functions of the dental technician would include:
– The casting of models from impressions of patients’ mouths.
– The construction of appliances based on these models from the
– 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
– The keeping of dental stores.
• The expert committee emphasize the dental technician
should not take impressions of the mouth and that he
should not have contacts with patients.
• (Auxiliary Dental Personnel. World health Organization.
Technical report series. No. 163)
34. Training of the dental technician
• Candidates for training should have a standard of
basic education sufficient to support their technical
• This basic education should include secondary
• Training period of the dental technician
• The World Health Organisation Expert Committee considers
3 years of training, desirable.
• This should not be less than two years and if possible should
probably be extended over a period of three years.
• The course should be followed by a period of practical work
in a laboratory before the trainee receives license.
35. • Curriculum
• Formal training should include theoretical education and
• Following elements should be included in the curriculum:
Instructions in basic principal of chemistry and physics that relate to
the needs of dental laboratory technicians.
Instruction in the use and care of tools, implements and equipment
that are important to the dental laboratory technician.
Instruction in those elementary principals of the biological sciences
that will enable dental laboratory technician to understand his
functions as an auxiliary to the dentist.
Instruction to those techniques that are used in fabrication of
Crown and bridge work.
Any other appliances needed by the appliances.
36. Instruction and responsibility of dental laboratory
technician as a member of the dental health team
including information about ethics
Extensive information about dental materials and
experience in use of materials in fabricating appliances.
Information about the role that the dentist plays in
providing dental health care, so that dental laboratory
technician may in turn understand the relation of his
responsibility to that of the dentist.
• In countries where it is not at first possible to institute
courses of formal nature in institutions, it is recognized that
dental laboratory technicians may be trained through the
medium of apprenticeships, although this admittedly is not
efficient as formal educational programs.
• When apprenticeship methods are used, they should be
conducted only by fully qualified dental laboratory
• Denturist is a tem applied to those dental laboratory
technicians who are permitted to fabricate denture
directly for patient without dentist’s prescription
• Dental services were included in the health plan of
one of the first systems of health insurance in the
world, a system introduced in 1883 in Germany.
• Because of shortage of dental personnel, legislation
was passed in 1914 in German Imperial Diet
permitting dental laboratory technician to work
directly with the public in supplying complete
• But later quality of work declined; hence in March
1952 Federal Republic of Germany enacted
legislation confining the practice of dentistry to fully
trained and qualified dentists. 37
38. • During same time due to shortage of trained dental
technician in Canada, many technicians from Germany
moved to Canada and they began working directly with
• They organised a denturist society across Canada and
began a legislative battle to gain professional
recognition and legal status.
• Denturists in the United States, encouraged by the
successes in Canada, began to organize similar efforts
in the various state legislations to legalize denturism.
39. • First denturist type legislation was filled in Illinois in
1955. In the period 1977-1980, denturism became
legal in Maine, Arizona, Oregon and Colorado.
• The arguments over denturism have generated great
controversy in many countries where denturism
legislation has been introduced.
• DENTURISM has been defined by the American Dental
Association as "the unqualified and illegal practice of
• (Waterman GE; Effective use of dental assistant; public health
report; Vol. 67, No. 4, April 1952; 390-394.)
40. • A "denturist," according to the ADA, is "a person who is
educationally unqualified and not licensed for the
necessary protection of the public, to practice dentistry in
any form on the public".
• On the other hand, the National Denturists Association, the
organization of U.S. dental laboratory technicians seeking
to be licensed independently, describes a denturist as "a
highly skilled laboratory technician who has devoted his
lifetime to the making of full and partial dentures".
• The divergence in these two definitions reflects the
controversy surrounding the concept of denturism and its
• (Flanders RA; The denturism initiative; Public health reports;
Sept-Oct 1981; Vol 96, No 5; 410-417.)
41. • Denturists are now practising in many
developed as well as underdeveloped
• Reason behind denturism in developed
countries like United States,
– low cost of denture to needy people who are old,
– no provision for denture in Medicare;
– people think dentists are middle person for giving
42. DENTAL HEALTH EDUCATOR
• In few 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 the auxiliaries are allowed to conduct
fluoride mouth rinsing programmes to groups of
• In the United Kingdom, a small group of dental health
education officers (who may not be first trained as
dental surgery assistant) are employed as number of
local authorities and practices to educate in matter of
• In Finland personnel with greatest oral health
education (OHE) work load are dental assistant and
43. • They teach modern theories of health education,
emphasizing on the factors that strengthen self
confidence and the power of the patient to
decide for her/himself, rather than merely
presenting him/her with information.
• The possibilities and interest of patient are
considered to be of primary importance.
• The most important mean of promoting oral
health were the model of the parents,
encouraging and strengthening self confidence
and removing dental anxiety.
45. THE NEW ZEALAND SCHOOL
• 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 came into being at the urge of Sir Thomas Hunter, a
founder of the New Zealand dental association and a pioneer in the
establishment of a dental school in New Zealand.
• Hunter knew of the success of the dental hygienist in United States
and saw in these women means of correcting the deplorable defects
he saw in the teeth of New Zealand children.
• 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
• When child reaches the age of thirteen he is discharged from the
services of dental nurse.
46. Functions of School Dental Nurse
• 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.
• Examining patients and charting the dental condition
• Performing prophylaxis.
• Placing fillings in both permanent and deciduous dentition.
• Extracting teeth under local anesthesia.
• Making topical application of preventive medicaments.
47. • Recognizing malocclusion and lesions whose treatment is
beyond her scope, and referring them to a dentist.
• Carrying out routine examination and treatment of the
children in her group.
• Giving special attention to teaching the principles of oral
hygiene and prevention of dental disease not only to
individual children but also to school classes, teachers,
women’s organization, parent – teacher association and
48. • Training of nurse
The object of training should be to produce personnel who are
capable of maintaining specific groups of preschool and school
children in a state of sound dental health by means of treatment in a
restricted field given at regular and frequent intervals (normally every
six months) and by instructions in the principles of oral hygiene.
School dental nurse work under the direction and control of dental
• Training period of nurses
A minimum of two calendar years
• Curriculum of nurses
Special instructions in the principle of teaching and public speaking,
visual education, and the preparation of models and posters for
The encouragement to develop confidence and initiative in this field
Instruction in the history of dentistry, the history and ethics of
nursing, and the role of various organizations that are concerned with
the promotion of child health.
Instruction in the use, care and repair of instruments and equipment.
49. • Work of dental nurse is supervised by the senior dental
officer. One supervising dental officer is allocated to 50
nurses, so nurses function with high degree of
• Percentage of utilization of children’s dentals service is
almost 98% of the primary and intermediate school
population and 64% of preschool children.
• After many years of steady growth, staffing saturation,
reduction in need of restorative treatment due to
widespread of fluoridation; the school dental nurse
program in New Zealand is now in the process of
• (Puder EE. THE NEW ZEALAND DENTAL NURSE. American Journal of
Public Health.1970 (60); 7:1259)
50. • The education of the dental nurse is an intensive
two-year post-high school course, during which
time she is salaried by government.
• Upon graduation, her status changes from
student dental nurse to school dental nurse and
she then serves her country in this capacity.
• There are no dental nurses engaged in any area of
service other than the School Dental Service.
• (Puder EE. THE NEW ZEALAND DENTAL NURSE. American
Journal of Public Health.1970 (60); 7:1259)
51. SCHOOL DENTAL NURSE PROGRAMS
IN OTHER COUNTRIES
• The New Zealand school dental nurse plan has
attracted tremendous attention in dental circle all over
the world. Many countries has adopted same concept
or modified according to local environment.
• New Zealand program is expanded well into Southeast
Asia under support of world Health Organisation and
Colombo Plan, which includes many countries such as
Ceylon, Malaya, North Borno, Thailand, Indonesia,
Hong Kong, New Guinea, Ghana, Australia and England.
• Canada imported New Zealand Dental Nurse model
since 1971, trained at the community college level.
52. • The Dental Nurse name was retained in Manitoba, and in
Saskatchewan and other federal regions,
– the term Dental Therapist or Saskatchewan dental nurse was
– Both were trained to provide emergency, preventive and
restorative care to children, but Dental therapists held expanded
clinical regimen, also providing emergency care to adults.
• 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.
• (Puder EE. THE NEW ZEALAND DENTAL NURSE. American
Journal of Public Health.1970 (60); 7:1259)
53. DENTAL THERAPIST
• These ancillaries, earlier called dental dressers, were
employed in the school dental service in parts of Great
• Their training and employment were opposed by the
dental profession and the scheme was abandoned in
• The scheme was again introduced in 1960 in response
to a shortage of dental manpower in the dental
services and dental therapists have always been
employed almost entirely within these existing services
and cannot be employed in the general dental services.
• Dental therapists were formally established as a class
of auxiliary dental worker by regulations made in 1963.
54. • Dental therapist is more conserved term than dental nurse as they
work under direct supervision dentists .
• Level of job satisfaction in dental therapist in developed countries is
more than underdeveloped countries because system of
remuneration, the characteristics of the working environment, and
the type of service in which an individual works all exert an influence
upon the individual experience and their working life.
• Dental therapists in Canadian armed forces are permitted to organize
and conduct dental inspections and to categorize patterns into
• To meet the emerging crisis in the workforce, in 1995 an American
Dental Association task force recommended a significant expansion of
the dental team.
• They considered New Zealand school dental nurse and Canada’s
dental therapist model.
• In 2001 few Alaskan students were sent to New Zealand for training.
After returning back they were recruited to Community Health Aide
(CHA) program as paediatric oral health therapists.
55. • Person who is permitted to carry out certain specified preventive
and treatment procedures on the prescription of a dentist including
the preparation of cavities and restoration of teeth.
• 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
• The training of therapists is for a period of 2 years including the
• They can perform all functions as a school dental nurse, but are not
allowed to perform endodontic procedures and interpretation of x-
• In some countries, school dental nurse and dental therapists are
allowed to perform only preventive work.
57. Dental Hygienist
Dr.Alfred Civilion Fones
Concept in early 20th century
Fones Clinic in Bridge port.
Worlds first Oral Hygiene
Irene newman receive
first dental hygiene
58. DUTIES ASSIGNED TO DENTAL
• Scaling and polishing
• Applying fluorides, and
• Educating patients to
practice sound dental
• Diagnostic data
• Desensitization of
teeth after scaling
• Bleaching of teeth
• Occlusal splints
• Sealant placement
59. • Dental hygienists are well-educated
• In late 1970’s, the American Dental Hygiene
Association began to support alternative
practice methods that would allow the dental
hygienist to become the primary provider of
preventive services in order to meet the
health care needs of the public in accordance
with state dental and dental hygiene practice
61. • Three states of U.S (California,Coloardo and
• CALIFORNIA RDHPA
• 3years of clinical experience Successful completion
of 150 hrs course
oral prophylaxis, root planing, applying pit and fissure sealants, charting
and examination of soft tissue under supervision of dentist.
Bachelors degree or its
62. • Colorado has no restrictions on hygiene
practice and a dental hygienist may be an
owner, but these practices must have an
agreement with a dentist to provide direct
supervision for local anaesthesia and general
supervision for X-rays.
• New Mexico allows dental hygienists to
engage in collaborative practice based on
written agreement with one or more
63. • ROLE OF DENTAL HYGIENIST AS DENTAL
HYGIENE PUBLIC HEALTH
• Fales HM (1958) suggested three levels of
competence within the groups of dental hygienist
working in public health;
– the certificate dental hygienist,
– the dental hygienist with bachelor’s degree and
– the dental hygienists with graduate training in public
health beyond the bachelor’s degree.
• (Fales HM.The potential role of the dental hygienist in public health
programs. American Journal of Public Health Dentistry 1958(48);8:1054-7)
64. • A certified dental hygienist has
two years of technical training in dental hygiene
state board license, and
Is with or without experience.
• This classification of dental hygienist is
primarily equipped to perform in the service
area of the public health program.
• (Fales HM.The potential role of the dental hygienist in public health programs. American
Journal of Public Health Dentistry 1958(48);8:1054-7)
65. • Degree Dental Hygienist with Graduate
Training in Public Health (M.P.H.)
• Dental hygienists in public health positions use
a variety of skills in implementing community
oral health programs that have positive effect
on their communities.
• Most public health jobs require a combination
of skills defined in multiple roles.
66. Logue S, Geurink KV (2005) has enumerated following possible role that
dental hygienist can play in public health.
SERVICE PROVIDERS / CLINICIAN
• The public health dental hygienist provides clinical
services to a targeted population, including assessment of
oral health conditions and preventive care.
• Topical and systemic fluorides, dental sealants, and
fluoride varnishes are preventive therapies to be
considered for clinical care in public health setting.
67. HEALTH EDUCATOR / WELLNESS PROMOTOR
• The community dental health educator must reinforce
the relationship of oral health to total health.
• Public health dental hygienist can participate in
networking with other health professional such as
dentists, physician, dental nurses and public health
68. CONSULTANT / RESOURCE PERSON
• A resource person or as consultant for dental
information and provide technical assistance at the
local, state or federal level.
CONSUMER ADVOCATE / CHANGE AGENT
• As a dental professional, the hygienists can be a leader
for the consumer and can be asked to be a vocal
advocate for oral health.
• As a researcher, a dental hygienist uses scientific
methods and knowledge to identify and purse a specific
area of interest.
• Dental hygienists employed in the research arena work
in setting that vary from state health department to
universities to private industry.
70. TRAINING OF DENTAL HYGIENIST
Dual role an auxiliary to the dentist in private
practice or as a member of public health team
• Training period
– 2 to 4 years
– It is thought that a minimum period of one calendar
year would be appropriate for countries willing to
introduce this type of personnel into their health
71. • Curriculum of Dental hygienist
– Basic information on the structure and functions
of human body, with emphasis on oral cavity.
– A special study of masticatory apparatus, including
its supporting structures and the macroscopic and
microscopic aspects of teeth.
– Basic principles of chemistry and bacteriology to
serve as a foundation for the understanding of the
causation of dental caries, and a study of its
prevention and control.
72. Topical application of medicaments
Study of the main chemical substances
Dental health education methods and
Most common diseases of the oral cavity
Instruction of the patient at the chair
73. EXPANDED FUNCTIONS DENTAL
• 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
74. • Program - 1921 in response to a high incidence
of dental disease and the inability of existing
dental manpower to provide the needed
• In 1960, the American Dental Association
advocated careful examination of the values of
delegating to expanded functioning personnel
those duties which were reversible (i.e., did not
include the cutting of soft and hard tissues)
75. • Coupled with then perceived dental
manpower shortage, this statement led to a
review of the educational requirements,
productivity and quality of services by
expanded duty personnel.
• The personnel could be trained to perform the
desired services within considerably shorter
periods of training than required for dental
76. • One such study was done in the Division of
Dental Health of the Philadelphia Department
of Public Health; they termed them as ‘Dental
• The first large scale service application of the
expanded duty principle were made in
They were called “Techno-Therapists”.
77. Placement and removal of
removal of matrices
Insertion of calcium
hydroxide and/or other
liners and cement bases
carving of amalgam
Finishing and polishing of
developing and mounting
Place silicate and plastic
Contour stainless steel
crowns for full coverage
Take full mouth and
The initial duties of the technotherapists consisted of the following:
(Soricelli DA; Implementation of the delivery of dental services by auxiliaries-the Philadelphia
experience; AJPH, 1972, Vol.62, No. 8; 1077-1087.) 77
78. • 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
79. NEW TYPES OF DENTAL AUXILIARIES
Community dental health coordinator
Oral preventive assistant
Advanced dental hygiene practitioner
80. • NEW TYPES OF DENTAL AUXILIARIES
Some countries have an acute dentist
shortage and have no facilities for training
In 1958, the expert committee auxiliary dental
personnel of the World Health Organisation
suggest two new types of dental auxiliary for
81. • To address oral health care workforce
concerns, several efforts are under way that
would expand the workforce by incorporating
new models of care as
• Community dental health co-ordinator
• Oral preventive assistant
• Advanced dental hygiene practitioner
82. 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
– 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.
83. DENTAL AIDE
• They perform duties which include, elementary
first aid procedures for the relief of pain,
– Extraction of teeth under local anaesthesia,
– Control of haemorrhage, and
– Recognition of dental disease important enough to
justify 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.
84. COMMUNITY DENTAL HEALTH
• To be recruited from within their own distinct
communities, Community Dental Health Coordinators
(CDHCs) will help the underserved within the community
to navigate the health care delivery system, breaking
down barriers to care and serving as patient advocates,
facilitators and motivators.
• Work under a dentist’s supervision in health and
community settings such as schools and senior citizen
centres, Head Start programs and other public health
• Trained to promote oral health and
to provide the most basic preventive services
85. • They will not diagnose disease, nor will they
perform any irreversible procedures.
• Developed in two phases.
Phase 1- development of an 18-month training
program has been completed.
Phase 2- involves pilot training programs at three
sites: one Native American, one urban and one
86. ORAL PREVENTIVE ASSISTANT
Oral Preventive Assistant (OPA) workforce model is
designed to foster an expanded preventive
capability within the dental team by providing
certain basic preventive services and freeing
dentists and dental hygienists to concentrate on
patients with more complex needs.
• OPAs will provide patients with oral health
education and information —
– Coronal polishing for all patients and
– Scaling for patients with plaque-induced gingivitis -
contingent on state regulations.
87. ADVANCED DENTAL HYGIENE PRACTITIONER
• In November 2004, (ADHA) designed model with
intention to provide primary oral health care services
to patients who are medically compromised, children,
adolescents and geriatric populations.
– They termed them as Advanced Dental Hygiene
– The ADHPs would practice in a variety of settings such as
rural clinics and other institutions where they will
provide basic oral health care to underserved and
• It is intended that the ADHP will be one of the
comprehensive health care team members who will
identify and make appropriate referrals for those in
need of more comprehensive dental services
88. • The scope of practice includes but is not limited to the
– Health education, counselling, and health promotion;
– Diagnosis, treatment, and referral of oral diseases and conditions
within a multidisciplinary care team;
– Cavity preparation;
– Palliative therapy;
– Atraumatic restorative therapy;
– Pain management strategies;
– Nutritional interventions;
– Prescription writing for select medications;
– Evaluation of health promotion and disease prevention programs
for specific populations;
– Case management; and
– Consultation/collaboratation with other health professionals
89. The Evolutionary Process Of Dental
• Type of personnel involved directly or indirectly
in rendering dental services can be classified
into three groups according to the level of their
– Professional personnel (qualified practitioners and
– Subsidiary, or sub-professional, personnel (auxiliary
– Non-professional (unqualified practitioner,
90. • Five evolutionary stages are identified in the
field of dental health care.
• Stage I - Undifferentiated occupation
• Diseases of teeth are usually abandoned to their
own courses. Toothaches and infections are treated
with folk medicines. With the development of public
health physicians, nurses, priest and nuns working in
isolated villages may have dental forceps and
anesthetics to extract teeth in emergency cases.
• Stage II - Differentiated occupation
• Some individuals are entirely devoted to practice of
dentistry (indigenous practitioners) without any type
of formal training or qualifications. The necessary
skills are required under an apprenticeship system.
91. • Stage III - Initial professionalism
• Formal training with a duration of one to two years are
organized by dental practitioners, who are united as a
group or a guild
• Before admission to the profession, candidates have to
meet requirements imposed by guild
• The group of persons practicing dentistry takes on a
formal character and a dental profession comes into
92. • Stage IV
– Intermediate professionalism
• Independent dental schools are established at the
• Dental courses are increased in length(3 – 6 Years)
• The minimum requirement for admission is complete
• Weaknesses in the law or in its enforcement may still
permit unqualified person to practice.
• The utilization of certain types of auxiliary personnel
such as chair side assistance and laboratory technician,
becomes firmly established.
• Courses of training and regulation are established by the
profession for its auxiliary.
93. • Stage V
– Advanced professionalism
• Dentistry acquires full recognition as a health
• Dental education becomes more balanced, with an
increasing emphasiz laid on the biological sciences.
• Post graduate dental education is developed and the
number of dental specialities increases.
• Dentistry becomes strongly organized and
• Dental practice by unqualified personnel disappears.
94. BENEFITS OF AUXILIARIES
• With rapid population growth and increasing
demand for dental care, more and more
dentists are required. But this is an expensive
• Hence training an auxiliary is more economical,
less time consuming and fewer burdens to
• Results in definite benefits to dentists, patients,
auxiliaries and to whole community, financially,
95. I IMPACT ON INDIAN SCENARIO
• There exists a serious maldistribution of the dental
professionals with nearly 75% dentists practicing in
urban areas catering to 25% population.
• Unfortunately, only auxiliary personnel who exist in
India are dental surgery assistant, laboratory
technician, dental hygienists and ethically.
• They have to undergo a training of 2 years in
institutions which have been recognized by
Ministry of Health; Government of India and
certificate course recognized by the Dental Council
96. • The most suitable types for Indian set-up will
be school going dental nurse and EFDA
• They can play a major role not only in
providing basic dental care but also in
prevention of dental diseases both for
children and general underprivileged
97. International Dental Journal, April, 2014. 10.1111/idj.12063
Dental manpower planning in India: current scenario and future
projections for the year 2020
• The output of qualified dentists has increased
substantially over last decade and at present there
are over 117,825 dentists working in India.
Although India has a dentist to population ratio of
1:10,271, the newly graduating dentists find it
difficult to survive in the private sector.
• At present less than approximately 5% graduated
dentists are working in the Government sector.
98. • If the present situation continues there will be
more than one lakh dentists over supply by
the year 2020.
• Continuation of the current situation will lead
to wastage of highly trained dental manpower
and create a threat to the professional
integrity of the dentists.
99. Demographics & Current Scenario with
Respect to Dentists, Dental Institutions
& Dental Practices in India.
N. K Ahuja. Renu Parmar
Indian Journal of Dental Sciences.
101. Utilization of dental care: An Indian outlook
Gambhir RS, Brar P, Singh G, Sofat A, Kakar H.J Nat Sci Biol Med. 2013 Jul-Dec;
Various factors influencing utilization of dental services
103. Vashisth S, Gupta N, Bansal M, Rao NC. Utilization of
services rendered in dental outreach programs in rural
areas of Haryana.
Contemp Clin Dent. 2012;3:164–6.
• A retrospective study was conducted to evaluate the
type of patients, disease pattern, and services rendered
in dental outreach programs in rural areas of Haryana,
• A total of 1371 individuals attended the outreach
program seeking the treatment.
• Results - indicated that utilization of dental services was
found to be more in females than in males.
• The utilization of dental services was found to be
influenced by the socio-demographic characteristics of
the population like age, education, occupation, etc.,
• Conclusion: That there was need to motivate people
giving them information but paying attention to the
individual reasons which restricted their behavior. 103
104. Goel P, Singh K, Kaur A, Verma M. Oral healthcare for
elderly: Identifying the needs and feasible strategies for
service provision. Indian J Dent Res. 2006;17:11–21
• A three-phase survey was conducted in Delhi in
2003 by Maulana Azad Dental College and Hospital and
supported by the Government of India WHO
• Objective = To identify the oral health practices
and patterns of utilization of dental services, to
assess oral health status and treatment needs of
the elderly population
• To test alternate strategies for controlling oral
health problems among the elderly.
105. • The rural areas of Delhi were included. Most of
the subjects (80%) reported availability of
dental services in their area, of which a major
proportion was being provided by the private
• One-fifth of the subjects - dental problems
• 60% of these visited a dentist to avail dental
• Reasons given by the subjects as barriers to
accessing oral health care were related to lack
of priority for oral health (attitudes) and their
dependent status (non-ambulatory/disabled
• 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
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