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Series of Reports on European Orthodontics |
Specialist Practice, Erding, Germany
Department of Orthodontics, University of Athens, Greece
Eastman Dental Institute for Oral Health Care Sciences, University College, 256 Gray's Inn Road, London WC1X 8LD, U.K.
Centre for Dental Postgraduate Education, University of Edinburgh, Edinburgh, U.K.
Department of Orthodontics, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
Abstract
This paper reports on a survey which was undertaken to investigate the delegation of orthodontic tasks and the training of chairside support staff in Europe. Two questionnaires were posted to all members of the EURO-QUAL BIOMED II project together with an explanatory letter. The first dealt with the delegation of nine clinical tasks during orthodontic treatment. The second with the types of chairside assistant employed in each country and the training that they are given. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 22 countries. They indicated that there was no delegation of clinical tasks in six of the 22 countries and delegation of all nine tasks in five countries. The most commonly delegated tasks were taking radiographs (in 14 of the 22 countries) and taking impressions (in 13 of the 22 countries). The least commonly delegated tasks were cementing bands (in five of the 22 countries) and trying on bands (in six of the 22 countries). Seven of the 22 countries provided chairside assistants with training in some clinical orthodontic tasks. Eighteen of the 22 countries provided general training for chairside assistants and offered a qualification for chairside assistants. Four of these 18 countries reported that they only employed qualified chairside assistants. Of the four countries which reported that they did not provide a qualification for chairside assistants, two indicated that they employed chairside assistants with no formal training and two that they did not employ chairside assistants. It was concluded that there were wide variations within Europe as far as the training and employment of chairside assistants, with or without formal qualifications, and in the delegation of clinical orthodontic tasks to auxiliaries was concerned.
Key words: Chairside Support Staff, Europe, Orthodontic Tasks, Training.
Introduction
This survey was one of a series carried out by the Professional Development Group (PDG) of the EUROQUAL BIOMED II project (ter Heege, 1997
).
The PDG were aware that the law differs widely from country to country within Europe as far as the delegation of clinical tasks in dentistry is concerned. However, a review of the literature revealed that, although there was good data for a few countries, no data was available for many countries with regard to exactly which tasks could be delegated or of the training provided for orthodontic auxiliaries or chairside support staff.
The survey was limited to non-dentist personnel who perform clinical tasks related to orthodontics (orthodontic auxiliaries), or who assist dentists and orthodontists, at the chairside (chairside support staff). It did not seek to obtain information relating to professions complimentary to dentistry, including dental technicians, hygienists, and therapists, who may perform some of the clinical tasks listed in the questionnaire (such as scaling and polishing, and taking radiographs) in some countries.
Aims
This survey aimed to establish, in the countries surveyed:
Methods
The methodology described in the general introduction to this series of papers was used.
However, in this particular survey two questionnaires (Figures 1 and 2), rather than one were employed.
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It was possible to validate the responses from 22 countries.
As far as delegation to a nurse (chairside assistant) or orthodontic auxilliary was concerned, the responses indicated that all nine of the orthodontically related tasks listed in the questionnaire (Figure 1
) could be delegated in five of the 22 countries (Austria, Finland, the Netherlands, Norway, and Sweden). In a further five countries (Czech Republic, Denmark, Germany, Portugal, and Spain) at least five of the specified tasks could be delegated. At the other end of the scale, it was reported that none of the specified tasks are delegated in six countries (Belgium, France, Greece, Hungary, Poland, and Slovenia), and only one task in a further four countries (Ireland, Italy, Switzerland, and the U.K.). In three of these four countries (Ireland, Italy, and the U.K.) the task which could be delegated was reported to be the taking of radiographs. This was the most commonly delegated task (reported as taking place in 14 of the 22 countries). The next most commonly delegated task was the taking of impressions (reported as taking place in 13 of the 22 countries). The least frequently delegated tasks were reported to be cementing bands, taking place in five of the 22 countries, and trying in bands, taking place in six of the 22 countries (Figure 3).
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With the exception of four countries (Albania, Belgium, Hungary, and Italy), it was reported that there was formal training, which could lead to a formal qualification for chairside assistants (dental nurses) in all responding countries. Of these four countries, two (Albania and Hungary) reported that no chairside assistants, either qualified or unqualified, were employed. The responses from a further four countries (Norway, Slovenia, Sweden, and Switzerland) indicated that chairside assistants without formal training and a qualification were not employed as chairside assistants. In the remaining 14 countries it was reported that there were chairside assistants with both formal general (as opposed to orthodontic) training and a qualification and those with no formal training (Figure 4).
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For many years, in the United States of America and Canada, a range of routine orthodontic tasks have been delegated to suitably trained dental nurses (chairside assistants), who work as orthodontic auxiliaries under the supervision of an orthodontist. The current survey has indicated that there is no uniform pattern for the use of orthodontic auxiliaries in Europe. An analysis of the results of this survey has indicated that with the exception of the Czech Republic, Portugal, and Spain, delegation is commoner in Northern European countries. As Portugal and Spain currently have fewer dentists per 10,000 inhabitants (Eaton et al., 1998) than any other countries in the European Economic Area and relatively few orthodontists (Widström et al., 1996) it is not surprising that at least five of the tasks listed in the questionnaire were delegated, thus improving the availability of orthodontic treatment to their populations. However, three of the countries which reported that they allowed delegation of all the tasks listed in the questionnaire (Finland, Norway, and Sweden) currently have high dentists to population ratios (Eaton et al., 1998) and relatively large numbers of orthodontists for their populations (Widström et al., 1996). As far as the decision whether to delegate routine orthodontic (or other tasks) is concerned, in some countries, existing national laws and the views of the dental profession may have exerted greater influence in the past, than the ‘national wish’ to make orthodontic treatment more available to the population.
As far as training was concerned, it was encouraging to see that 18 of the 22 countries who responded to the questionnaire indicated that they employed chairside assistants (dental nurses) with general dental training and qualifications in dental nursing. However, there was clearly a wide range of practice in that two countries reported that they did not train or employ chairside assistants and two that they only employed chairside assistants with no formal training. Fourteen reported that they employed both formally trained and untrained chairside assistants, and four that they employed only formally trained and qualified chairside assistants.
Although seven countries reported that they provided specific training in orthodontic tasks for chairside assistants, only two (Finland and Sweden) reported that they allowed trained orthodontic auxiliaries to undertake all nine of the tasks listed in the questionnaire once they had completed training. Four of the seven allowed most of the nine tasks to be delegated after specific orthodontic training and the final country (Bulgaria) only two tasks. It was perhaps surprising that three of the five countries which reported that they allowed all nine orthodontic tasks to be delegated and many of those who reported that they allowed some tasks to be delegated, also reported that they provided no specific (formal) orthodontic training for the chairside assistants who carried out these tasks. It may well be that in these countries training is provided informally, at the chairside, by the orthodontists concerned.
In conclusion, this survey has shown a wide diversity in current practice with Europe as far as the delegation of orthodontic tasks to chairside assistants is concerned and in the training and employment of formally trained or untrained chairside assistants.
Acknowledgments
The authors would like to thank members of the EURO-QUAL BIOMED II project, and colleagues in the countries who took part in the survey for their help and advice. Thanks are also due to Kate McWilliams for her help in producing the figures.
References
Eaton, K. A., Widström. E. and Renson, C. E. (1998) Changes in the numbers of dentists and dental caries levels in 12-year-olds in the countries of the European Union and European Economic Area, Journal of the Royal Society of Health, 118, 40–48.[Medline]
ter Heege, G. J. (1997)EURO-QUAL, Towards a Quality System for European Orthodontic Professionals,European Commission, Biomedical Health Research, Directorate General XII, Science, Research and Development,I.Q. Press, Amsterdam, The Netherlands.
Widström, E., Eaton, K. A. and van der Heuvel, J. (1996)Dentistry in the EU and EEA—a Council of European Chief Dental Officers' Survey,STAKES, Helsinki.
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  F. Gijbels, D. Debaveye, M. Vanderstappen, and R. Jacobs Digital radiographic equipment in the Belgian dental office Radiat Prot Dosimetry, December 1, 2005; 117(1-3): 309 - 312. [Abstract] [Full Text] [PDF]
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