1. DENTAL AUXILIARIES Hassan M. Alnuaimy Msc orthodontics

2.  A dental auxiliary or ancillary is a person who is given responsibility by a dentist so that he/she can help the dentist render dental care, but who is not himself or herself qualified with a dental degree.

3.  These new paraprofessionals recieve a less rigorous training of a shorter duration compared to the dentist.  They were expected to perform well demarcated tasks efficiently  Dental auxiliary is a generic term for all persons who assist the dentist in training the patients  In Britain,they have been known as Dental Ancillaries.

4.  WHO Classification 1) Non-operating auxiliaries Clinical laboratory (Assist the dentist in his ( Assist the professional clinical work ) in technical laboratory procedures)

5.  Revised classification 1) Non- operating ancillaries: Dental surgery Dental secretary/ Dental laboratory Dental health Assistant receptionist technician educator 2) operating ancillaries: School dental Dental therapist Dental hygienist Dental Expanded Nurse function ancillaries

6.  Non operating auxiliary  Assist the dentist or dental hygienist in treating patients  Not legally permitted to treat patient independently  Also called as dental assistant,chair side dental assistant, clinical auxiliary. Duties of dental assistant  Reception of the patient  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 preperation of instruments

7.  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

8.  Presentation of documents to the surgeon for his completion and filling of these  Assistancce with X-ray work and the processing and mounting of X-rays  Instructions of patient, where necessary, in the correct use of tooth brush  Aftercare of persons who have had general anaesthesia

9.  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.  Patient is in a fully supine position  The assistant will hand the particular instrument that the dentist need

10.  And also perform 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

11.  This is aperson who assist the dentist with his secretarial work and patient reception duties.

12.  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, in UK 3-5 years.  Duties include the laboratory part of: 1. Prothetic work 2. Orthodontic appliances 3. Crown and bridge. 4. Implants.

13. 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 are licensed/registered  ADA defines denturism as the fitting and dispensing of dentures illegally to the public

14.  This is the person who instructs in the prevention of dental disease and who may be permitted to apply preventive agents intraorally

15.  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. They are not allowed to undertake any intraoral procedures.

16.  Dental nurse scheme was established in New zealand in 1921 due to the extensive dental disease found in army recruits during first World war.  The training extends to over a period of 2 years to cover both the reversible and irreversible procedures

17.  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

18.  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

19. 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

20.  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.  In 1906, she become the first dental hygienist  Dr.Alfred Civilion Fones is considered as the father of dental hygiene

21.  Duration of course was for a period of about seven months.  A dental hygienist means a person not being a dentist or a medical practitioner, who scales, cleans or polishes teeth or give instructions in dental hygiene

22.  Cleaning of mouth and teeth with particular attention to calculus and stains  Topical application of Fluorides, sealants and other prophylactic solutions  Screening for preliminary examination of patients as individuals or in groups, such as school children or industrial employees, so that they may be referred to dentists for treatment  Instruction in oral hygiene

23.  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

24.  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

25.  The expert committee on Auxiliary Dental Personnel of the WHO has suggested two new types of dental auxiliaries: 1) Dental licentiate 2) Dental aide

26. Dental licentiate :  Semi-dependent operator  Trained for 2 years  Duties: -Dental prophylaxis -Cavity preparation and filling of the primary and permanent teeth -Extractions under local anaesthesia -Drainage of dental abcesses -Treatment of the most prevalent diseases of supporting tissues of the teeth -Early recognition of more serious dental conditions 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

27.  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

28. 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

29.  Auxiliaries based programs have long been the backbone of public dental care in some countries  The oldest and best known is the New Zealand School dental nurse plan,introduced in 1921

30.  As dental auxiliaries came to be accepted more and more by the dental profession, their numbers increased and individual dentists had to carry a greater responsibility for them.  Accordingly, it was realised in some countries that dental students should be trained to work with auxiliaries and begin to accept responsibility for them at an early stage in their undergraduate careers  With this, in 1961, the US public health service established dental auxiliaries utilisation (DAU)programme,which initiated the training of dental students in modern methods of working with dental surgery assistants and also the practice of four-handed dentistry

31.  Educational benefits: While concentrating on treating the consequences of dental disease, provisions can be made to include prevention and educational activities in public dental health programmes.  Preventive benefits: Dental services can be developed primarily on the basis of preventive approach, both for the community and the individual.  Economical benefits: With rapid population growth and increasing demand for dental care, more and more dentists are required, But unfortunately, this is an expensive process. Hence training an auxiliary is more economical, less time consuming and fewer burdens to the society  In general, this result in definite benefits to dentists, patients, auxiliaries and to whole community, financially, psychologically and ethically.

32.  Preventive and Community Dentistry, Soben Peter(third 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