Dental auxiliary staff – According to the dental auxiliary staff regulation the dentists using the services of dental auxiliaries must post, in a common area of the office, a note that explains duties and functions deemed to be delegated within stipulated settings and/or circumstances. The notice should be readily accessible to all office personnel. Posting this notice, however, is not the end of the dentist’s responsibility for adequate supervision of dental auxiliary staff. The Dental Practice Act requires supervision of auxiliaries for all delegated duties.
Delegation of duties and responsibility by the supervising dentist beyond the auxiliary’s scope of practice is not only illegal, but also unethical for the dentist and dangerous for his/ her patients.
Dentists must also understand that they cannot avoid responsibility for acts committed by dental auxiliary staff under their supervision. Failure to supervise auxiliaries properly can result in Dental Council/State Board disciplinary action against a dentist’s license or create a civil lawsuit. As defined in the Dental Practice Act, a Direct Supervision of dental auxiliary staff means supervision of dental procedures based on instructions given by a licensed dentist who must be physically present in the treatment facility during performance of these procedures. A General Supervision of dental auxiliary staff means supervision of dental procedures based on instruction given by licensed dentist, but not requiring the physical presence of the supervising dentist during the performance of those procedures.
In dental offices, there are three valuable members of the care-giving team for dental auxiliary staff: the dentist, the dental hygienist and the dental assistant.
In modern day dentistry, the dentists are generally hire more assistants to perform routine tasks so that they may devote their own time to more profitable procedures. Most assistants of the dental auxiliary staff learn their skills on the job, although an increasing number are trained in dental-assisting programs; most programs take one year or less to complete. Because of the nature of their work, Dental assistants generally work in a well-lighted, clean environment.
Their work area usually is near the dental chair so that they can arrange instruments, materials, and medication and hand them to the dentist when needed. Dental assistants must wear gloves, masks, eye wear, and protective clothing to protect themselves and their patients from infectious diseases. Following safety procedures also minimizes the risks associated with the use of X-ray machines.
Dental assistants of the dental auxiliary staff perform a variety of patient care, office, and laboratory duties. They work chair side as dentists examine and treat patients. They make patients as comfortable as possible in the dental chair, prepare them for treatment, and obtain their dental records. Assistants hand instruments and materials to dentists and keep patients’ mouths dry and clear by using suction or other devices. Assistants also sterilize and disinfect instruments and equipment, prepare trays of instruments for dental procedures, and instruct patients on postoperative and general oral health care.
Some dental assistants prepare materials for impressions and restorations, take dental X-rays, and process X-ray film as directed by a dentist. They also may remove sutures, apply topical anesthetics to gums or cavity-preventive agents to teeth, remove excess cement used in the filling process, and place rubber dams on the teeth to isolate them for individual treatment.
Those with laboratory duties make casts of the teeth and mouth from impressions, clean and polish removable appliances, and make temporary crowns. Dental assistants with office duties schedule and confirm appointments, receive patients, keep treatment records, send bills, receive payments, and order dental supplies and materials.
Dental assistants of the dental auxiliary staff should not be confused with dental hygienists, who are licensed to perform different clinical tasks.
In a Dental Office generally following guidelines are followed while delegating the duties to the dental auxiliary staff:
(a) Unless specifically so provided by regulation, a dental assistant may NOT perform the following functions or any other activity which represents the practice of dentistry or requires the knowledge, skill and training of a licensed dentist: (1) Diagnosis and treatment planning; (2) Surgical or cutting procedures on hard or soft tissue; (3) Fitting and adjusting of correctional and prosthodontic appliances; (4) Prescription of medicines; (5) Placement, condensation, carving or removal of permanent restorations, including final cementation procedures; (6) Irrigation and medication of canals, try-in cones, reaming, filing or fiffing of root canals; (7) Taking of impressions for prosthodontic appliances, bridges or any other structures which may be worn in the mouth; (8) Administration of injectable and/or general anesthesia; (9) Oral prophylaxis procedures.
(b) A dental assistant may perform such basic supportive dental procedures as the following under the general supervision of a licensed dentist: (1) Extra-oral duties or functions specified by the supervising dentist; (2) Operation of dental radiographic equipment for the purpose of oral radiography if the dental assistant has completed the required training of radiology; (3) Examine orthodontic appliances.
(c) A dental assistant may perform such basic supportive dental procedures as the following under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist. (1) Take impressions for diagnostic and opposing models, bleaching trays, temporary crowns and bridges, and sports guards; (2) Apply non-aerosol and non-caustic topical agents; (3) Remove post-extraction and periodontal dressings; (4) Placement of elastic orthodontic separators; (5) Remove orthodontic separators; (6) Assist in the administration of nitrous oxide analgesia or sedation however, a dental assistant shall not start the administration of the gases and shall not adjust the flow of the gases unless instructed to do so by the dentist who shall be present at the patient’s chairside at the implementation of these instructions. This regulation shall not be constructed to prevent any person from taking appropriate action in the event of a medical emergency; (7) Hold anterior matrices; (8) Remove sutures; (9) Take intraoral measurements for orthodontic procedures; (10) Seat adjusted retainers or headgear, including appropriate instructions; (11) Check for loose bands; (12) Remove arch wires; (13) Remove ligature ties; (14) Apply topical fluoride, after scaling and polishing by the supervising dentist or a registered dental hygienist; (15) Place and remove rubber dams; (16) Place, wedge and remove matrices; (17) Cure restorative or orthodontic materials in operative site with light-curing device.
With the support of the hygienist, dentists can provide better professional care to more patients, thus increasing both the quality of the dental treatment and the productivity of the office.
A registered dental hygienist may perform all duties assigned to registered dental assistants, under the supervision of a licensed dentist as specified earlier. However, Dental hygienist may perform the following duties in addition to those mentioned earlier for Dental Surgery Assistant (DSA):
1. Root planing;
2. Polish and contour restorations;
3. Oral exfoliative cytology;
4. Apply pit and fissure sealants;
5. Preliminary examination, including but not limited to: (A) Periodontal charting; (B) Intra and extra-oral examination of soft tissue; (C) Charting of lesions, existing restorations and missing teeth; (D) Classifying occlusion; (E) Myofunctional evaluation.
6. The following direct supervision duties of dental assistants:
(i) Taking impressions for diagnostic and opposing models;
(ii) Applying non-aerosol and non-caustic topical agents;
(lii) Removing post-extraction and periodontal dressings;
(iv) Removing sutures;
(v) Taking intra-oral measurements for orthodontic procedures; Checking for loose bands; Removing ligature ties;
Applying topical fluoride; and Placing elastic separators.
7. The following direct supervision duties of registered dental assistants:
(i) Test pulp vitality;
(ii) Removing excess cement from supragingival surfaces of teeth;
(iii) Sizing stainless steel crowns, temporary crowns and bands;
(iv) Temporary cementation and removal of temporary crowns and removal of orthodontic bands; and
(v) Placing post-extraction and periodontal dressings.
A registered dental hygienist may perform the procedures set forth below under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist:
(1) All duties so assigned to a dental assistant or a registered dental assistant, unless otherwise indicated;
(2) Periodontal soft tissue curettage;
(3) Administration of local anesthetic agents, infiltration and conductive, limited to the oral cavity; and
(4) Administration of nitrous oxide and oxygen when used as an analgesic, utilizing fail- safe type machines containing no other general anesthetic agents.
REGISTERED DENTAL HYGIENIST IN EXTENDED FUNCTIONS (RDHEF)
Duties and Settings
An RDHEF may perform all duties assigned to dental assistants, registered dental assistants and registered dental hygienists. In addition to it the RDHEF can also perform the certain specified duties in a Dental Office. An RDHEF may perform the procedures set forth below under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist:
(1) Cord retraction of gingivae for impression procedures;
(2) Take impressions for cast restorations;
(3) Take impressions for space maintainers, orthodontic appliances and guards;
(4) Prepare enamel by etching for bonding; The Dental Councils or Dental Boards in
(5) Formulate indirect patterns for endodontic most of the countries require the dentist to post and core castings; examine and diagnose all new patients prior to
(6) Fit trial endodontic filling points; and delegating general supervision duties to auxiliaries.
(7) Apply etchant for bonding restorative materials.