The dental team extends far beyond just the dentist. Behind every successful dental practice is a team of skilled dental auxiliaries. They play a vital role in supporting dentists and ensuring efficient oral healthcare delivery. From ensuring the patients' oral hygiene routine is on point to educating patients on the same, from sterilizing instruments to assisting in chairside procedures, from crafting appliances to helping bring the dentists' treatment plan to reality, they're an invaluable part of dental care.
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’. In India, dental auxiliaries include
Dental hygienists
Dental mechanics (technicians)
Dental surgery assistants
Dental nurses
However, The Dentist Act, 1948 recognizes only two types of auxiliaries: dental hygienists (a person who is not a dentist or a medical practitioner, who scales, cleans, or polishes teeth, or gives instruction in dental hygiene) and dental mechanics (a person who makes or repairs denture and dental appliances).
There are only two approved courses for dental auxiliary training in India:
Dental mechanic (a two-year program after completing the 12th grade)
Dental hygienist (a two-year program after completing the 12th grade)
There are 68 dental colleges providing paradental courses in dental mechanics and dental hygiene, offering a total of 1,186 positions for dental mechanics and 833 for dental hygiene training. Additionally, 13 colleges offer dental operating room assistant (DORA) training, with 195 positions available.
In the early 1900s, thorough cleaning of patients' mouths proved beneficial to patients but it was time-consuming for dentists. Dr. Alfred Fones pioneered the integration of hygienists in dental offices in 1906. He trained his office assistant, Mrs. Irene Newman, in both oral cleaning and dental health education. Following his success, Dr. Fones secured funding from Bridgeport city for an educational program on Oral Hygiene, with the school adjacent to his office. Young women enrolled and were taught by local dentists and faculty from dental and medical schools.
Dental hygienists often perform initial periodontal assessments, including probing and charting, scaling, and root planing. They focus on explaining the importance of oral hygiene, demonstrating proper brushing and flossing techniques, recommending appropriate oral care products, and setting achievable goals with patients. To achieve a smooth workflow between dentists and hygienists, effective communication and coordination of care are crucial, especially in complex cases requiring multidisciplinary approaches. This also helps with time management and workload distribution.Dr. Janani Priya K.S, MDS, Post Graduate Student, Department of Periodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
In India, dental hygienists should register with a state dental council. They are posted in primary health centers, community health centers, district hospitals, and government or private dental teaching institutions like other medical professionals. Their duties include:
Primary Oral Diagnosis (reviewing medical history, examining oral hygiene status, dental caries, pyorrhea, and fluorosis, screening of cancer)
Preventive treatment (removing calculus and plaque from teeth surface, applying preventive materials on teeth - pits and fissure sealants, and fluoride gels)
Oral hygiene and health education (teaching the proper oral hygiene techniques and frequency of using a toothbrush, inter-dental brush, and dental floss, educating about dental plaque, and the relation of oral health to other systemic diseases)
Tobacco cessation counseling (creating awareness of the harmful effects of smoking and chewable tobacco)
Diet counseling (teaching dietary practices for good oral health)
The role of dental hygienists in periodontics is evolving in various ways. They are increasingly involved in advanced periodontal therapies, such as administering local anesthesia, performing periodontal maintenance procedures, and even assisting in surgical procedures under the supervision of periodontists.Dr. Janani Priya K.S, MDS, Post Graduate Student, Department of Periodontics, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
In the early days, artisans like silversmiths and goldsmiths played a role in crafting artificial teeth alongside their main jewelry work. In the 19th century, most American dentists either made artificial teeth themselves or employed assistants. Independent dental laboratories began to emerge by the early 20th century. Gradually, a pattern of training technicians developed and now they receive formal education with skill training.
The dental mechanics handle all the dental laboratory work like designing, constructing, and repairing a variety of dental appliances. The dental mechanics diploma course covers the latest advancements in dental materials and techniques including digital dentistry. However, the students are not practically exposed to these recent advances in digital dentistry due to the lack of advanced infrastructure in government dental colleges. Few private colleges are able to expose dental mechanics to recent advances due to advanced infrastructure in their hospitals.Mr. R. Sudhakar, B.Sc., DDM, Dental Technician, Chennai
Dental technicians receive dental impressions or casts or digital 3-D intraoral scans from dentists along with the prescription of the treatment plan. They fulfill dentists' prescriptions for the construction and repair of extraoral and intraoral appliances and maxillofacial prostheses.
Communication between dentists and dental technicians always plays a key role in the final perfect prosthesis and in reducing the appointment of patients for corrections in the prosthesis. The expectations of the prosthodontist should be communicated with the technician prior to processing of final prosthesis. Even if the prosthesis gets repeated, it should be well communicated with the technician along with the reasons for repeat, and the ways to rectify it. The technician should understand the needs of the dentist. They should have thorough knowledge about the dental materials as material selection also plays a crucial role in the longevity and esthetics of the restoration. They should also have good knowledge about contacts, contours, and the importance of marginal adaptation to improve the function of the prosthesis. Last but not least, they should have the skill to recreate the aesthetics. A prosthesis made by a skilled technician makes the patient and the doctor satisfied.Dr. Amani Guguloth, MDS, Consultant Prosthodontist, Hyderabad, India.
Dental technicians craft dentures (complete, removable partial, implant-supported, and implant-retained), crowns and bridges, implants, inlays, onlays, splints, braces with customized brackets, bands, and wires, functional orthodontic appliances (Herbst or Twin Block), retainers (Hawley, Begg wrap around, Essix), space maintainers, and habit-breaking appliances.
One distinctive aspect of the role of dental technicians in orthodontics is their emphasis on creating appliances that promote gradual tooth movement and alignment. Unlike other dental specialties that focus on fixed or removable restorations, orthodontic technicians must understand the biomechanics of tooth movement to fabricate braces, aligners, and other devices that effectively guide teeth into proper alignment over time. Skilled technicians work closely with orthodontists to understand each patient's unique treatment plan and requirements. Their expertise enables them to provide valuable input and suggestions to optimize treatment success.Dr. Mahalakshmi A, BDS, FDS (Orthodontics), Tenkasi, Tamil Nadu, India
In India, they are mostly employed in government service or private dental colleges under direct supervision. They may also work for dentists, be self-employed, or work for commercial dental laboratories.
Dr. C. Edmund Kells, the pioneer of dental X-rays, made history by hiring the first female assistant in 1885, breaking the norms of the time. Back then, women seldom visited dental offices unaccompanied, but Dr. Kells's move, led to the hiring of women assistants by other dentists and made women patients feel at ease entering dental offices alone.
Dental assistants are trained personnel who collaborate with dentists. They function as the dentist's second pair of hands (four-handed dentistry). Some responsibilities in this role include:
Sterilizing dental equipment and instruments
Assisting the dentist or dental hygienist during chair-side procedures (adding rubber dams and using suction to keep patients' mouth dry, handing instruments and materials to dentists, mixing dental materials, helping in radiological procedures)
Scheduling appointments
Escorting patients to treatment rooms
Updating patient records
Processing payments from patients
Dental nurses often serve as the patients' initial point of contact upon entering the dental practice. In India, the demand for dental nurses has surged. Yet, India lacks a standardized professional group of dental nurses with a lack of structured education and formal training programs. Ideally, the dentist-to-dental nurse ratio should be 1:1. The responsibilities of a dental nurse are as follows:
Maintaining the dental clinic
Prevention of infection
Recording information provided by a dentist relating to the patients' dentition, and soft tissues and maintaining the dental records
Preparing equipment, and materials for dental procedures
Providing chairside support to the dentist during dental procedures
Supporting patients and colleagues if there is a medical emergency
Providing oral health advice prescribed by the dentist
One of the frequently overlooked professional groups among allied health professionals is dental auxiliaries. The National Commission for Allied and HealthCare Professions Bill 2020 does not recognize auxiliary workers in the dental profession. The National Dental Commission Bill passed in the Indian parliament in 2023, which replaces the Dentists Act 1948, overlooks the definition and mention of dental auxiliaries.
The statistics in 2020 show that only around 6700 dental auxiliaries are available in India. According to the representatives of the Government Dental Mechanics Association of different states and the Federation of Indian Dental Hygienists’ Association, these numbers violate the standards outlined by the World Health Organization for both developing and underdeveloped nations.
Due to the limited number of qualified dental technicians, many private commercial laboratories face challenges in maintaining a balanced workforce. Consequently, some unqualified technicians are brought in to assist. They work alongside qualified technicians and gain experience. The TN Dental Technicians Association is actively addressing this issue, striving to ensure that every laboratory employs fully qualified technicians only. We want the government and dental council to take proactive measures to lead this initiative, by strengthening rules for establishing a dental laboratory and ensuring only qualified technicians are employed.Mr. Ramani Ramachandran, DDM, B.A., Dental Technician, Chennai.
Despite their significance in dental care, dental auxiliaries in India often face neglect and lack of recognition. The discrepancy between the importance of dental auxiliaries and their current status underscores the urgent need for policy reforms and increased investment in training programs to address the shortage of skilled professionals in this field. By doing so, India can enhance its oral healthcare infrastructure and better meet dental the needs of its population.
References
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Venkat Singh. (2018). Dental Manpower Inside Into An Indian Perspective. https://www.researchgate.net/publication/323305444_Dental_Manpower_Inside_Into_An_Indian_Perspective
Bhalla M, Yadav P, Siddiqui M, Bhalla A. Operating Auxiliaries: A Review. IOSRJDMS [Internet]. 2014 [cited 2024 Apr 11]; 13(10):56–61. Available from: http://www.iosrjournals.org/iosr-jdms/papers/Vol13-issue10/Version-2/M0131025661.pdf
https://dciindia.gov.in/Rule_Regulation/Dentists_Act_1948.pdf
https://nationalskillindiamission.in/updates/2395/
https://werfidha.wixsite.com/fidha
MSM