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ETHICS IN DENTISTRY

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Dental Manpower DR JJ

CONTENTSIntroduction Effect of oral health on general healthLevels of health careExisting health infrastructureNational health expenditureOral Disease burden in India2

Dental health services- WHO ClassificationOral health care system in IndiaDental work force in IndiaDentist Dental Auxiliaries3

Role of dental AuxiliaryChallenges to oral health work force in IndiaRecommendationConclusionPrevious year questionsReferences

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Adentist, is asurgeon who specializes indentistry the diagnosis, prevention, and treatment of diseases and conditions of theoral cavity. The dentist'ssupporting team aids in providing oral health services. The dental team includesdental assistants,dental hygienists,dental technicians, and in some countries,dental therapists.5

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ORAL DISEASE BURDEN 7

Oral Disease burden is increasing in the country. This burden does not only have impact upon general health but also affect psychology and economy of the individuals, families and society. Oral problems are not only causing pain, agony, functional and esthetic problems but also lead to loss of working man-hours. 8

Oral health is an integral component of general health. Dental Caries and Periodontal problems are almost universal and are found in many populations and age groups across the globe and all economies. India is no exception to these problems and they are widely prevalent in India too. The other common oral health problems in India are Oral Cancer, Fluorosis and Malocclusion.

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About 60% of school children are suffering from Dental caries and more than 90% of adults are having periodontal diseases. Oral cancer is a life threatening - treatment modalities - expensive and are way beyond the reach of the common man.They can be prevented and controlled - health education and motivation 10

Thus it is a high time to activate preventive programmes.To achieve this, we need to have indulgence of dental manpower at various levels.This can be accomplished through the effective utilization and management of the Dental Health Care resources11

EFFECT OF ORAL HEALTH ON GENERAL HEALTH12

Oral health and general well-being are inextricably bound. Many conditions that plague the body are manifested in the mouth.The wide array of habitat renders the mouth-microbial paradise.13

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Oral infection can have an adverse effect on other organs of the body.Broad range of systemic disorders = Diabetes, AIDS, Sjogren's syndrome, as well as complications of treatments like Cancer Chemotherapy and Radiation.Periodontal disease - Infective Endocarditis Coronary Artery Disease, Stroke, diabetes etc.14

Public Health Expenditure

This is very unfortunate that till date in India no serious effort been taken to improve oral health of the masses.Till today oral health does not have a separate budget allocation in national or state health budget. As compared to other countries, we are still lacking in paying sufficient attention to such an important part of our health.

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In India with increasing level of oral diseases, limited resources and manpower it seems practically impossible to provide curative services to each and every individual, which is primary duty of Government of India.To find out a viable mean to handle such situation the only alternative seems to be PREVENTIVE APPROACH

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Social Impact Oral health is related to well-being and quality of life as measured along functional, psychosocial, and economic dimensions. Diet, nutrition, sleep, psychological status, social interaction, school, and work are affected by impaired oral and craniofacial health. 17

ORAL HEALTH CARE SYSTEM IN INDIAOral health care in India is delivered mainly by the following establishments:

Government organizations

a. Government Dental Colleges b. Government Medical colleges with dental wing c. District Hospitals with Dental Unit d. Community Health Centers e. Primary Health Centers - Dental units18

2. Non-governmental a. Private Dental Colleges b. Private Medical Colleges with Dental Wing c. Corporate Hospitals with Dental Units

3. Private practitioners a. Private dental practitioners b. Private dental hospitals c. Private medical hospitals with dental units19

4. Indigenous systems organizations a. Ayurveda b. Sidda c. Unani d. Homeopathy 5. Voluntary organizationsNGOsState IDAsColgate palmoliveRotary clubsLocal authorities, etc.

6. National oral health programmes20

DENTAL WORKFORCE

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Dentists Dental Auxiliaries

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DENTIST

A dentist is a person licensed to practice dentistry under the law of the appropriate state, province, territory or nation.

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Completion of an approved period of professional education in an approved institution.Demonstration of competence Legally entitled to treat patients independently, to prescribe certain drugs and to employ and supervise auxiliary personnel.Dentists must be both licensed and registered.

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After being trained for 4 years, followed by one year of paid CRRI, the student is conferred the degree of BDS.The student has to register with DCI through the state dental council. he/she can practice dentistry or can pursue PG in a specialty of his/her choice of subject, leading to a masters degree MDS.25

DEVELOPMENT OF THE DENTAL PROFESSION

Dental diseases have always afflicted human health.The first written evidence on dentistry is by Pierre Fauchard in 1728.Even the well known dentist G.V. Black had possessed a formal education of dentistry in just 20 months.Baltimore college of dental surgery (1840) was the first dental college in world. Later known as University of Maryland.

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First journal of dentistry was The American Journal of Dental Sciences.The first Organization was named The American Society of Dental Surgeons.The first census was in 1850 in the US which showed a dentist: population ratio of 1:8000.

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DENTAL PROFESSION IN INDIA

Dr. Rafiuddin Ahmed started the first dental college in Calcutta in 1920.At the time of independence, there were only 2 government institutions, Lahore and Bombay, and there were 19 private institutions such as 28

Nair dental college (Bombay) and The Calcutta college.Presently, there are 309 dental colleges in India.

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The World Health Organisation recommends a 1: 7500 dentist to population ratio whereas the dentist to population ratio in India is as low as 1:22500. (World Health Organization:Recent advances in oral health.InTechnical Report Series-826. World Health Organization; 2012:1-37.)In 2014, India had one dentist for 10,000 persons in urban areas and about 2.5 lakh persons in rural areas. (India Ministry of Health and Family Welfare and Dental Council of India. Status of dental colleges for admission to BDS course. At:http://mohfw.nic.in/Adental.html.)

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Almost three-fourths of the total number of dentists were clustered in urban areas, which house only one-fourth of the country's population.

(Tandon S:Challenges to the Oral Health Workforce in India. J Dent Education2004,68:29-33.)

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DENTAL AUXILIARY

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Dental auxiliary is generic term for all persons who assist the dentists in training patients.

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WHO Definition (1958)

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.The duties undertaken by dental auxiliary 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 OF DENTAL AUXILIARIES:

Dental auxiliaries may be classified according To the training they have received, The task they are expected to undertake, The legal restrictions placed upon them. While different titles have been given to groups of auxiliaries classified in this way, terminology is not consistent from one country to another. 35

Therefore, unless standard definitions are provided of what constitutes a dentist, a dental therapist, or any other dental health worker, national and international statistics cannot be comparable and meaningful. International Labour Organization and by the conference conducted by the World Health Organisation in New Delhi in 1967

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WHO CLASSIFICATION

NON OPERATING AUXILIARIES a) CLINICAL - a person who assists the dentist in his clinical work but does not carry out any independent procedures in the oral cavity. b) LABORATORY - a person who assist the professional (dentist) by carrying out certain technical laboratory procedures.

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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.

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REVISED CLASSIFICATION Slack GL, Burt BA (1981)NON OPERATING AUXILIARIESDental surgery assistantDental secretary/ receptionistDental laboratory technicianDental health educatorOPERATING AUXILIARIESSchool dental nurse Dental therapistDental hygienist Expanded function dental auxiliaries

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FUNCTIONS OF DENTAL AUXILIARIES

40Performing oral prophylaxisProviding health education Applying anti cariogenic agentPlacing & removing rubber damsPlacing & removing matricesPlacing & removing temporary restorationsPlacing, carving & finishing amalgam restorationsOffice & chair