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Certificate
This is to certify that the subject seminar
on Role of Dental Auxiliaries in Dental
health by Batch B of Final BDS (January
2015 batch) submitted is a bonafide work
done under my guidance and supervision.
Date:
Signature of
Faculty
Department of Public Health
Dentistry
Manipal College of Dental Sciences
Manipal

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Internal Examiner
Examiner

External

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Contents
Introduction................................................................................................................ 4
Classification by W.H.O (1967)................................................................................... 5
Degrees of Supervision............................................................................................... 6
(A)

Non-Operating Dental Auxiliaries......................................................................9

1. Dental Receptionist............................................................................................. 9
2. Dental assistant................................................................................................ 13
Educational and licensing requirements in U.S.................................................................13
Earnings and salary............................................................................................ 14
3. Dental Health Educator..................................................................................... 15
4. Dental Technician.............................................................................................. 19
(B)

Operating Auxiliaries....................................................................................... 23

1. School Dental Nurse.......................................................................................... 23

2. Dental Hygienist................................................................................................ 27
3. Expanded Functions/Duties of Operating Dental Auxiliaries (EFDA OR EDDA). .29
Frontier Auxiliaries.................................................................................................... 31
Dental Manpower in India......................................................................................... 34
Conclusion................................................................................................................ 40
References................................................................................................................ 41

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Introduction
A dental auxiliary 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.

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.

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Classification by W.H.O (1967)

1) Non Operating Auxiliaries
Clinical This is a person who assists the professional
(dentist) in his clinical work but does not carry out any
independent procedures in the oral cavity.
Laboratory This is a person who assists the professional by
carrying out certain technical laboratory procedures.
2) 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.
REVISED CLASSIFICATION
1) Non Operating Auxiliaries
Dental surgery assistant
Dental secretary/receptionist
Dental laboratory technician
Dental health educator
2) Operating Auxiliaries
School dental nurse
Dental therapist
Dental Hygienist
Expanded function dental auxiliaries

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Degrees of Supervision
ADA (1975) defined four degrees of supervision of auxiliaries, with the
assumption that ultimate responsibility was assumed by licensed dentist.
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
dentist. The supervisor provides continuing or individual assignments by
indicating generally what is to be done, limitations, quality and quantity
expected, deadlines and priorities. Additional, specific instructions are
given for new, difficult, or unusual assignments. The employee uses
initiative in carrying out recurring assignments. The supervisor assures
that the work is technically accurate and in compliance with instructions
or established procedures.

2. DIRECT SUPERVISION:
It is a term that is used to refer to situations in which a supervisor is
present at all times. The supervisor oversees activities as they occur and
provides constant direction, feedback, and assistance. For some types of
workplaces, direct supervision is required for safety and health reasons.
In others, it may be strongly recommended to make a workplace run

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more smoothly. : The dentist is in the dental office, personally diagnoses

the condition to be treated, personally authorizes the procedure and
before dismissal of the patient, evaluates the performance of the dental
auxiliary
One example of a workplace in which direct supervision is required is in
a medical practice. Technicians may need direct supervision for
performing certain types of procedures. While they are authorized to do
these procedures, they cannot do them without being monitored by a
doctor. For example, a dentist may be required to supervise a dental
hygienist during certain types of dental procedures. Likewise, a
veterinarian must be present for some procedures performed by a
veterinary technician.
Another setting in which direct supervision is used is prisons and jails.
In a facility that uses this approach to managing inmates, people are
incarcerated in pods, which consist of cells that surround a public day
area. A corrections officer works in the day area, not a private office or
secured area, interacting directly with inmates when they are out of their
cells. This allows for rapid intervention in the event that problems
develop and it also provides a mechanism for monitoring behavior to
offer rewards for good behavior.

3. INDIRECT SUPERVISION:
Indirect supervision is characterized by some form of authority over the
work of employees not under direct supervision. In other words, the
"supervisor" who provides indirect supervision is responsible for the
work, but not for the worker. The descriptions above were written in
relation to the employee under direct supervision; the following
subsections describe persons with responsibility for exercising indirect
supervision. The dentist is in the dental office, authorizes the procedures

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and remains in the dental office while the procedures are being
performed by the auxiliary.

4. PERSONAL SUPERVISION:
The dentist is personally operating on a patient and authorizes the
auxiliary to aid treatment by concurrently performing supportive
procedures.

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(A) Non-Operating Dental

Auxiliaries
1. Dental Receptionist

PRIMARY RESPONSIBILITIES
Responsible for administering the day-to-day activities of the business
office, including: maintenance of the records of patients, scheduling of
patients, accounts receivable, maintaining appearance and order of
dental office, presentation of financial treatment plan options, and
recall/recare system.
SPECIFIC DUTIES
o
o
o
o
o
o
o
o
o
o
o

Reception Management
Manage day-to-day operations of dental office
Open and close dental office according to office protocol
Review the office for a neat, professional appearance and make
necessary changes
Check the daily schedule for accuracy and post it in all treatment
rooms
Answer and respond to telephone calls with professionalism
Review supplies for reception and provide order to Doctor.
Maintain petty cash
Patient Management
Maintain a professional reception area; organize patient education
materials, etc.
Greet and welcome patients and visitors to the practice

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o Check in patients according to office protocol, verifying and

updating patient information
o Manage recall and inactive patient system
o Oversee patient relations & handle patient complaints, under the
doctors indirect supervision
o Help explain office policy to patients
o Confirm the next days appointments according to protocol and
patient preferences
o Schedule patients for efficient use of doctor and staff time
o Check patient quick-fill list to try to fill in cancellation and noshow appointment times
o Collect payment from patients at the time of treatment
o Make follow-up appointments as needed
o Prepare financial treatment plans and present plan options to
patient at end of their appointment
o Assist in the treatment room as needed
o Records Management
o Gather and accurately record insurance information from patients
o See that records are stored securely.
o Accurately file patient information
o Arrange patient charts and radiographs for the next days
appointments
o Track cases and referrals to and from other doctors
o Insurance
o Update insurance information on all patients at all times
o Submit treatment plans for predetermination of benefits
o Prepare claim forms for patients with dental insurance
o Organize supporting materials for claim forms, such as radiographs
or written narratives, as directed by the doctor.
o Mail or electronically submit claim forms from office
o Assist in the resolution of problems with third-party payers
o Inventory Management

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o Monitor inventory and order dental office supplies as needed

o Monitor and make sure all dental office equipment is working
properly

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Office Participation
Be an active participant in staff meetings
Perform other tasks as assigned by the doctor.
Accounts Receivable Management
Enter patient financial activity in computer
Maintain accounts receivable activity
Prepare bank deposits
Prepare statements
Follow-up insurance claims
Follow-up delinquent accounts
Arrange payment schedule with patients
Billing
Prepare billing statements promptly and accurately mail billing
statements as directed by the doctor.
Prepare and mail overdue account letters as directed by the doctor.
Telephone patients with accounts overdue
Post checks received each day
Manage patient financial accounts
Correspondence
Sort, organize, and distribute mail
Prepare and send out new patient and referral thank-you letters as
directed by doctor.
Prepare and send out continuing care notices as directed by the
doctor.
Prepare and send out correspondence as directed by the doctor.
Marketing and Public Relations Management
May assist with the design of marketing and promotional materials
(print and electronic)

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o May assist with dental office advertising/recruiting ads for new

staff
o May assist with dental office facility management
PERSONNEL REQUIREMENTS
o
o
o
o
o
o
o
o
o
o
o
o
o

Education/Experience
High school diploma
2 years office experience desired
Legible handwriting for notations in charts
Interpersonal
Good interpersonal skills to maintain effective rapport with
patients, dentists, other staff members and community
Effective verbal skills to communicate with patients and staff
Team player
Able to adapt to office policy improvements (office is constantly
striving for improved customer care/service)
Conflict resolution experience
Customer service or patient relations experience
Quick response/accurate data entry to present treatment plans to
patients in a short time frame
Communicate all concerns to the doctor.

2. Dental assistant
Dental Assistants assist the dental operator (dentist or other
treating dental auxiliary) in providing more efficient dental treatment, by
preparing the patient for treatment, sterilizing instruments, passing

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instruments during the procedure, holding suction devices, exposing

dental radiographs, taking impressions, and fabricating provisional
crowns. Dental operators can focus more time on the procedure; the
dental assistant then effectively becomes the operator's extra hands.
Educational and licensing requirements in U.S.
In some states, dental assistants can work in the field without a college
degree, while in other states; dental assistants must be licensed or
registered.
Dental assistants are required to meet the minimum certification to work
in the field. There are many things that dental assistants must consider
while working in the field and arguably the most important is infection
control.
The Commission on Dental Accreditation of the American Dental
Association accredits dental assisting school programs, of which there
are over 200 in the United States. To become a Certified Dental
Assistant, or CDA, dental assistants must take the DANB (Dental
Assisting National Board) CDA examination after they have completed
an accredited dental assisting program, or have at least two years of onthe-job training as a dental assistant. Some dentists are willing to pay a
dental assistant-in-training that has a good attitude and work ethic.
Expanded duties dental assistants or Expanded Functions Dental
Assistants, as they are known as in some states, may work one on one
with the patient performing restorations after the doctor has removed
decay. Ideally a dental assistant should have both administrative and
clinical skills although it's still acceptable to have one or the other.
Duties may also include seating and preparing the patient, charting,
mixing dental materials, providing patient education and post-operative

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instructions. They also keep track with inventory control and ordering
supplies.
In the UK, Registered Dental nurses are prohibited from carrying out
any form of direct dental treatment on the patient, including teeth
whitening procedures, under the GDC scope of practice.
Dental nurses found to be carrying out dental procedures are liable to be
removed from the statutory GDC register.
However, in the Republic of Ireland, other parts of the UK, and parts of
North America, it is often dental nurses (and teeth whitening
technicians) who carry out teeth whitening procedures rather than
dentists. This practice mainly occurs in clinics focusing solely on laser
teeth whitening. In Ireland, registration as a dental nurse with The Irish
Dental Council is voluntary; however, nurses who are registered and
who carry out teeth whitening may face disciplinary action if caught.
In Australia, a formal qualification is not required to work as a dental
assistant. However, this is usually preferred by most dentists to ensure
that their staff has enough background knowledge about dentistry.
Australian dental assistants are not required to be registered with the
Australian Dental Association.

Earnings and salary

Dental assistants are currently listed by the US Bureau of Labor
Statistics as a healthcare support occupation, and therefore do not earn
the same salary as dentists. Their median salary in the US was $33,470
annually, or $16.09 per hour, in 2010.[2] Salary ranges vary widely by
state and by major metropolitan area. The lowest-paying state, West

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Virginia, pays its lowest-earning dental assistants around $18,490 per

year, while the highest-paying state, Alaska, pays its top earners around
$56,760 annually. The lowest-earning dental assistants in Santa Fe, NM,
earn around $17,950 per year, while the highest earners in San
Francisco, CA earn around $59,370 per year.
3. Dental Health Educator
This is the person who instructs in the prevention of dental diseases and
who may also be permitted to apply preventive agents intra orally.
In a few countries, the duties of some dental surgery assistants have been
extended to allow them to carry out certain preventive procedures. In
Sweden, additional weeks of training are given, after which auxiliaries
are allowed to conduct fluoride nourishing programs to group of school
children. They are, however, not allowed to undertake any intra oral
procedures.
Few responsibilities of a dental health educator are:
a) Assessing Individual and Community Needs. This means that a health
educator needs to determine the health needs and concerns of a specific
population or person. Besides this the health educator also needs to
perform a capacity assessment to find ways to empower the community
and identify skills and resources they have to help solve problems. The
health educator is responsible for helping others in a community to help
themselves. Another aspect of this is for educators to collect and analyze
data from their specific populations and use this to determine priority
areas where health education programs need to be placed.

b) Plan Health Education Strategies, Interventions and Programs. This

part takes place after the needs of a population have been assessed. It

P a g e | 17

involves recruiting stakeholders to help develop and support an effective

health program. Goals and objectives must be developed specific to the
proposed health ed. Program. After the goals and objectives are set up
then interventions can be developed. These interventions and strategies
must be fitting to the needs of that community and atmosphere. They
should raise awareness and plan strategies and programs that will meet
the objectives. By using the Rule of Sufficiency health educators can
determine how and if their strategies are sufficiently forceful and
efficient enough to help objectives and goals be met.

c) Implement Health Education Strategies, Interventions and Programs.

After assessing all the needs and planning the programs and
interventions it is time for the health educator to implement the health
education program into the target population. They are first responsible
for understanding the people in the population and know how to get
people to participate in the program, what time the program should be
held, what kind of assistance is needed or what extent of understanding
the people have for the health issue being acknowledged. Health
educators should be comfortable using a variety of educational methods
to help present their program. Then if problems are discovered during
the implementation they should be addressed and objectives and goals
might need to be revised.
When implementing an educational program the health educator is also
responsible for dressing professionally and adhering to the Code of
Ethics.

d) Conduct Evaluation and Research Related to Health Education. This

responsibility for health educators focuses on evaluating the worth of a

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program and if it is successful in meeting its desired goals and

objectives. For an evaluation to be effective the health educator must
have made realistic objectives back when they were planning their
program. Otherwise the program may not be able to meet its expected
goals and could therefore be terminated. Data collected and analyzed on
a program should reflect how it is holding up and progressing and what
things might need to be modified in the future. The program will also
develop based on its research and new information that it generates, the
health educator is responsible for interpreting and conducting research
and using the results to improve their program

e) Administer Health Education Strategies, Interventions and Programs.

This responsibility of the health educator is to coordinate and administer
the performance of a program. Health educators must facilitate
coordination with personnel and programs. They need to make sure that
personnel and members of their program have an equal understanding
and knowledge of their education program. Sometimes the educator is
required to coordinate activities between their program and other similar
programs within a community.

f) Serve as a Health Education Resource Person. A health educator is

also responsible for being a resource person. This means that they must
have the skills to access and acquire health information and resources
when called upon by clients or associates. They must know how and
where to retrieve information.
But besides this they must also be able to establish effective
relationships with others and be able to communicate information
regarding health in an effective, nonthreatening way.

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g) Communicate and Advocate for Health and Health Education.

Basically this means that the health educator has the responsibility to
communicate effectively to clients, associates or whomever else the
information necessary to improve and protect their health. Good
communication is an essential tool for health educators.
Besides relaying and translating information they must also advocate
and support their profession and be promoters of health. Health
educators can be called upon to instruct and communicate health needs
to individuals and groups. They need to support, initiate and abide by
rules and procedures that will enhance the health of a target population.

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4. Dental Technician
The Art and Science of Dental Technology
Dental laboratory technology is the art and science of manufacturing
corrective devices and replacements for
natural teeth.
There is a skilled professional behind the
scene, working on the written order or
prescription of the dentist, who manufactures
the restoration or device. This is the dental
laboratory technician.
Each restoration the technician makes will be different and each must
simulate the function of the natural teeth. But, beyond that, the
technicians great challenge is to capture and recreate both the perfection
and the imperfection of natural teeth.
History of the Dental Laboratory Technician
As the art and science of dentistry continued to develop, special
processes and skills were developed in manufacturing prosthetic
devices. Since these processes and skills were in demand by other
dentists, the practice of sending out laboratory work to those possessing
the processes began.
Dr. W. H. Stowe opened the first dental laboratory in Boston in 1887.
The establishment of the commercial dental laboratory led quickly to the
training of apprentices and thus the dental laboratory technician
The Necessary Skills
Good candidates for careers in dental technology usually possess good
eye-hand coordination and color perception, dexterity in using small
instruments, the patience to attend to minute detail and an interest in
learning the underlying material science.

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The Work Setting

Most dental technicians are employed in commercial dental laboratories.
Commercial dental laboratories are often very small, having only two or
three employees. There are also, however, some very large labs with
over 100 employees. Some private dental offices have their own
laboratory.
Military services still train and employ a number
of dental technicians. Schools teaching dental
technology offer some teaching positions for
experienced technicians.
CAD/CAM Dentistry, (Computer-Aided Design
and Computer-Aided Manufacturing in Dentistry), is an area of
Dentistry utilizing CAD/CAM technologies to produce dental
restorations.
Getting Started
Many dental laboratories larger ones in particular offer positions for
trainees. Persons hired at the entry level may rapidly progress to being
productive employees, performing a limited range of laboratory
procedures.
Another route to a career in dental laboratory technology is by
completing one of the two-year or four-year degrees in dental
technology offered through educational programs. Download the
current list of U.S. schools offering dental laboratory technology
programs: U.S. Dental Lab Schools
These courses provide students with broad-based theory and an
introduction to laboratory procedures across the various dental
technology specialties.

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A graduate may expect to be hired at a salary not significantly higher

than that of a paid trainee, but should be able to progress far more
rapidly to a professional level.

Country
India

United kingdom

United States of America

Qualifications
required
Diploma for 2 academic years
(D.D.T-diploma in dental
technology)
Candidate must have passed at
least matriculation examination of
a recognized university.
Registered with GDC
Completion of a course approved
by GDC such as:
1) BTEC National Diploma in Dental
Technology (or)
2) BSc (Hon) degree in Dental
Technology
Education and training through a
two-year program at a community
college, vocational school,
technical college, university or
dental school.
Graduates of these programs
receive either an associate degree
or a certificate (certified by
National Board for Certification in
Dental Laboratory Technology)

New Zealand & Australia

Few programs offer a four-year

baccalaureate program in dental
technology.
The profession of dental
technology is registered under the
Health Practitioners Competence
Assurance Act 2004
Graduates with a Bachelor of
Dental Technology (BDentTech)

P a g e | 23
degree are automatically entitled
to register with the Dental
Technicians Board in order to
practice as Registered Dental
Technicians.
Opportunities for postgraduate
study for the Postgraduate
Diploma in Dental Technology
(PGDipDentTech), and the Master
of Dental Technology (MDentTech)
and Doctor of Philosophy (PhD)
degrees.

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The Professional Dental Technician

Most states set no minimum qualifications for persons to be employed as
dental technicians. However, the industry encourages standards for the
benefit of the dental patient.
New materials, techniques and equipment are
regularly introduced to dental technology and
technicians must continue their education through
training courses and seminars.
Technicians who have at least five years of education
and/or experience in dental technology are encouraged to distinguish
themselves by taking the examinations to be Certified Dental
Technicians (CDTs) in different areas. Since certification is voluntary
in most states, it represents not only compliance with established
standards, but also a personal commitment to quality and
professionalism.

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The Future of Dental Laboratory Technology

Dentistry and dental laboratory technology have been, are and will
continue to be ever-changing interrelated fields of endeavor. Both health
and aesthetics will continue to be driving forces in the continuing
development of dentistry.
As we move onward further into the 21st century, we see a period of true
promise and steady growth in dentistry and dental laboratory sales.
There will be no decline in the demand for dental services, rather the
demand will grow.

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(B) Operating Auxiliaries

1. School Dental Nurse
This is an operating Dental Auxiliary, who is permitted to diagnose
dental disease and to plan and carry out certain specified preventive and
treatment measures, including some operative procedures in the
treatment of dental caries and periodontal disease in defined group of
individuals, especially school children.
Interest in an organized plan to improve dental conditions among
children in New Zealand first became evident in 1905. Treatment of
these children was particularly difficult on account of the distance,
which often separated small communities. Also, Dentists were in short
supply during World War I (1914-18) and treatment of young children
was not as accepted an area of dental practice at that time.
The School Dental nurse Scheme was established in Wellington, New
Zealand in 1921 due to extensive dental disease found in army recruits
during World War I. the man who influenced its formation was T. A.
Hunter, a founder of New Zealand Dental Association and a pioneer in
the establishment of a dental school in New Zealand. The name of the
school where they were trained was The Dominion Training School for
Dental Nurse.
The training extends to over a period of two years to cover both
reversible and irreversible procedures.

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Upon completion of training, each school dental nurse is assigned to a

school where she is employed by the government to provide regular
dental care for between 450 and 700 children.
Each school which takes more than 100 children has its own dental
clinic. When a school dental Nurse is assigned to a school, she is
accepted as a member of the staff in the same was as are the teachers.
In New Zealand, the dental school nurse is predominantly in the schoolbased salaried service and is expected to provide care for the children at
nearly 6-month intervals. They are under general supervision of a district
principal dental officer. The dental nurse inspector who is delegated
certain responsibilities visits these school dental clinics about twice as
often as the principal officer.

Duties:

Oral examination.
Prophylaxis.
Topical fluoride application.
Advice on dietary fluoride supplements.
Administration of local anesthetics.
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.

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Additional skills a nurse could develop in their career include:

Further skills in oral health education and oral health promotion
Assisting in the treatment of patients who are under conscious
sedation
Further skills in assisting in the treatment of patients with special
needs
Intra-oral photography
Shade taking
Place rubber dam
Measuring and recording plaque indices
Pouring , casting and trimming study models
Removing sutures after the wound has been checked by a dentist
Applying fluoride varnish as part of a programme which is
overseen by a consultant in dental public health or a registered
specialist in dental public health
Constructing occlusal registration rims and special trays
Repairing the acrylic component of removable appliances
Tracing cephalographs

P a g e | 29

Because of this system works well in New Zealand it does not mean that
it would work for any other country because New Zealand is a small
country and one with advanced social services.
Operating auxiliaries with functions similar to those of the New Zealand
School Dental Nurse are employed in a number of other countries, many
of which have started their own training schools.
In Saskatchewan, a Canadian province and the only place in North
America where someone other than a dentist may legally drill and fill
the teeth, the nurses receive direct supervision during the first two
months and then work with a more experienced dental nurse for the third
month. If the performance is found to be satisfactory, then they work
without direct supervision. The dentist does the initial examination and
meets each nurse at least once a week.
Dental Nurses are presumed to provide care at less cost than dentists.
They are less expensive to train than the dentists and their salaries are
similar to those of physical therapists and school teachers.

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2. Dental Hygienist
Dental hygienist is an individual who has completed an accredited dental
hygiene education program and an individual who has been licensed by
the state board of dental examiners to provide preventive care services
under the supervision of a dentist.
Functions that may be legally delegated to the dental hygienist are based
on the needs of the dentist, the educational preparation of the dental
hygienist and state dental practice acts and regulations but always
include at a minimum scaling and polishing of teeth.
Tasks performed are-:
Educate and council children and adults on dental health and
plaque control, oral hygiene and nutrition
Patient screening procedures, such as assessment of oral health
conditions, review of health history, oral cancer screening ,head
and neck inspection and dental charting and taking blood pressure
and pulse
Removing deposits and stains from the teeth by scaling and root
planning
Giving LA for dental procedures
Assist in prevention and control of dental carries
Select and use appropriate fluoride treatment and polish tooth
restorations
Taking and developing dental radiographs

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Making impression of patients mouth for construction of study

casts and mouth guards
Apply and remove periodontal packs
Instruct patient o how to look after their teeth and mouth after
operation
Assist in management of periodontal diseases
Teaching patients appropriate oral hygiene practices
Performing documentation and management activities
Applying preventive materials to the teeth e.g. fluoride , sealants

P a g e | 32

3. Expanded Functions/Duties of Operating Dental

Auxiliaries (EFDA OR EDDA)
This is a person who is permitted to carry out certain specified treatment
and preventive measures including reversible procedures under the
direct supervision of a dentist. An efda is a dental assistant or a hygienist
in some cases, who has received further training in duties related to
direct treatment of the patient though still working under the direct
supervision of a dentist.
It excludes diagnosis, treatment planning, cutting of hard and soft tissues
and prescribing drugs. They are allowed reversible procedures that are
procedures that could be repeated by the dentist without any harm to the
patient if the work performed by auxiliary is of unacceptable quality.
Procedures permitted are: Placing rubber dam
Restoration of a teeth in which cavities have been prepared by the
dentist with amalgam and other plastic filling materials
Taking radiographs
Taking impression
Topical application of fluoride
Making of study models
Making of impression trays
Casting and polishing of inlays and dentures
Placing and removing matrix bands

P a g e | 33

Removing sutures
Monitoring of nitrous oxide
Removing and replacing ligature wires on orthodontic appliances
Applying pit and fissure sealants and desensitizing agents
REGISTERED RESTORATIVE ASSISTANT IN EXTENDED
FUNCTIONS
May perform any duties that a dental assistant may perform
Perform following duties under direct supervision; Cord retraction of gingiva during impression
Taking impression on cast restoration
Formulating indirect patterns for endodontic post and core
castings
Fitting trial endodontic filling points
Drying canals previously opened by the dentist
Testing pulp vitality
Removing excess cement from subgingival tooth surface with a
hard instrument
Fitting and cementing stainless steel crowns
Placing class 1 3 and 5 non metallic restorations
Taking face bow transfers and bite registration

P a g e | 34

Taking final impressions for tooth borne removable prosthesis

P a g e | 35

Frontier Auxiliaries
It refers to the community of nurses and former dental assistants who are
provided training to work in rural areas which are distant to public or
private dental clinics.
In developed countries dentists remain in urban areas and are too
distant making it difficult for inhabitants to receive regular
comprehensive care or emergency pain relief.
They are trained to provide services like:
1. Simple dental procedures
2. Basic dental health education
3. Organizing fluoride rinse programs
4. Simple denture repairs
5. First aid can be rendered in case with pain
In 1981, 1 week training program was conducted for frontier auxiliaries
in Alaskan communities, 40 or more miles away from the nearest dentist.
2 years later case reports from the community showed that large no of
simple dental health problems had been solved and references had been
made to urban dentists for elective work.
NEW AUXILIARY TYPES
Expert committee on auxiliary dental personnel of who (1959) suggested
2 new types of dental auxiliaries

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1. The DENTAL LICENTIATE: He is a semi-independent operator

trained for 2 years.
They are responsible to the chief of regional or local health service.
Their services occur in rural or frontier areas and hence the
supervision and control would probably be remote.
Duties performed by them include:
Dental prophylaxis
Cavity preparation and fillings of primary and permanent
teeth
Extractions under local anesthesia
Drainage of dental abscesses
Treatment of the most prevalent diseases of supporting
tissues of teeth
Early recognition of more serious dental conditions.

2. THE DENTAL AIDE

This type dental auxiliary is of even briefer training period
who would perform functions similar to those of the medical
corpsmen now seen in military services
Training of sterilization procedures is of utmost importance
They operate only within a salaried health organization and
be under close supervision at first

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Formal training extends from 4-6 months followed by a

period of field training under direct and constant supervision.
They are useful in some countries having shortage, with no
facilities for training dentists.
Their duties include
Elementary first aid procedures for relief of pain
Extraction of teeth under local anesthesia
Control of hemorrhage
Recognition of dental disease which is important enough to justify
transportation of the patient to a center where proper dental care is
available.

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Dental Manpower in India

Each country evolves a pattern of medical including dental care
which is suitable to its social conditions, economic system,
political ideology and experience.
Patterns show variation from country to country and from time to
time.
Pattern of practicing dentistry may be organized in different ways,
the most common being solo practice in which dentist is a private
practitioner setting up his own clinic, and employing assistants as
and when required. He may have an honorary or part-time
attachment at a government, semi- governmental or public trust
health facility. Sometimes a newly passed graduate maybe working
as an assistant to get experience. A small number of dentists may
be employed fulltime in one of the organizations mentioned above.
The concept of group practice or polyclinics envisages a group of
medical/ dental practitioners coming together and setting up a
common facility. They may be organized as partners in a common
endeavors and share the cost of maintenance of the premises. They
are responsible for the technical work individually.
Group practice may develop into a big organization consisting of
various specialties in medicine and/ or dentistry. There are many
advantages of such a big organization
Increase in quality and continuity of care,
Patient convenience to have different services available at one
place,
Economical as the common expenses are shared without
duplication,

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Same benefits are derived by the patients and the providers of the
service.
Development of dental practice along this line has been seen in
many places across India.
Due to extreme shortage of dentists in India in the preindependence period as noted by the Bhore Committee,
suggestions were made by the committee on of which was to train
the dental hygienists.
The Mudaliar Committee in 1959 also recommended training of
dentists, dental hygienists and dental mechanics.

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India is diverse in geography, culture and religion. It is

predominantly a rural nation as 72% population lives in rural areas.
Health of its population depends on:

Health care delivery systemIt is based on the principle of health for all through primary health
care approach which is foundation of rural health care. According
to national family health survey conducted by ministry; 1/3rd
population is in urban area and 2/3rd in rural. The poor mainly are
concentrated in the rural areas esp. in the north, and mainly
practice agriculture (according to World Bank). They are less
literate and have less access to oral health care facilities,
subsequently suffering most from oral diseases.
Health care system is affected by infrastructure deficiency and
variation in quality of services provided. Since independence, India
never had oral health status data and this proved a great problem
for Indian policy makers in assessment of oral health services.
Integrated network is present to provide different levels of care to
populationDental college/medical college(tertiary care)
District hospital
Primary health centre
Subcentre(rural dispensary)
Rural health has around 1,36,815 subcentres, around 26,952
primary health centres and 3708 community health centres.

P a g e | 41

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Socio-demographic profileIncludes socioeconomic status, literacy rates, infant and maternal

mortality rates, human development index etc.
Oral health care delivered through primary health care
infrastructure is of limited resources and dental manpower.
India produces about 18,000 dentists per annum. Dentist
population ratio in urban areas is 1:10000 and in rural is about 1;
2,50,000. This distribution of dentists is grossly uneven indicating
that about 90% dentists are in urban areas and only 10% in rural
areas (for the 72% population). In most states, dentists are not
posted at community and primary health centers. Government
establishments cater to a small population, majority treated by
private setups. Shortage of equipment and materials and facilities
result in minimal curative services.
Accessibility is also a serious problem in dentistry. The major
missing link causing this serious problem is absence of primary
health care approach in dentistry, reasons being geographic

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imbalance in distribution of dental colleges, variation in dentist

population ratio. It is difficult for poor urban and rural people to
get emergency care. Community oriented health programs are
seldom implemented. Reasons for contradiction are geographic
variation, uneven dentist population ratio,
poor specialist: generalist ratio, poor dentist: auxiliary ratio and
low priority to oral health.

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Conclusion
India is the 7th largest country in the world. Need of the hour is to
develop an effective dental care delivery system which is equitably
distributed, with a well qualified , dedicated work force for which
these levels of supervision are a must.

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References
Soben Peter, Essentials of Public Health Dentistry 5th Ed, Arya
Publications, Chapter 19, Pg- 476-485
CM Marya, Textbook of Public Health Dentistry, Jaypee Publications,
Chapter 17, Pg- 213-219
Nicola Ursula Zitzmann, Edgar Hagmann andRoland Weiger. (18 JUN
2007). Clinical Oral Implants Research. Available:
http://onlinelibrary.wiley.com/doi/10.1111/j.16000501.2007.01435.x/abstract. Last accessed 11th October 2014.
Dental technician/dental technologist Retrieved from
http://www.nhscareers.nhs.uk/explore-by-career/dental-team/careers-inthe-dental-team/dental-techniciandental-technologist/