DENTAL AUXILIARY

AMRITA SCHOOL OF DENTISTRY

1. DENTAL AUXILIARIES

2. 2 CONTENTS Introduction Classification Operating Auxiliaries Non- operating Auxiliaries Frontier Auxiliary Degrees of Supervision

3. 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 qualifies with a dental degree. DEFINITION 3

4. NON-OPERATING AUXILIARIES 1 .Clinical Auxiliary: This is a person who assists the professional in his clinical work but does not carry out any independent procedures in the oral cavity. 2. Laboratory Auxiliary: This is a person who assists the professional 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 CLASSIFICATION (WHO,1967) 4

5. Revised classification: Non operating ancillaries: Dental surgery assistant Dental secretary/ receptionist Dental laboratory technician Dental health educator Operating ancillaries School dental nurse Dental therapist Dental hygienist Expanded function dental ancillaries 5

6. Dental Surgery Assistant: Is a person who assists the dentist with his clinical work but does not independently carry out any procedures in mouth. Functions: Smooth running of the clinical area. Management of instruments, equipments and materials, including cleansing, sterilizing and recycling. Supplies instruments to the dentist at chairside as needed. NON OPERATING ANCILLARIES 6

7. Dental Laboratory Technician: Is a non operating auxiliary who fulfils the prescriptions provided by dentist regarding the extra oral constructions and repair of oral appliances and bridge work. He undertakes many mechanical tasks like casting of models from impressions made by the dentist, Include the fabrication of dentures, splints, orthodontic appliances, inlays and special trays 7

8. Denturists: Is a term applied to those dental laboratory technicians who are permitted to fabricate dentures directly for patients without a dentist’s prescription. Several countries (Tasmania, Denmark) have allowed laboratory technicians to work directly with the public. The ADA defines denturism as “ the fitting and dispensing of dentures illegally to public.” Demonstrating Denture Construction-Brisbane 1940 8

9. Duties of Denturists/ Dental technicians Working with a dentist in the clinic, assisting with treatment by helping to fit attachments at chairside. Working with a dentist or a clinical dental technician in the clinic. Assisting with treatment by Taking impressions Recording facebows Carrying out intra-oral and extra-oral tracing Carrying out implant frame assessments Recording occlusal registrations Tracing cephalographs Carrying out intra-oral scanning for CAD/CAM Taking intra and extra-oral photographs. 9

10. Dental Secretary/Receptionist: The person who assists the dentists with his secretarial work and patient reception duties. Dental Health Educator: Is a person who instructs in the prevention of dental diseases and may also be permitted to apply preventive agents intraorally. 10

11. School Dental Nurse This type of ancillary was established in New Zealand in 1923 to deal with a large amount of dental disease present among the school children. The government made provision for training young women as school dental nurses who would provide the bulk of the treatment in school dental services. Operating Ancillaries 11

12. Saskatchewan Health Dental Plan (SHDP), Trained and employed dental therapists/ SDN in school based clinics to provide basic dental care to all children. Only school-based program staffed by dental therapists to ever exist in North America. The program achieved significant success during the course of its existence from 1974 to 1987. However, it was terminated in 1987 12

13. Services( Saskatchewan DHP) Diagnosis (radiographs, treatment planning), Prevention (oral hygiene instruction, both chair side and classroom, prophylaxis, topical application of fluorides) Restorations (stainless steel crowns, intra-coronal restorations/fillings) Oral surgery (extractions of primary and permanent teeth), pulpotomies and emergency procedures. Children would be re-examined on a semi-annual basis. Dental health education was considered to be the most important element of the program. 13

14. Duties of School Dental Nurse Oral examination Prophylaxis Topical fluoride application Advice on dietary fluoride supplements Administration of LA Cavity preparation & placement of amalgam filling Pulp capping Extraction of primary teeth Individual patient instruction in tooth brushing & oral hygiene Class room & parent-teacher dental health education Referral of patient to private practitioners for more complex Services. 14

15. Dental Therapist: Is a 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 Cavity preparation in deciduous and permanent teeth Restorative skills Vital pulpotomies Extraction of deciduous teeth Training period is for 2 years 15

16. Dental Hygienist: This type of ancillary was first employed in 1906 in USA and in 1913 the first formal training was established. Performs certain specified preventive and treatment measures in the treatment of periodontal diseases. Dr. Alfred C Fones - Father of dental hygiene Mrs. Irene Newman-First dental hygienist Duties: Scaling & Polishing of teeth Topical application of fluoride Provision of dental health education In some countries they are permitted to take radiographs, make impressions for study models and polish restorations. 16

17. Expanded Function Dental Auxiliaries (EFDA): Also known as expanded function dental hygienist, expanded function dental assistant, expanded function auxiliary, expanded duty dental auxiliary. An EFDA is a dental assistant who has received further training in duties related to direct treatment of patients, though still working under the supervision of dentist. They undertake reversible procedures, which could be either corrected or redone without undue harm to patient’s health. 17

18. Placing and removing temporary restorations Placing and removing matrix bands Removing and replacing ligature wires Placing and removing rubber dams Condensing & carving amalgam restorations in previously prepared tooth Applying final finish & polish to previously listed restorations Exposing and developing radiographs Removing sutures Duties of EFDA 18

19. Four levels of training: Certified Dental Assistant (CDA) Preventive Dental Assistant (PDA) Dental Hygienist Dental Hygienist with expanded Duties Certified Dental Assistant (CDA) The training course for CDA is up to 8 months and he is taught traditional chair side duties. The only intra-oral duty was exposing radiographs. 19

20. Preventive Dental Assistant (PDA) The PDA had to be a Certified Dental Assistant. Courses up to 3-6 weeks. Duties:- Polish coronal portions of the teeth without instrumentation and take impressions for study models. Topically apply caries preventive agents, Place & remove rubber dams Maintain a patients oral hygiène 20

21. Dental Hygienist with Expanded Duties: Eligibility – one year practical as a dental hygienists Training – 4 months Functions Removing sutures Finishing and Polishing amalgam and resin restorations Placing & removing Matrix band Retracting gingiva for impression Fitting and removing orthodontic bands Cementing temporary crowns Placing Temporary restorations 21

22. FRONTIER AUXILIARIES Nurses and former dental assistants can provide valuable service with minimum of training in rural areas. In 1981 , Alaskan communities 1 week training program was conducted for frontier auxiliaries. Simple prophylaxis, basic dental health education, dental first aid can be rendered for those with pain and subsequently referred to nearest dentist Perform Fluoride rinse programmes & simple denture repair 22

23. New Auxiliary Types: The expert committee on auxiliary dental personnel of the WHO has suggested two new types of dental auxiliaries: The dental licentiate The dental aide Dental Licentiate: Functions as a semi independent operator. Functions: Oral prophylaxis Cavity preparation & fillings of primary & permanent teeth Extractions under L.A. Drainage of dental abscesses Early recognitions of more serious conditions. 23

24. Dental Aide: The duties include, elementary first –aid procedures for the relief of pain including: Extraction of teeth under L.A. Control of haemorrhage Referral 24

25. DEGREES OF SUPERVISION (ADA) General Dentist has authorized the procedures and are being carried out in accordance to the diagnosis and treatment plan of the dentist Indirect Dentist authorizes the procedures and remains in dental office while the procedures are being performed by auxillary Direct Dentist does the diagnosis of the condition, personally authorises the procedure and evaluates the performance before dismissal of the patient Personal Dentist is personally operating on a patient and authorises the auxiliary to aid treatment by concurrently performing supportive procedures 25

26. REFERENCES Essentials of Preventive and Community Dentistry- Dr. Soben Peter Textbook of Preventive and Community Dentistry - SS Hiremath 26