Dental Nursing in India: Present and Future

Introduction

A scheme for dental nursing was established in Wellington, New Zealand, in 1921 due to the extensive dental diseases found in army recruits during the First World War. T.A. Hunter is regarded as the founder and pioneer in the establishment of a dental school in New Zealand.

A dental nurse assists the dentist in all aspects of patient care related to the dental treatment, including preparing the patient for treatment and/or surgery, and also supports other team members. They also perform administrative duties.¹

Scope for dental nurses across the globe

Formal training in the field of dental nursing was first established in the 1930s, during which the importance of the role of a dental surgery assistant was recognized. This created the need for a specific type of education for a chairside assistant that would prepare them for providing professional support both in surgical procedures and the overall management of patients.

In 1993, the Nuffield Foundation identified the training and regulation of dental auxiliaries and reported the role of the dental nurse as ‘formally reappraised, defined, and nationally recognized both inside and outside dentistry’. As a result, the concept of dental nurse registration evolved.²

Dental nurses have generally been referred to as dental therapists since the 1980s.3 In New Zealand, they were initially trained to perform oral prophylaxis, intracoronal restorations, extraction of primary teeth, as well as provide dental health and diet counseling. Now, as dental therapists, they provide a full range of preventive and restorative services, including placement of preformed stainless steel crowns, as well as pulpal therapy for primary teeth. In 2006, the curriculum for dental therapy and hygiene was structured into a three-year academic program, which provided the therapists the advantage of learning both simultaneously in a single program. An additional dental therapy program was established in Auckland in 2002 that has also made the transition to a joint therapy/hygiene curriculum.³

The Childsmile initiative

In 2006, the Scottish government initiated Childsmile, an oral health improvement program, for children in Scotland in view of their poor oral health, as well as the variations in their oral health. An action plan was formulated for improving oral health and modernizing the dental services in Scotland for infants and preschool children, which could probably be achieved only through the enhanced duties of dental care professionals (DCPs) and support workers. The National Health Service (NHS) education program offers training to registered dental nurses and others, to develop a skilled workforce. This training requires mandatory attendance for standardized courses and satisfactory demonstration of the acquired skills in order for the dental nurses to participate in direct care delivery as part of the Childsmile initiative.⁴

The United Kingdom currently leads the world with regard to the number of professional dental nurses, as it mandates dental nurses to be fully trained and registered after a limited period of training.^1,2 The General Dental Council (GDC) had 55,691 registered dental nurses – the largest percentage of registrants at 51%, as of January 2017.^3,5 The GDC describes dental nurses as ‘registered dental professionals who provide clinical and other support to registrants and patients’.⁶ According to GDC, newly qualified dental nurses are a part of the Professionals Complementary to Dentistry (PCD). They are eligible to join the dental team after undergoing a recognized, approved, and externally validated training program and gaining a nationally recognized qualification that can be registered with the GDC.⁷ Registration with the GDC for all DCPs responsible for patient care, directly or in a supporting role, became mandatory on August 1, 2008. The GDC (2009) publication, Scope of Practice, offers clear and definite guidance on the expected roles of all dental registrants.⁸

The requirement for registration of dental nurses not only formally recognized their skills and professionalism but also expanded their clinical roles and responsibilities. It is, therefore, a great opportunity for both individual dental care professionals and the team as a whole.⁸

Since their introduction in New Zealand, dental nurses/ therapists have improved access to oral health care in several countries. The details pertaining to the number of registered dental nurses, their roles and responsibilities, etc., are well documented in various countries including Australia, Canada, Malaysia, Tanzania, and the United States.³

Need for dental nursing in India

In India, the need for dental nursing professionals, essentially to create awareness regarding the importance of oral health as a part of general health, has increased as oral cavity problems lead to mental trauma and social isolation in addition to affecting oral health.

Dental caries is the most common dental problem that affects 3.9 billion people worldwide.⁹ A demand-based calculation of dental manpower needs in India suggests one dentist for every 13,239 people, irrespective of the regional spread.^10,11 There is a mismatch between the demand and availability of oral health care facilities, especially in rural regions. This can be overcome by an even-handed dispensation of existing dental manpower to such areas.¹²

The incidence of oral disease, which is largely preventable and manageable, can be reduced by providing basic treatment needs and carrying out health promotion activities. This necessitates an extensive dental workforce which would include dental surgeons, general dentists, dental auxiliaries, and PCDs.¹³

A remarkable contribution can be made by the synergistic work of dentists and professional dental nurses. Thus, qualified dental nurses with good standards of professionalism and skills for providing goodquality patient care are indispensable. Unfortunately, in India, dental nursing is just beginning to emerge as a profession. Indian Dental Nursing offers Diploma in Dental Nursing certification to students after completing training and assessment following a one-year study period.¹ Thus, establishment of systematic education and training of dental nursing professionals in India would positively impact oral health, leading to enhanced health and welfare of the general population as a whole.

Conclusion

Dental disease is a significant public health concern that greatly impacts the quality of life, which in turn affects the performance of an individual and life in general. There is a vast difference in the oral health status between urban and rural populations of India and developed countries.¹⁴ The existing situation demands the formulation and implementation of a national policy in India to develop oral health care and make it more affordable and accessible to the population through dental nurses. This can be achieved by standardizing and recognizing the field of dental nursing as a profession, which will also enhance health literacy and lessen the inequalities in dental health.¹⁵ There is a need for dental health planners and policy makers who have the relevant qualifications and training to understand the unique needs and resources for the development of an effective policy. It is the responsibility of the Dental fraternity in India to implement such policies in collaboration with the state and central governments, to ensure better oral health and quality of life throughout the country.

Conflict of Interest

None.