DENTAL THERAPY PRACTICE IN NIGERIA, SOUTH AFRICA AND UNITED STATE OF AMERICA

Written by..
EGBAI HENRY CHINEDU (RDTH)

   

                   INTRODUCTION

Dental therapists provide basic dental treatment and preventive dental services in a variety of settings. Dental therapists most often work with or in collaboration with dentists to provide community-based preventive health programs to meet identified community needs.Worldwide there are at least fifty-four countries currently utilizing dental therapists services, including many employed therapists in different health centres in Nigeria. Dental therapy is an acceptable component of dental profession in Nigeria. The employment of dental therapists also holds promise for creating a more culturally diverse oral health workforce and creating sustainable jobs for people of color who may not have considered a career in the oral health field. State and federal policymakers should consider how dental therapists can be used to improve public health in a market that is increasingly being held to cost, quality, and accessibility standards.

 In the absence of nationally recognized educational standards, concerns have been raised that as dental therapy initiatives move forward, unprofessional approach to work of dental therapists at different skill levels will emerge, rather than a uniform vision of dental therapy practice. While there is always a case for flexibility in education and special types of practitioners within a given field, it is important that the basic education for that field be well defined.　

However,dental therapy profession is not uniform through out the world. It varies depending on country,place of work and quality of education acquired.                  
WHO IS A DENTAL THERAPIST

A dental therapist is a member of the dental team who provides preventive and restorative dental care usually for children, adolescence, and adults. The precise role varies and is dependent on the therapist educational level, and the various dental regulations and guidelines of each country.

                                                 HISTORY OF DENTAL THERAPY

According to David A. Nash and Ron J. Nagel, (2005). In 1913, Dr. Norman K. The president of Newzealand dental association, proposed a system of school clinics operated by state and staffed by dental therapist to address the dental needs of children between the age of 6 to 14 years. At that time the idea was considered to be an unorthodox.

In great Britain during the first World war, dental dressers were the people who carryout examinations and treatment for children in some parts of England, their roles was eliminated by the dentist acts of 1921 because of their unprofessional ways of handling patients. The works of dental dressers were later reintroduced in Newzealand scheme as dental therapist when the high need of dental needs of children were rediscovered in 1960. The Newzealand therapist were carryingout similar functions with the dental dressers of England but under the supervision of a dentist.

The success of Newzealand program was so significant that many countries facing similar problem adopted it. The countries include South Africa , Malaysia, Hongkong and so on.

                                                  DENTAL THERAPY HISTORY IN USA

In november, 2000. Oral health America sponsored a conference in Boca Raton, Florida. The point of discussion was that introducing the Newzealand style of dental therapy training could have a positive impact on aheressing the oral health disparities among Americans. Six students from Alaska were sent to Newzealand in february 2004 to study the Newzealand style dental therapist.

                                                    DENTAL THERAPY HISTORY IN SOUTH AFRICA

Dental therapy was introduced in South Africa as far back 1970. From Newzealand With an award of diploma. And recentltly in that country university of Kwazulu Natal is the only school awarding BSC and masters degree. in dental therapy after rigorous classes and clinical training.

                                                    DENTAL THERAPY HISTORY IN NIGERIA

According to Dental therapy board of Nigeria, (1991). The history of Dental therapy profession dates back to the precolonial era. High incidence of periodontal and cancrum oris were prevalent and are still common in Nigeria. This was due to poor oral hygiene and lack of good nutrition in the early fifties, thus the ever increasing demand of oral health care lead to an increase in the awareness of the importance and the use of preventive measure. This brought about the birth of dental therapy profession in Nigeria

Establishment- In 1958, a school was established by Miss Vera creaton, a Briton at No. 1 Broad street, Lagos for training of dental hygienist which later metamorphosis into Federal school of Dental Technology and Thrapy, Enugu, Nigeria.

                                                    PRACTICE OF DENTAL THERAPY

Dental therapy provides basic dental treatment, and preventive dental services in varieties of setttings. Dental therapist most often work with or in collaboration with dentists , to provide community base preventive health programmes , to meet identified community needs.

World wide, there are atleast fifty four countries utilizing dental therapist services.

THE PRACTICE OF DENTAL THERAPY IN UNITED STATE OF AMERICA

In 2009, Minnesota became the first US state to enact legislative, creating a new dental team member, the dental therapist, who is to help improve access to oral healthcare and consequently to reduce the disparities in oral health by providing services previously delivered only by dentists.

As at 2003, dental therapist were only allowed to practice in Alaska as dental health aid thareapy (DHAT)

In 2010, the kellog foundationn announced that the evaluation of the dental therapist in Alaska was found to provide safe, effective and competent care. Recently many states in USA have either created or proposed legislation to create dental therapist position and liscensure pathway. In addition there are precently other states investigating dental therapy and other workforce models in an effort to improve access to oral healthcare.(Patricia, J., 2012).

THE PRACTICE OF DENTAL THERAPY IN SOUTH AFRICA

According to South African department of halth, (1978). A registered dental therapist must refer to a dentist or dental specialist, all cases outside the scope of the profession of dental therapy which may include but not limited to;

-pupal exposure

-impacted teeth

-malocclusion

-the replacement of missing teeth including the requirements for fixed and removable prosthesis or implants.

A registered dental therapist in South Africa may only practice independently after serving atleast one year under the control and clinical supervision of a registered dentist or another dental therapist registered in the category of independent practice for atleast three years and with approval of t0he board.                              DENTAL THERAPY PRACTICE IN NIGERIA

In Nigeria, the practice of dental therapy varies from different establishments such as tertiary hospitals, federal medical hospitals state hospitals, primary health care centres and private clinics.

There is no general lay down of duties assigned to dental therapists in Nigerian hospitals, but each establishment set their own rules guiding the duties of a dental therapist in that organization.

Most teaching hospitals in Nigeria and Federal medical hospitals allows therapist to carryout only scaling and polishing and other preventive measures such as deep scaling and oral health education.

In some state hospitals were their are short of dental personnels, dental therapist maybe allowed to carryout more duties such as scaling and polishing, curretage, topical floridation, oral health education and so on.

In private clinics, dental therapist carryout almost all preventive proceedures such as scaling and polishing, curretage, taking of impression,they can also be allowed to carryout some minor conservative and surgical treatment such as temporary fillings,extraction of decidous tooth and mobile tooth.

In Nigeria a registered dental therapist can also operate a private clinic just like in South Africa and USA.

PROBLEMS FACING DENTAL THERAPIST (NOT LIMITED TO A COUNTRTY)

Rebecca Claunch, (2009). States that daily challenges in dental therapist are numerous and varies . with that in mind, be aware that dental therapist are expected to do more, and perform at a level that is frequently not consistent with pay or appreciation.

For many therapist, a developing trend appears as a continual effort by dentist and staff to marginalize the dental therapist abilities and knowledge. Despite ever increasing education liscensure standards. Dental therapist work indifferently everyday, utilizing a dental therapy education, critical thinking and skills attained through rigorous training and preparation.

As dental therapy becomes more complicated, and as information and technology move forward at rapid rates,the stress related in treating patient in this environment is immense, advances and continue to explode on the horizon for dental therapist, unfortunately many dental establishments will wait for years before seeing or acquiring any of the modern equipments.

Tight budget controls in the dental therapist units often leave therapist working in a demoralized conditions striving to provide the best treatment possible using what ever means that are available.

In some dental clinic, after the therapist had finish treatment, the dentist comes to examine the work done, this scenerio fuels the mind set that the dentist checks the therapist work as if the therapist is not a proficient health care professional capable of treating patient competently .circumstances like this promote depression while low morale creeps in slowly.

　

RECOMMENDATIONS TO IMPROVEMENT OF DENTAL THERAPY            PRACTICE IN NIGERIA

In order to improve the services rendered by dental therapist in Nigeria, the following factors should be put into consideration by both the government, the therapist board, dental therapist training schools and hospital managements.(Karl, D. 2017).

1 Proper training of dental therapist during school and after school in other for them to familiarize with the modern and changing trends in the profession.

2 Qualified teachers should be allowed to mentor the students and those without proper qualifications should be layed aside.

3 There should be conducive environment for learning and upto date equipments for clinical and laboratory trainings.

4 Government should enact laws that will favour the improvement of workers and dental therapist in particular.

5 Government should provide adequate training centres for internship which will enable students to go straight to training centres immediately after graduation instead of staying at home for a longer time and not having interest again on what they had been trained to become.

6 Interns students should be posted to other units of preventive or conservative departments during training, such as xray unit. This will expose and expand their general knowledge of dentistry.

7 Dental therapist should be paid on time in order to motivate them.

                                                                                      CONCLUSION

Nigerians have a substantial unmet need for dental care, as it is indicated by the number of dental cases recorded in each working day in Lagos university teaching hospital Idiaraba, and many other government and private owned dental centres in Nigeria. The coexistence of these circumstances provides an opportunity for improving dental health and adequate training of dental therapist in tackling this dental problems with other team of dental personnels through direct support of an efficacious prevention program and implementation of an insurance plan to cover costs of dental services that can help control dental disease, reduce the backlog of need for care, and improve the quality of life for most Nigerians.

Regrettably, there is no uniform roles performed by dental therapist all over the countries in the world. What is applicable in USA may not work in Nigeria and may not be applied in South Africa but one thing is common among the roles of a dental therapists in the three countries which is the scaling and polishing of the teeth and oral health education. United state of America and South Africa are far ahead of Nigeria in the practice of dental therapist. Because both countries dental therapists are giving the opportunities to carryout many other preventive and retorative duties in both government owned hospital and private hospitals. This privilage may be attributed to the fact that they have a standard training facilities in training dental therapist to degree level. Nevertheless Nigeria is gearing up in improving the trainings giving to dental therapist, so they could be able to compete with their counterparts in other part of the countrty this can be seen in the recent liscencure giving to Federal school of dental therapy and technology Enugu to award BSC degrees in dental therapy. And we hope that many other improvent will come up as time goes on.