Introduction

The prevalence and severity of dental caries is increasing in Africa and the majority (90%) of these remain untreat-ed (1). An integrated approach to control of oral diseases may prevent complications including apical pathologies through simple strategies (2-4). In this strategy, a team approach involving dentists and dental auxiliaries is ad-visable. In the continent where the ratio of dentists to the needy population is low, dental assistants, dental thera-pist, hygienist and technicians find a role in supporting the dentist by carrying out minor functions in the dental clinic and also help in providing quality services in the dental clinic in a cost-effective manner (5-7).

 

The increased oral health needs in Cameroon is not matched by proportionate distribution of dentists. Den-tal auxiliaries provide additional workforce for the deliv-ery of oral health care. There is no training program for dentists in the country. Although dental auxiliaries were formally trained by the government in the mid 70’s until 1998, only a private non- governmental organization is training dental therapists today. Dental auxiliaries receive less rigorous training of a shorter duration compared to the dentists and they are expected to perform well demarcated tasks efficiently (8). The objective of the study was to determine the training and impact of dental auxiliaries in the oral health delivery in Cameroon

 

Materials and Methods

A cross-sectional study of 47 dental auxiliaries recruited from six out of 10 provinces in Cameroon was conducted in the first quarter of 2010. This population represented 27.8% of all practicing dental auxiliaries in Cameroon. The six provinces are Littoral, North West, South West, Western Far north and Central. Ethical clearance to con-duct the study was obtained from the respective pro-vincial organs of the Cameroonian Ministry of Public Health. Informed consent was obtained from the partici-pants after being informed of the objective of the study and assured of strict confidentiality of their responses. Participation was voluntary and no incentive was de-clared. An 18-item self-administered, bilingual (English and French), questionnaire which elicited information on demography, location and institution of work , dura-tion of work, duration of training, type of training, their role in the clinic, the number of patients treated per day, and opinion of their job was used for data collection. Epiinfo version Epi 3.1.5 was used for data analysis. Test for significance was done using Chi square. P≤0.05 was con-sidered significant.

 

Results

Two-fifths (40.4%) of the respondents worked as dental therapists. Seven out of every ten respondents worked in urban  areas. A quarter (25.5%) of the respondents work in a government owned  hospital. Majority (70.2%) of the respondents had worked for < 10 years (Table 1). Out of the respondents, 80.9% had received formal training. A total of 61.7%  received training  for <3 years, 26.1% have not received any additional training  after qualifying and three-quarters (77.8%) signified interest  in further training. Among the informally trained 55.6% and

44.4%  were trained  by dentists  and dental  technicians respectively (Table 2). Most (80.9%) of the respondents carry out amalgam fillings, dental  prophylaxis (74.5%), composite fillings (70.2%), extractions (57.4%), ART (53.2%).Other procedures  include wound    suturing (38.3%), fabrication of partial dentures (36.2%), RCT (29.8%), minor injuries (27.7%), full dentures (17%) and mandibular reduction (6.4%). Out of the respon-dents, 10 (25.0%) treat ≤5 patients, 21 (52.5%) treat 6-10 patients, 5 (12.5%) treat 11-15 patients, 4 (10.0%) treat ≥ 16 patients (Table 3). A total of 13 (29.5%) of respondents worked alone i.e. without any direct supervi-sion while 31 (70.5%) had been working under the su-pervision of dentists. More than 69.2% started working without any direct supervision in < 5 years of finishing their training (Figure 1). Most respondents (80.9%) find their work rewarding and interesting, (57.4%) useful to the society (57.4%) and 38.3% tasking (Table 4).

 

Discussion

The present study has revealed that majority of auxilia-ries were dental therapists, working in urban settings and a minority trained and working in Government fa-cilities. The available training program produces dental therapists who may help in achieving integration of oral health into primary health as suggested by World Health Organization if organized redistribution is done (9). The urban location of auxiliaries typifies the inequitable dis-tribution of health workers in developing countries while the fact that only 25.6% of them received their training at Yaoundé University Teaching Hospital in the late seven-ties is consistent with the current state of affairs in the

 

Click to view table 1

 

 

continent where Governments invest little in oral health training and care. This scene favors the development of informal training programs which may suffer from lack of standardization. Majority (70.2%) of the respondents had worked for less than 10 years showing that the in-crease in number of dental auxiliaries recent which is in line with increased burden of oral health disease.

Majority of respondents had qualified within three years of the study while 77.8% signified interest in further train-ing. This desire may be exploited in training programs that aim to produce auxiliaries with expanded functions or advanced dental therapists to serve as Mid-level Oral Health Providers akin to what is operational in the State of Minnesota, USA (10).

 

This study shows that a number of auxiliaries operated in-dependently for common procedures including amalgam fillings, composite fillings, extractions, restorative treat-ment and denture fabrications. Majority (80%) of them found this quite rewarding. This suggests that this cadre of providers can meet, to a level, the treatment needs in the country. More than half of respondents treated 6-10 patients per day. There has to be however, a clear distinc-tion of what may not be safely handled at this level. Avail-able reports indicate that dentists object to delegating of duties that involve hard and soft tissue cutting (11).

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Conclusion

This study highlighted the importance of dental aux-iliaries in the oral healthcare delivery. Training and job specification was highly variable. This study calls for the establishment of a regulatory agency to standardize the training and job specification of dental auxiliaries in Cameroon.

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Click to view table 4

References

 

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2. FDI. Conferences on oral health. http://www.fdiworldental. org/content/conferences-oral-health. Accessed 01/01/ 10.

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7. Hiremath SS. Dental auxiliaries. Textbook for Preventive and Community Dentistry. 2009. 1st ed. Ch18; pg 205. Rakmo press, Delhi.

8. John J. Dental auxiliaries. A Textbook for Preventive and Community Dentistry. 2006. 1st ed. Ch. 12 Pg 148.

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10. Bio-Medicine Minnesota Passes Legislation Allowing Mid-level Oral Health Provider. http://www.bio-medicine.org/ medicine-news-1/Minnesota-Passes-Legislation-Allowing-Mid-level-Oral-Health-Provider-46256-1/. Accessed 02/07/ 10.

11. Gift HC. Utilization of auxiliaries and attitudes of dentists toward the delegation of duties. J Am Dent Assoc. 1976; 93(6):1080-5.

12. Nash D, Ruotoistenmäki J, Argentieri A, et al. Profile of the oral healthcare team in countries with emerging economies. Eur J Dent Educ. 2008; 12 Suppl 1:111-9.