Expanded use of auxiliary personnel in orthodontic practice

Abstract

A survey of all Massachusetts orthodontists was conducted to determine the tasks presently delegated to auxiliaries and the procedures to be delegated to trained personnel in the future. Responses were received from 111 of 198 orthodontists. More than 85 per cent of the respondents presently involved auxiliaries in patient education, dental and lateral head radiography, minor emergency adjustments, and removal of cement. Placement and removal of arch wires, checking of loose bands, tracing of lateral head radiographs, taking of impressions, and removal of separators, were delegated by 55 to 80 per cent of the orthodontists questioned. Fewer than half of the respondents allowed auxiliaries to tie elastic thread, insert separators, fit, cement, and remove bands, fit retainers or headgears, or construct arch wires. If properly trained auxiliaries become available, and if their involvement is legal and covered by malpractice insurance, more than 60 per cent of the orthodontists plan to delegate all procedures mentioned except fitting, cementing, and removal of bands, fitting of retainers, and construction of arch wires. Those favoring expansion of auxiliary duties had been in practice less than 10 years, in cities over 50,000, treating more than twenty patients per day, in offices with three or more chairs, and presently employing two or more dental assistants. Male auxiliaries would be acceptable to 50 per cent of the orthodontists polled. The major reservations of opponents to expanded auxiliary duties involved (1) potential impaired quality of service, (2) hazard to patient-orthodontist relationship, and (3) nonacceptance by patient and/or parent. Those who favored expansion of auxiliary duties were concerned with the difficulty in training, high salary level, and insufficient patient load to warrant their employment.