1. DENTAL AUXILIARIES Submitted by Fathima Yasmin
Guided by Dr.Mahmood Moothedath,Dr.Aseela,Dr.Aswathi

2. INDEX -INTRODUCTION -DEFINITION
-CLASSIFICATION; OPERATING AUXILIARIES NON-OPERATING AUXILIARIES; CLINICAL AND LABORATORY -REVISED CLASSIFICATION; NON-OPERATING AUXILLIARIES: DENTAL SURGERY ASSISTANT DENTAL SECRETARY DENTAL LABORATORY TECHNICIAN DENTAL HEALTH EDUCATOR OPERATING AUXILIARIES: SCHOOL DENTAL NURSE DENTAL THERAPIST DENTAL HYGIENIST EXPANDED FUNCTION DENTAL
AUXILIARY

3. Continued
-FRONTIER AUXILIARIES -NEW AUXILIARY TYPE; DENTAL LICENTIATE DENTAL AIDE -DEGREE OF SUPERVISION OF AUXILIARIES -AUXILIARIES IN PUBLIC PROGRAMS -EFFECTS OF AUXILIARIES ON DENTAL EDUCATION -BENEFITS OF USING AUXILIARIES -IMPACT OF AUXILIARIES IN INDIAN SCENARIO -CONCLUSION -REFERENCE

4. INTRODUCTION
The concept of dental team encompasses the various providers of dental care who have different roles, functions, and periods of training and who combine to treat patients
With increasing health consciousness, the demand for dental care increases among the public, there was necessity to make it affordable and available to all.
Inorder to provide cost effective services and satisfy demands, the dedication of some responsibility to suitable trained paraprofessionals become inescapable in the dental field.

5. Continued
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.

6. DEFINITION
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.

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

8. 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 Expanded function
Nurse dental ancillaries

9. DENTAL SURGERY ASSISTANT
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, dental nurse
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

10. Duties continued
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

11. Duties continue
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

12. 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.
Patient is in a fully supine position
The assistant will hand the particular instrument that the dentist need

13. And also perform additional tasks such as retraction, aspiritation...
Continued
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

14. DENTAL SECRETARY/RECEPTIONIST
This is aperson who assist the dentist with his secretarial work and patient reception duties.

15. 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.

16. 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
Thier craft is called denturism
ADA defines denturism as the fitting and dispensing of dentures illegally to the public

17. 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

18. Continued
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.

19. 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

20. 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

21. 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

22. 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

23. 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.
In 1906, she become the first dental hygienist
Dr.Alfred Civilion Fones is considered as the father of dental hygiene

24. Continued
Duration of course was for a period of about seven months.
As per Indian Dental Act of 1948, 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
In India, there are about 5-6 institutions where training is given

25. DUTIES OF THE DENTAL HYGIENIST
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
Resource work in the field of dental health

26. 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

27. 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

28. Four level of training and qualification
Certified dental assistant
Preventive dental assistant
Dental hygienist
Dental hygienist with expanded duties

29. 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

30. Dental hygienist Course duration: 8 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

31. 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

32. 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

33. Dental licentiate: Dental aide Suggested in 1959
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

34. 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

35. Degree of supervision continued.................
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

36. AUXILIARIES IN PUBLIC PROGRAMS
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

37. EFFECTS OF AUXILIARIES ON DENTAL EDUCATION
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

38. Training in expanded auxiliary management (TEAM) pragramme
In the USA,Public Health Service announced a plan to make funds available for teaching dental students to work with, manage and supervise dental health team comprising both operating and non-operating auxiliaries. This is called TEAM programme
Facility for training the appropriate dental school supervisory staff in utilisation of Expanded Function Operating Dental Auxiliary(EFODA) was included in the programme
Some countries have an acute shortage of dentists and have no facilities for training the dentist. Under such situations, measures must be taken to provide even the most rudimentary dental care for the population

39. BENEFITS OF USING AUXILIARIES
While concentrating on treating the consequences of dental disease, provisions can be made to include prevention and educational activities in public dental health programmes.
Dental services can be developed primarily on the basis of preventive approach, both for the community and the individual.
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

40. In general, this result in definite benefits to dentists, patients, auxiliaries and to whole community, financially, psychologically and ethically.
It is the essential that those people who plan and organise dental care services should be aware of the problems that might exist and are able to relate to their own particular situations.
Only with this can better utilisation of dental auxiliary be made and real dental care is available, eventually to all communities in the world

41. IMPACT OF AUXILIARIES IN INDIAN SCENARIO
The only auxiliary personnels who exist in India are the dental surgery assistant, laboratory technician and dental hygienists
The most suitable types of auxiliary for the Indian set up will be school going dental nurse and Expanded Function of Dental Auxiliary(EFODA)
These auxiliaries will not only provide the basic dental care but also play an important role in prevention of dental diseases both for school going children and general public (underprivileged population)

42. Continued
School dental nurse will be extremely useful for lacking care of oral and dental problems among school going children who constitute about 40% of the total population.
Besides this, providing appropriate oral health care to school going children in younger age helps in preparing the children as better patient and development of positive attitude to oral health at a later part of the life. Thus such personnel will provide not only optimal dental care to the community but also enable to do so more economically and efficiently.

43. CONCLUSION
Certain parts of the task require top-level skill and knowledge and in dentistry, these are called professional services. Some other parts of the task require less skill and knowledge. These may safely and advantageously be delegated to auxiliary personnel.
The community benefits from this sort of division of labour are that, training time for professional personnel can be conserved, thereby saving the cost and man power to tackle the enormous untreated disease burden of the society.
These who do receive full training can make their best services available to a larger segment of population.
Hence, the training of dental auxiliaries, not only helps in tackling the major problem of the common dental diseases of the developing countries in particular, but also the philosophy of preventive dentistry can be practiced more efficiently in the countries suffering from financial crisis and lack of professional personnel

44. REFERENCES
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