Dental Public Health Al Azhar University Gaza Lama k El Banna

2. College of Dentistry
Dental Public Health
Dental Needs, Dental Demand
& Dental Manpower
Organization of Dental Care
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic

3.  To study the dental disease and the facilities for
dental care a number of leading questions about
the function of a public dental health program
must be answered:
1. What are the dental needs of a community
population?
2. How large is the demand for dental treatment
in the population?
3. What dental manpower is available to serve
the population?
4. To what extent will prevention of disease
obviate the need for treatment?

4. Dental Health Needs
 Taxonomy of need:
1. Normative needs:
The professional person defines this
need as requiring some action. E.g.:
Carious tooth → need cavity preparation and
filling.
2. Felt need:
Asking people whether they feel that
they need it, can make an assessment of the
need for a service. This is inadequate since
some asymptomatic conditions; people feel
that they do not need to be treated.

6. 3. Comparative need:
It is identified by making comparisons with
other areas or services.
4. Expressed need or demand:
It is a felt need turned to action. Mean that
when a patient feels pain, stain or cavity, he
may demand the dental service.

7.  Dental needs: are the resultant of two forces,
the disease susceptibility and previous care.
 Surveys are needed to assess dental needs, and
to implement dental health services.
 Dental needs vary from country to country and
from society to another according to many
factors:

8. I. Degree of development of the area.
II. Age and dental needs.
III. Dental needs and sex.
IV. Dental needs and income.
V. Dental needs and race.

9. I. Degree of development of the area:
A. Underdeveloped areas (Primitive areas):
1) Basic demand of such population is to be
alive and free from acute dental pain (by
exodontia), which can be reached by the
most elementary public health and
medical services without the aid of
dentistry as a specialty. In these areas no
need for dental health education for
prevention, just instruction on oral
hygiene, nutrition and water fluoridation
is sufficient.

10. 2) The demand of restoration may be felt but
there is no urge for it (as all member of the
community share).
3) The needs are simple and the demand can
easily be satisfied.

11. B. Developing areas (slightly developed):
1) Where there are lack of education, lack of
dental manpower and lack of economic
resources. So there is neither prevention of
dental diseases nor conservation of affected
teeth.
2) Dental needs and demands slightly exceed
those of primitive areas.

12. 3) Their demands are mainly exodontia and
prosthodontia (Full dentures or partial
dentures of simple design) which can be
accomplished in hospitals or in private
practices.
4) The dental demands increase as the
socioeconomic level improves.
5) Surveys are needed to establish better dental
services and to provide dental health
programs.
6) Prevention and early control of disease can
be planned for the new generation.

13. C. Developed areas:
1) In these areas we shall be thinking not only
in terms of pain and infection elimination
but also in terms of restoration of teeth to do
a good function forms.
2) Placement of missing teeth is a demand.

15. 3) Maintenance care for controlling early lesions
and dental diseases.
4) Preventive measures (water fluoridation) and
educational measures (instructions of oral
hygiene and nutrition) so that the population
may experience a lower prevalence of disease.
This is termed "Comprehensive dental care".

16. II. Age and dental needs:
Dental surveys show that the incidence of
certain diseases is correlated to age.
1) Traumatic injuries of anterior teeth:
More than 10% of trauma occurs at an
age of 12 - 14 years continue steadily, but at
slower rate.
2) Decayed teeth needing filling:
Reach their peak between 15 - 24 years.
3) Need for extraction:
Increase steadily throughout life until
age of 65.

18. 4) Need for periodontal treatment:
Reach their peak at 40 years although it is
high through the middle age.
5) Need for crowns and bridges:
In the middle age of life.
6) Need for partial denture:
Follows the need of crown and bridge.
7) Need for full denture:
In later years of life.
8) Oral cancer:
In later years of life.

19. III. Dental needs and sex:
1) Needs for fillings and periodontal care:
The same in both sexes, but women
may show slight more interest to their
oral health (to avoid cosmetic
disfigurement).
2) Needs for extraction:
Lower among women than men.
3) Needs for dentures:
Lower among women than men.

21. IV. Dental needs and income:
1) In the developed countries:
High income people → lower dental
needs. This may be due to the preventive
measures and the more frequent visits to
the dentist (Better educated).
2) In less developed countries:
High income people → higher dental
needs. This is more clearly in the younger
age group.

22. V. Dental needs and race:
In the USA differentiation between Whites
and Blacks shows greater needs among Black.
The difference occurred in the needs of filling,
periodontal treatment, extraction and
prosthodontia. Regarding racial difference, it
was found that Indian and China groups have
high needs for periodontal treatment than the
other USA citizens, in contrast, lower needs
for caries treatment.

23. Demand for Dental Care

24.  Factors affecting demand:
1. Automatic factors.
2. Dentist's efforts to stimulate demand.

25.  Factors affecting demand:
1. Automatic factors:
They are termed automatic because any
increase in one or more of them is
automatically associated with an increase in
the demand. These factors will increase the
quality of demand for dental care regardless
the effort of dentist.
A. Gross increase in population:
Utilization of dental service varies with
size of community. The larger the
community the greater the utilization rate.

26. B. Urbanization:
Proportionally more persons in urban than
in rural areas visit dentist more regularly.
Utilization difference is mainly due to
difficulty of getting to service
(transportation).
C. Education:
Utilization rate of dental service increases
with the increase in the level of education.

27. D. Occupational changes:
A direct relation exists between
occupational status and frequency of dental
visit. Persons in professional occupation visit
dentist more frequently than manual workers.
E. Income per capita:
Income per capita is correlated positively
with demand of dental service. On the other
hand, cost was found to be a major barrier
for utilization of dental service.

28. 2. Dentist's efforts to stimulate demand:
This includes dentist's efforts in the dental
health education to make the patient recognize
the sequel of neglected oral and dental
condition and to maintain the dental apparatus
healthy and functioning.

29. Dental Manpower

30. • The demand and the supply of dental care are
linked with the number of people in the dental
profession (Dentists and Auxiliaries) and the
way they make use of their time.

31.  Many factors affect the measurement of
the dental manpower:
1. Supply of dentist.
2. Geographic distribution within the
country.
3. Growth trends in supply of manpower.
4. Productivity of dentist.
5. Utilization of the dental health manpower.

32. 1. Supply of dentist:
The Dentist/Population ratio varies from
country to another.
• In Egypt:
 The number of dentists is 15000 dentists
(1999-2000).
 This represents 1 Dentist : 4000
individuals (reasonable ratio) but the
distribution is unsuitable.

33. 2. Geographic distribution within the country:
The geographic distribution of the dental
manpower varies from country to another.
• E.g. In Egypt:
 2/3 of the private offices are present in Cairo
and Giza and the other governorates suffer
from lack of dentist and dental specialists.
 Most dentists are practicing in private offices,
and smaller number join together to form
group practices.
 Any increase in the number of dentists should
be associated with an increase in the number
of auxiliaries.

34. 3. Growth trends in supply of manpower:
Growth in the number of manpower should
copy with:
 Gross increase of the population.
 Increase of demand, which is associated
with the increase of education and
socioeconomic level.

35. 4. Productivity of dentist:
It is hard to be measured, but it is known
that by the increase of dentist age. There are:
A. Decrease of the manual dexterity.
B. Reduction in the working time.

36. 5. Utilization of the dental health manpower:
Utilization may be affected by:
A. Number of manpower: as any decrease in
the manpower supply will lead to a
decrease in the dental health utilization.
B. Dentist productivity: a rational measure for
dental productivity includes information
on the reduction in incidence and
prevalence of dental disease.

37. Organization of Dental Care

38. • Dental care can be given more efficiently when
more workers share the task.
• The need to apply in one area more knowledge
than can be possessed by one man is not the only
reason for teamwork. Some tasks actually require
more than two hands. Other tasks are more
quickly or better performed if one worker
confines himself to part of the task, leaving other
parts to other workers. A reason for division of
labor lies in the different levels of knowledge
attainable within one field by persons of differing
attitude and opportunity for training.

39. • Certain parts of a task require top level skill
and knowledge. In dentistry, these are called
"professional services".
• Other parts of the task require less skill and
knowledge. These safely be delegated to
auxiliaries personnel.

40. I. Non operating:
A. Clinical:
1) The Dental Assistants.
2) Chair-side Dental Assistant.
B. Laboratory:
 Dental Laboratory Technicians.
II. Operating:
1. Dental auxiliaries.
2. Dental Hygienist.
II. New Auxiliary Type for Underdeveloped
Areas:
A. The dental licentiate.
B. The dental aides.

41. I. Non operating:
A. Clinical:
1) The Dental Assistants:
There is great variability in the utilization
of dental assistants from office to office, and it
is difficult to lay down rules concerning the
training and duties of assistants. The duties of
dental assistants generally include:

42. 1. Reception of the patient.
2. Preparation of the patient for any treatment.
3. Preparation and provision of all necessary
facilities such as mouthwashes, napkins.
4. Sterilization, care and preparation of
instruments.
5. Preparation and mixing of restorative
materials, including filling, and impression
materials.

45. 6. Care of the patient after treatment until the
patient leaves.
7. Preparation of the surgery for the next patient.
8. Preparation of documents to the surgeon for his
completion and filling of these.
9. Assistance with X-ray work and the processing
and mounting of X-rays.
10. Instruction of the patient, where necessary, in
the correct use of the toothbrush.
11. After care of persons who have had general
anesthesia.

47. 2) Chair-side Dental Assistant:
It has been found that the addition of one
dental assistant increases the number of
patients treated by a dentist by 33 percent if
he was using one chair side dental assistant
and by 62 percent if he was using two chair
side dental assistants.

48. • The increase in output depends upon
standardized operative techniques, which use a
minimum number of instruments and careful
attention on the assistant to anticipate the
operator’s needs. The quality of service and
patient control are both improved under such a
system because the operator will work under less
physical and mental strain.

50. • Currently, the utilization of dental assistant is
an accepted item of dental operating. The term
"four-handed dentistry" is now given to the art
offsetting both the dentist and the dental
assistant in such a way that both can easy
reach of the patient's mouth. The patient is in a
fully supine position.

52. • Newly designed dental equipments and
carefully planned trays containing instruments
for the operations scheduled for a given session
permit the assistant to handle the dentist a
particular instrument at the moment he needs it.
She also performs additional duties as retraction
or aspiration.

53. B. Laboratory:
 Dental Laboratory Technicians:
This group has little effect in the field
of preventive dentistry and dental care for
young children but affects in a very
important way the efficiency of dental
treatment for older patients. The work is
done mainly by men rather than by women.
Originally, training was carried out in the
dental office and this resulted in variation in
the quality of the training. There are two
reasons, which encouraged the presence of
commercial dental laboratories working for a
number of dentists.

54. 1) Few dentists have enough work to justify the
employment of a full-time technician.
2) The procedures involved in dental laboratory
work are often such as to profit by division
of labor. One technician becomes an
excellent porcelain man, another an expert
gold man, one for orthodontic appliances, the
other for chrome cobalt partial dentures, and
so on. Simple plastic work can be delegated
to the apprentices in the laboratory.

56. II. Operating:
1. Dental auxiliaries:
For sometime now, experimental efforts
have been made in some countries to train
dental auxiliaries to perform operations of
limited nature in the mouths of patients.
Dental assistants have been chosen for
these trials, and the duties involved in those
procedures which were generally agreed to
be repairable, that is, could be either
corrected or redone without undue harm to
the patient's health.

57. • The assistants would not prepare cavities or
make decisions as to pulp protection after
caries had been excavated, but would work
alongside the dentist and take over routine
restorative procedures as soon as the cavity
preparation had been completed, the
training for this type of dental assistants is
over two years period and include basic
instructions in dental science and
instructions to perform the following
operations:

58. 1) Placing and removing rubber dam.
2) Placing and removing temporary restorations.
3) Placing and removing matrix bands.
4) Condensing and carving amalgam restorations
in previously prepared teeth.
5) Applying the final polish to the previously
placed restorations.

64. 2. Dental Hygienist:
Dental hygienists are usually of two ranks:
A. Public health dental hygienists.
B. Clinical dental hygienists.

65. A. Public health dental hygienists:
They receive one or more years of health
education and public health training beyond
dental hygiene certification. The public health
hygienists do a great deal as a resource person.
They screen or preliminary examine patients
such as school children or industrial employers
in order that they may be referred to dentists
for treatment.

66. • Actual classroom teaching is possible where
additional training in education has been
received. In a public health program the
hygienist goes where dentists cannot, and
presents a point of view much closer to that of
the children with whom she is usually working
than could the dentist.

68. B. Clinical dental hygienists:
This receives less training than the public
health hygienist does. Their duties are limited,
and the usual functions of clinical dental
hygienist are cleaning of the mouth and teeth
with particular attention to calculus and stains,
polishing of the restoration, topical fluorides
applications and other prophylactic solutions.

71. III. New Auxiliary Type for Underdeveloped
Areas:
Some countries have an acute dentist
shortage and have no facilities for training
dentist. The WHO suggests two types of
dental auxiliary for such situation:
A. The dental licentiate.
B. The dental aides.

72. A. The dental licentiate:
They should be a semi-independent
operator trained for not less than 2 calendar
years to perform dental prophylaxis, cavity
preparation and fillings of primary and
permanent teeth, extractions under local
anesthesia, drainage of dental abscess,
treatment of the most prevalent diseases of
supporting tissue of the teeth, and the early
recognition of more serious dental
conditions.

73. • These people, presumably men, might be
responsible to a fully trained dentist at the
national level or to the chief of the local health
service. Supervision and control would
probably occur in rural or frontier areas.
Measures should be taken to increase the
duration of their training and their educational
requirements.

74. B. The dental aides:
Are conceived to be persons of even briefer
training who would perform functions as
elementary first aid procedures for the relief
of pain including extraction of teeth under
local anesthesia, the control of hemorrhage,
and the recognition of dental disease
important enough to justify transportation of
the patient to a center where proper dental
care is available. Supervision and control are
important particularly at first.

75. • The formal training period might last from 4-6
months followed by a period of field training,
under dental aides will probably disappear so
soon as a sufficient number of dental
licentiates or full qualified dentists become
available.