SURVEY OF THE DENTAL WORKFORCE IN THE COMMONWEALTH · PDF file · 2012-12-20SURVEY...

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SURVEY OF THE DENTAL WORKFORCE IN THE

COMMONWEALTH

2007

Author

Dr Anthony S Kravitz OBE, BDS, MFGDP(UK), MPhil, FFGDP(UK)

Honorary Treasurer

Commonwealth Dental Association

© Dr Anthony S Kravitz

No part of this survey may be produced in other written or published material without the written permission of

the author, which may be obtained from [email protected] . However, the content of the survey may

be quoted as part of personal presentations, provided the original author is acknowledged.

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The Commonwealth is an association of 53 countries. In addition there are a number of self-governing British, Australian and New Zealand dependencies

which derive benefit from being associated with the Commonwealth. Its nearly 2 billion citizens, about 30 per cent of the world's population, are drawn from the broadest range of faiths, races, cultures and traditions.

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Contents

Part 1 .................................................................................................................................. 5 Introduction ....................................................................................................................... 5 Definitions .......................................................................................................................... 5 Aims and Objectives ......................................................................................................... 6 Methodology ...................................................................................................................... 6 Results ................................................................................................................................ 6 Part 2 ................................................................................................................................ 14 Part 2 ................................................................................................................................ 15 Independent countries .................................................................................................... 15 Antigua and Barbuda ..................................................................................................... 15 Australia........................................................................................................................... 17 Bahamas ........................................................................................................................... 18 Bangladesh ....................................................................................................................... 21 Barbados .......................................................................................................................... 22 Belize ................................................................................................................................ 25 Botswana .......................................................................................................................... 27 Brunei Darussalem.......................................................................................................... 29 Cameroon......................................................................................................................... 31 Canada ............................................................................................................................. 33 Cyprus .............................................................................................................................. 35 Dominica .......................................................................................................................... 37 Fiji..................................................................................................................................... 39 Gambia ............................................................................................................................. 41 Ghana ............................................................................................................................... 43 Grenada ........................................................................................................................... 45 Guyana ............................................................................................................................. 47 India ................................................................................................................................. 49 Jamaica ............................................................................................................................ 51 Kenya ............................................................................................................................... 53 Kiribati ............................................................................................................................. 55 Lesotho ............................................................................................................................. 57 Malaysia ........................................................................................................................... 59 Maldives ........................................................................................................................... 61 Malta ................................................................................................................................ 63 Mauritius ......................................................................................................................... 65 Mozambique .................................................................................................................... 67 Namibia ............................................................................................................................ 69 New Zealand .................................................................................................................... 71 Nigeria .............................................................................................................................. 73 Pakistan ............................................................................................................................ 75 Papua – New Guinea ....................................................................................................... 77 St Vincent and the Grenadines ...................................................................................... 79 Samoa ............................................................................................................................... 81 Sierra Leone .................................................................................................................... 83 Singapore ......................................................................................................................... 85 Solomon Islands .............................................................................................................. 87 South Africa ..................................................................................................................... 89

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Sri Lanka ......................................................................................................................... 92 Tanzania........................................................................................................................... 94 Tonga ................................................................................................................................ 96 Trinidad and Tobago ...................................................................................................... 98 Tuvalu ............................................................................................................................ 100 Uganda ........................................................................................................................... 102 United Kingdom ............................................................................................................ 104 Vanuatu .......................................................................................................................... 106 Zambia ........................................................................................................................... 108 PART 3 ........................................................................................................................... 110 Dependencies (not full members of the Commonwealth) .......................................... 110 Bermuda......................................................................................................................... 110 British Virgin Islands ................................................................................................... 112 The Cayman Islands ..................................................................................................... 114 Cook Islands .................................................................................................................. 116 Falkland Islands ............................................................................................................ 118 Gibraltar ........................................................................................................................ 120 Montserrat ..................................................................................................................... 122 Tokelau........................................................................................................................... 124 Turks and Caicos Islands ............................................................................................. 126 PART 4 ........................................................................................................................... 128 Commonwealth member countries with no information .......................................... 128

Malawi 128 Nauru 128 St Kitts and Nevis 128 St Lucia 128 Seychelles 128 Swaziland 128

PART 5 ........................................................................................................................... 129 Dependencies with no information .............................................................................. 129

Anguilla 129 Niue 129 Pitcairn Islands 129 St Helena & Dependencies ..................................................................................... 129 South Georgia and the South Sandwich.................................................................. 129

Further statistical information .................................................................................... 130

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Part 1 Introduction

The information in this publication is derived from a survey of the dental workforce across the Commonwealth, conducted by the author from March 2006 until February 2007. The data shown was collected from the dental associations, supplemented with verification from other sources such as the dental councils, Federation Dentaire Internationale (FDI) and the CIA Worldfactbook. In many cases, for example where there is no dental association, individual dentists had to be contacted, so the data cannot be confirmed as robust in its accuracy as verification was not possible. Some countries were not contactable during the period of the survey. Where fairly recent data was available from other sources – such as presentations in a meeting in Fiji in November 2005 or the FDI website, these data are recorded but as “Out of date” or “Incomplete data”. For these countries the information should be treated as indicative rather than absolute.

Definitions

Dental hygienists – are persons legally entitled to operate on patients, but their functions were originally limited to oral hygiene and the preventive aspects of dental care1. However, the role of these workers is developing across the world. Generally, they are now permitted to undertake the cleaning and polishing of teeth, scaling, removal of deposits, “accretions” and stains, and apply prophylactic materials such as fissure sealants2. In many countries hygienists are also permitted to undertake preliminary screening and other simple procedures - for example, preliminary charting in Norway and the Netherlands, diagnosis in parts of the USA and refixing temporary crowns and inserting temporary fillings in the UK3. Dental therapists – are persons legally entitled to operate on patients and their functions were originally limited to the restoration of simple carious lesions and simple extractions1. In the United Kingdom and New Zealand these functions have been progressively developed since then to include more comprehensive diagnostic and restorative care. Dental technicians or Dental laboratory technicians– in this survey are persons who fabricate prostheses such as dentures, crowns, veneers and bridges in the dental laboratory from impressions provided by a dentist (in some countries “dental technicians” install and repair equipment – where this is the case an alternative title is supplied).

Clinical dental technicians, or denturists, are recognised health professionals who may take impressions, to fabricate, repair and adjust complete dentures, partial dentures and removable implant retained dentures4. Dental nurses or dental chairside assistants – are persons who assist the dentist to provide clinical care to patients, without directly offering clinical care themselves. In some countries they are able to undertake radiography and/or give oral hygiene instruction for patients

1 Allred H (1977) The Training and Use of Dental Auxiliary Personnel. Copenhagen: WHO.

2 Nuffield-Foundation (1993) The Education and Training of Personnel Auxiliary to Dentistry. London. 3 Kravitz A and Treasure E (2004) European Union Manual of Dental Practice: www.bda.org, 3rd ed. Brussels: EU Dental Liaison Committee. 4 Denturists Association of Ontario, 2004

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Aims and Objectives

The Aim of this survey was to obtain information about the delivery of oral health services in Commonwealth countries, to assist the CDA to focus its activities in the most beneficial way. The Objectives were to collect information about payment systems, and the education, training, registration, employment and demographics of dental workers in all 53 Commonwealth countries and as many Dependencies as could be contacted.

Methodology

A standardised survey form was constructed, based on a form produced by the author for a similar survey conducted by him for a postgraduate research degree, in 2003. Whilst almost every country being surveyed used English as a primary language in their business affairs, nevertheless notes were embedded to try to ensure that cultural differences did not render the meaning of each question ambiguous. The survey form was sent by Email to contact names in each dental association, or to other prominent members of the dental profession in a country where no dental association was known. In a few instances forms were sent by fax. The data harvested was enhanced with information downloaded from various websites, including the FDI and CIA. Often the Ministry of Health in an individual country had a website with some helpful information. With many countries immediate contact was enabled, the form was filled in speedily and expeditiously and few follow-up questions of clarification were necessary. However, with some, clarification questions were not answered promptly, properly or even not at all. No contact was possible with any relevant person in a number of countries, particularly but not exclusively the small island nations. However, some information was obtainable from the FDI and from data captured by the author on a visit to Fiji in 2005. The data for these countries is included in parts 3 and 4, but have not been included in the analyses below. There were several countries where no dental information is known and these are listed in part 5. Finally, Fiji has been included in this survey as it was a member of the Commonwealth until its suspension at the end of 2006 and the data had already been collected.

Results

The full data can be found in Parts 2 and 3. This is an analysis of the information there. More or less completed data was obtained from 39 full member countries of the Commonwealth and 7 Dependencies which are associated with the Commonwealth. Additionally, data is included from 8 countries and 2 Dependencies which was obtained from other sources and relates to a period earlier than 2006.

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Unfortunately, India was unable to provide data about the numbers of dental auxiliaries, so, given the size of the country (approximately just over half of the whole population of the Commonwealth), the absence of these figures does give concern about the rest of the comparative data. Just under half the countries (22) reported that an oral health policy was in existence. Some of the others stated that there was some other governmental policy or strategy for dentistry. Dentists

The survey covered Commonwealth countries with a population of just under 2 billion people. The countries not surveyed5 had a combined population of just under 15 million people, so this survey covered 99.25% of the Commonwealth, by population. There were over 164,500 dentists recorded in the survey, with 43% of them practicing in India6. About 63% of dentists on average are male (this excludes countries which were unable to report on their gender mix). In member countries, where this is recorded, this varied from 30% (Kenya) to 92% (Sierra Leone).

Population No of %age Pop/dent Population No of %age Pop/dent

2006 dentists male ratio 2006 dentists male ratio

Antigua & Barbuda 69,108 16 80 4,319 Malta 400,214 170 75 2,354

Australia 20,264,082 10,609 77 1,910 Mauritius 1,240,827 225 86 5,515

Bahamas 303,770 72 58 4,219 Montserrat 9,439 3 67 3,146

Bangladesh 147,365,352 2,619 67 56,268 Mozambique 19,686,505 62 50 317,524

Barbados 279,912 68 52 4,116 Namibia 2,044,147 84 87 24,335

Belize 287,730 35 63 8,221 New Zealand 4,076,140 2,406 73 1,694

Bermuda 65,773 50 50 1,315 Nigeria 131,859,731 4,400 55 29,968

Botswana 1,639,833 94 47 17,445 Pakistan 165,803,560 6,344 55 26,135

British Virgin Islands 23,098 11 90 2,100 PNG 5,670,544 20 85 283,527

Brunei Darussalem 379,444 80 81 4,743 St Vincent 117,848 20 60 5,892

Cameroon 17,340,702 159 45 109,061 Samoa 176,908 10 17,691

Canada 33,098,932 18,565 77 1,783 Sierra Leone 5,300,000 15 92 353,333

Cayman Isalnds 45,436 30 87 1,515 Singapore 4,492,150 1,351 NK 3,325

Cook Islands 18,000 8 2,250 Solomon Islands 552,438 19 29,076

Cyprus 784,301 696 57 1,127 South Africa 44,187,637 4,644 NK 9,515

Dominica 68,910 11 66 6,265 Sri Lanka 20,222,240 1,400 51 14,444

Falkland Islands 2,967 2 100 1,484 Tanzania 37,445,392 208 90 180,026

Fiji 905,949 100 60 9,059 Tokelau 1,392 1 1,392

Gambia 1,641,564 20 70 82,078 Tonga 114,689 16 7,168

Ghana 22,409,572 130 60 172,381 Trinidad & Tobago 1,065,842 264 65 4,037

Gibraltar 27,928 13 85 2,148 Turks and Caicos Is 21,152 9 88 2,350

Grenada 89,703 16 44 5,606 Tuvalu 11,810 1 11,810

Guyana 767,245 34 68 22,566 Uganda 28,196,000 200 65 140,980

India 1,095,351,995 71,421 60 15,337 UK 60,609,000 32,971 63 1,838

Jamaica 2,758,124 240 70 11,492 Vanuatu 208,869 6 34,812

Kenya 34,707,817 656 30 52,908 Zambia 11,502,010 45 86 255,600

Kiribati 84,494 2 42,247

Lesotho 2,022,331 18 67 112,352 1,952,567,428 164,518 11,868

Malaysia 24,385,858 3,837 43 6,355 Dependencies in lilac

Maldives 359,008 12 50 29,917 Unverified in grey

Table 1: Population per dentist The average population per dentist ratio is 11,869, which varied from 353,333 in Sierra Leone to 1,127 in Cyprus. Figure 1 shows the population to dentist ratios of all the countries with a ratio greater than 11,000 – nearly 26 countries, just under half of those recorded.

5 See part 5 6 The figures for Bangladesh were only an estimate

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Figure 1: Population to dentist ratios However, the full figures (Part 6) show that 39 of the 55 countries recorded have a population to dentist ratio of greater than 4,000 – and this includes all the African countries. All the African countries except South Africa and Mauritius are included in this group. Conversely, none of the CDA European or Caribbean regional countries (except Jamaica) appear in this group.

Dentist registration

Unsurprisingly “dentist” is a protected title in every country and registration is necessary. Most countries have a dental council, or dental board, although in a few this is shared with doctors as a “medical and dental council”. South Africa has a Health Professions Council embracing all the professions in the health field.

Dental associations

Of the countries which responded to this survey about a quarter do not have a dental association, although in 5 of the remainder the contact person reported that dentists were part of the medical association or a combined medical and dental association (see Annex). Only about 41% of dentists were reported to be members of an association. Some of the respondents without any form of dental association to join reported that the survey had stimulated them to try and form one.

Dentist training

About 43% of countries (23) have at least one dental school (see Annex). Altogether there are 309 dental schools in the Commonwealth, with India having 72.5% (224) of these. The length of training is usually 5 years, but in 6 countries (Bangladesh, Kenya, Mauritius, Pakistan, Singapore and Sri Lanka) it is only 4 years. Conversely, in Ghana the course is 7 years as students need to obtain a sciences degree first. The remaining countries send their students overseas for training – often to the UK or USA. Only 10 countries require post-qualification vocational training (Botswana, Ghana, Mozambique, Nigeria, Pakistan, Papua-New Guinea, South Africa, Trinidad, Uganda and for the NHS only in the UK). This is for one or two years.

P opulation per dentist 2006

0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000

Sier ra Leone

Mozambique

PNG

Zambia

Tanzania

Ghana

Uganda

Cameroon

Lesotho

Gambia

Bangladesh

Kenya

Ki r ibati

Vanuatu

Niger ia

Solomon Islands

Maldives

Namibia

Pakistan

Guyana

Samoa

Botswana

India

Sr i Lanka

Tuvalu

Jamaica

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Mandatory continuing education is also limited to 8 countries – Brunei, Canada, New Zealand, Nigeria, South Africa, Uganda, the UK and in Victoria only in Australia. Also, two Dependencies – the Cayman and the Falkland Islands. So, most countries have no form of mandatory continuing education for dentists once they have received their dental degree or diploma. Dental Auxiliaries

Excluding dental chairside assistants – whose use and scope of duties was very variable amongst Commonwealth countries, at least one form of dental auxiliary to assist dentists was recorded everywhere. Training and registration was also very variable. Generally hygienists and therapists tended to be female and laboratory technicians mainly male – but there were several marked variations to this formula.

Hygienists

About half the countries (27) reported that hygienists were part of their dental workforce. Usually the title is protected – restricted to those with a qualification in dental hygiene. However, in Antigua, Cyprus, Kenya and Pakistan the title is not so protected. These 4 countries, as well as Fiji, Gibraltar and St Vincent do not require the hygienists to register, but all the others do. Training is at the workplace in Antigua, but all the other countries require their hygienists to have been formally trained. For 15 of the countries training takes place overseas, with the remainder a mixture of special colleges or university hygiene schools. Table 2: Hygienists’ statistics

Training periods vary from a usual 2 to 3 years, but in Canada this is 4 years. Mandatory continuing education is in place in 4 countries (the Bahamas, Canada, the Cayman Islands and New Zealand), with the UK also shortly.

HYGIENISTS

No of Prot- Training LengthRegistrn Work Dentist to

hygs ected on own? DH ratio

Antigua 4 No Wrkplc No Yes 4

Australia 375 Yes Sp colls 2-3 yrs Yes No 28

Bahamas 20 Yes Overseas Yes M Yes 4

Bangladesh

Barbados 12 Yes Overseas Yes No 6

Belize

Bermuda 25 Yes Overseas Yes Yes 2

Botswana

British Virgin Islands 2 6

Brunei

Cameroon

Canada 17,231 Yes Univs 2-4 yrs Yes M Yes 1

Cayman Isalnds 9 Yes Overseas Yes M Yes 3

Cook Islands

Cyprus 7 No Overseas No NK 99

Dominica 0

Falkland Islands

Fiji 64 Yes Univ 2 yrs No NK 2

Gambia 1 Overseas 20

Ghana

Gibraltar 1 Yes Overseas No No 13

Grenada

Guyana

India NG Yes Sp colls 2 yrs Yes No

Jamaica 18 Yes Sp colls 3 yrs Yes No 13

Kenya 1 No Overseas No Yes 656

Kiribati

Lesotho 1 Yes Overseas Yes No 18

Malaysia

Maldives 2 Yes Overseas NK NK 6

Malta 22 Yes Hospital 3 yrs Yes No 8

Mauritius

Montserrat

Mozambique

Namibia 27 Yes Overseas Yes No 3

New Zealand 386 Yes Univ 3 yrs Yes M Yes 6

Nigeria

Pakistan 252 No Sp colls 2 yrs No No 25

PNG

St Vincent 1 Yes Overseas No No 20

Samoa 4 3

Sierra Leone 2 Yes Overseas Yes Yes 8

Singapore

Solomon Islands

South Africa 933 Yes Univs 2-3yrs Yes Yes 5

Sri Lanka

Tanzania

Tokelau

Tonga

Trinidad & Tobago

Turks and Caicos Is 2 Yes Overseas Yes Yes 5

Tuvalu

Uganda

UK 4,737 Yes Univs 2-3 yrs Yes Yes 7

Vanuatu

Zambia 2 Yes Overseas Yes Yes 23

M = Mandatory Continuing Education

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Most countries allow their hygienists to work without a dentist necessarily being on the premises. Therapists

About two thirds of countries use dental therapists as part of their workforce. The title is protected in all the countries except Kenya, Montserrat and Tanzania. Table 3: Therapists’ statistics

Most countries train them in special colleges or universities. Usually they qualify with a diploma, although in some cases it would be a degree. Training takes 3 years in most countries, although a few take 2 years and one (Nigeria) 4 years. However, in the Bahamas, Brunei, the Caymans, Dominica, Gambia, Ghana, Montserrat, St Vincent and the Turks and Caicos Islands they are sent overseas. To work in most countries registration is required – but this is not so in Fiji, Ghana, Malaysia, Montserrat, St Vincent, Sri Lanka and Tanzania. However, perversely Malaysia does require them to undertake continuing education – as do the Bahamas and New Zealand. In about half the countries therapists are permitted to work on their own, without a dentist on the premises. But in a number of others in practice the therapists also work unsupervised although this is not strictly legal. The number of dentists per therapist ranges from 0.2 (PNG) to 93 (Canada). In fact the dentist to therapist ratio in a number of

countries is approximately equal and clearly the use of therapists in these is pivotal to supporting dentists in the provision of oral healthcare.

THERAPISTS

No of Prot- Training LengthRegistrn Work Dentist to

DTs ected on own? DT ratio

Antigua

Australia 1,388 Yes Sp colls 2-3 yrs Yes No 8

Bahamas 1 Yes Overseas Yes M No 1

Bangladesh

Barbados

Belize

Bermuda

Botswana 110 Yes Sp colls 3 yrs Yes No 1

British Virgin Islands

Brunei 88 Yes Overseas 2yrs Yes M Yes 1

Cameroon

Canada 200 Yes Sp school 2.5 yrs Yes Yes 93

Cayman Isalnds 5 Yes Overseas Yes Yes 6

Cook Islands 6

Cyprus

Dominica 4 Yes Overseas NK NK 4

Falkland Islands 1 Yes Overseas Yes M Yes 2

Fiji 70 Yes Univ 3 yrs No NK 1.5

Gambia 1 Overseas 20

Ghana 4 Yes Overseas No Yes 32

Gibraltar

Grenada 5 3

Guyana 31 Yes Sp coll 2.5 yrs Yes No 1

India NG

Jamaica NG Yes Sp colls 3 yrs Yes No

Kenya 130 No Sp coll 3 yrs Yes No 5

Kiribati 2

Lesotho

Malaysia 2,066 Yes Sp coll 2 yrs No M NK 2

Maldives

Malta

Mauritius

Montserrat 1 No Overseas No 3

Mozambique 106 Yes Sp school 1.5yrs Yes M Yes 0.6

Namibia

New Zealand 716 Yes Univ 3 yrs Yes M Yes 4

Nigeria 1,500 Yes Sp school 4 yrs Yes No 3

Pakistan

PNG 115 Yes Dent school 3yrs Yes Yes 0.2

St Vincent 8 Yes Overseas 3yrs No No 2.5

Samoa 40

Sierra Leone

Singapore 250 Yes Polytech 3 yrs Yes No 6

Solomon Islands 14

South Africa 411 Yes Univs 3 yrs Yes Yes 8

Sri Lanka 500 Yes Sp school 2 yrs No NK 3

Tanzania NG No Sp schools 2 yrs No NK

Tokelau

Tonga 16

Trinidad & Tobago 50 Yes Sp school NG Yes Yes 5

Turks and Caicos Is 2 Yes Overseas Yes Yes 5

Tuvalu 1

Uganda 450 Yes Sp school 3 yrs Yes Yes 0.5

UK 694 Yes Univs 3 yrs Yes Yes 47

Vanuatu 6

Zambia 180 Yes Sp school 3 yrs Yes Yes 0.25


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Laboratory Technicians (DLTs) Table 4: Laboratory technicians’ statistics

Except for several small island countries, Laboratory technicians were employed everywhere, but the numbers varied from 1 dentist per DLT (several countries) to 35 in Tanzania.

Training modalities were mixed, extending from workplace only (3 countries) to 4-5 years in a Technical College (South Africa). But most of the smaller countries sent their personnel abroad to receive their training.

The title is protected (to those with a qualification) in just under half the countries, although many of these did not require registration. However, in some countries although the title is not protected, registration is necessary to work as a dental laboratory technician.

Clinical Dental Technicians

(CDTs)

Only 9 countries reported the (legal) use of CDTs, although many others noted that there was some illegal practice by these persons. The permitting countries are Antigua, Australia, Cameroon, Canada, Jamaica, Mozambique, New Zealand, Pakistan and Tanzania. The legislation permitting them in the UK came into force in July 2006. Two other countries reported that legislation permitted them but they had not been introduced. Training appeared to be from 2 to 4 years and registration was usually necessary. In Antigua they appear to be uncontrolled and in Jamaica control is not very effective, with most not registering

LABORATORY TECHNICIANS

No of Prot- Training LengthRegistrn Dentist to

DLTs ected DLT ratio

Antigua 4 No Wrkplc No 4

Australia 1,400 Yes Sp colls 2 yrs Yes 7.5

Bahamas 5 Yes Overseas Yes M 14

Bangladesh 643 Yes Sp colls Yes 4

Barbados 13 No Overseas Yes 5

Belize 4 No Overseas No 8

Bermuda 5 No Overseas Yes 10

Botswana 10 No Overseas Yes 9


Brunei 25 Yes Overseas 2-3yrs Yes 3.5

Cameroon 10 15

Canada 1,900 Yes Sp colls 3 yrs Yes & No 10

Cayman Isalnds 4 Yes Overseas Yes 7.5

Cook Islands

Cyprus 180 Yes Overseas No 2.5

Dominica 1 Yes Overseas NK 15

Falkland Islands

Fiji 10 Yes Univ 3 yrs No 10

Gambia 4 5

Ghana 23 No Sp coll 3 yrs No 23

Gibraltar 2 No Overseas No 6.5

Grenada 1 16

Guyana 25 No Workplc No 1

India NG Yes Sp colls 2 yrs Yes

Jamaica 120 Yes Sp coll 3 yrs Yes 2

Kenya 126 No Sp coll 3 yrs Yes 5

Kiribati

Lesotho 2 Yes Overseas Yes 9

Malaysia 1,048 No Sp coll 3 yrs No 2.5

Maldives 1 NK Overseas 12

Malta 26 Yes Hospital 3 yrs Yes 6.5

Mauritius 7 No Overseas No 32

Montserrat

Mozambique 14 Yes Overseas Yes 4.5

Namibia 32 Yes Overseas Yes 2.5

New Zealand 171 Yes Univ 3 yrs Yes M 12

Nigeria 1,000 Yes Sp school NG Yes 4

Pakistan 600 No Sp colls 2 yrs No 11

PNG 18 Yes Dent school Yes 1

St Vincent 5 No Overseas 3yrs No 4

Samoa

Sierra Leone 8 Yes Overseas Yes 2

Singapore NG No Overseas No NG

Solomon Islands 5

South Africa 700 Yes Technicon 4-5 yrs Yes 10

Sri Lanka 50 No Univ 2 yrs No 28

Tanzania 6 Yes Overseas No 35

Tokelau

Tonga

Trinidad & Tobago 30 No Workplc No 9

Turks and Caicos Is 0 Yes Overseas Yes 0

Tuvalu 1

Uganda 8 No Overseas No 20

UK NK Yes Colleges 4 yrs Yes NK

Vanuatu

Zambia 47 Yes Sp school 3 yrs Yes 1


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Only New Zealand (and in future, the UK) requires their CDTs to undertake continuing education. Other Classes of Auxiliaries

Several countries use auxiliaries which do not fit into the above classifications. Ghana, Guyana and Uganda have personnel who appear to be trained somewhere between dental chairside assistants and therapists, with varying scopes of practice just short of the usually permitted duties of fully trained dental therapists. In Uganda specially trained chairside assistants may undertake the duties of CDTs and in the UK there are dental nurses who have received specialized orthodontic training – and are referred to as orthodontic therapists. The whole (operating) dental workforce

Looking at the totality of the dental workforce which provides direct services to patients – ie excluding dental technicians and dental chairside assistants – gives a better picture of the supply of dental personnel. Of course this takes no account of the varying levels of dental disease or demand for dentistry.

Table 5: Population per dental worker

These figures were produced by estimating the provision of care by a dental auxiliary (hygienist, therapist or legal clinical dental technician) as being 43% of that provided by a dentist working equivalent hours – a figure used in the 2004 Workforce Review by the Department of Health of England7 - to provide an equivalent Population to Dental Worker. Using these data, there is an average population of 10,833 per dental workers across the Commonwealth, but this disguises major discrepan-cies against the average – there being nearly 300,000 potential patients in Sierra

Leone per dental worker – and only just over 1,000 in Bermuda. Of the 10 countries worst served by the availability of dental workers, 9 of these were in Africa. Indeed, as before only South Africa and Mauritius of the African countries do better than the average. This is seen most graphically in the following chart, which also shows that there is a step change after the 12th country (Kenya):

7 http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4086050&chk=C2HjhP

Population Population

per dental per dental

worker worker

Sierra Leone 294,281 Fiji 5,748

Tanzania 180,026 Mauritius 5,515

Ghana 161,685 Dominica 5,417

Mozambique 142,542 Malaysia 5,161

Lesotho 109,730 Tonga 5,013

Cameroon 106,751 Grenada 4,942

Zambia 93,315 St Vincent 4,937

PNG 81,649 Barbados 3,826

Gambia 78,694 Antigua 3,808

Uganda 71,654 Bahamas 3,749

Bamgladesh 56,268 Trinidad & Tobago 3,733

Kenya 48,724 Brunei 3,220

Maldives 27,917 Montserrat 3,146

Nigeria 26,137 Singapore 3,080

Pakistan 25,697 Malta 2,230

Vanuatu 23,182 Gibraltar 2,148

Kiribati 22,713 British Virgin Islands 2,100

Namibia 21,380 Turks and Caicos Is 1,973

Solomon Islands 21,346 Australia 1,718

Guyana 16,211 UK 1,717

India 15,337 Cook Islands 1,701

Sri Lanka 12,522 Falkland Isalnds 1,484

Botswana 11,605 Tokelau 1,392

Jamaica 10,906 New Zealand 1,381

South Africa 8,462 Cayman Isalnds 1,261

Tuvalu 8,259 Canada 1,230

Belize 8,024 Cyprus 1,122

Samoa 6,117 Bermuda 1,046

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Figure 2: population per dental worker, where this is greater than 4,000 (the red line

represents approximately the Commonwealth average)

Population per dental worker 2006 - over 4,000

0 25 50 75 100 125 150 175 200 225 250 275 300 325

Sierra Leone

Tanzania

Ghana

Mozambique

Cameroon

Lesotho

Zambia

PNG

Gambia

Uganda

Bamgladesh

Kenya

Maldives

Nigeria

Pakistan

Vanuatu

Kiribati

Namibia

Solomon Islands

Guyana

India

Sri Lanka

Botsw ana

Jamaica

South Africa

Tuvalu

Belize

Samoa

Fiji

Mauritius

Dominica

Malaysia

Tonga

Grenada

St Vincent

Thousands

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Part 2

Independent countries

Information supplied by the relevant dental associations, with published materials of: The Federation Dentaire Internationale (FDI) http://www.fdiworldental.org/home/home.html

The CIA World Factbook https://www.cia.gov/cia/publications/factbook/index.html

8 All the public service dentists also work part-time in private practice

Antigua and Barbuda

CDA region: Caribbean and Canadian Caribbean, islands between the Caribbean and the Atlantic south east of Puerto Rico. Independent since 1981, the islands are a monarchy under QE 2nd.

Population: 69,108 (2006)

Patients are seen in a private system or private insurance only. There is a very small public service with only 2 part-time dentists. Children are deemed as such when less than 15 years. There is no oral health policy.

There is no dental association.

Dentists (year of data 2006)

There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is with the Medical Board.

Number of registered dentists 16

Number of active dentists 16

Percentage of active dentists who are male 80%

Percentage of dentists working in general practice 100%

Percentage of dentists working in public salaried service8 P/t 12.5%

Dentist to population ratio: 4,319

Specialists (2006)

Specialist training is obtained abroad

Orthodontists 3 visiting

Oral and maxillofacial surgeons 2

Prosthodontists 1

16

Dental Care Professionals (Auxiliaries) 2006 Antigua and Barbuda

Hygienists

Dental hygienist is a not protected title and training normally takes place in the workplace. Registration is not necessary and continuing education is not mandatory.

Number of hygienists 4

Dentist to hygienist ratio 4

Percentage of hygienists who are male 0%

Hygienists only work in private practice. They usually work with a dentist on the premises.

Therapists

Number of registered therapists 0

Dentist to therapist ratio

Percentage of therapists who are male

Laboratory Technicians

Dental technician is not a protected title. Whilst training is usually at the workplace, some have trained overseas. They do not need to be registered and continuing education is not mandatory.

Number of registered technicians 4

Dentist to technician ratio 4

Percentage of technicians who are male 75%

Technicians work in private practice.

Clinical dental technicians

Clinical dental technician is not a protected title. Whilst training is usually at the workplace, some have trained overseas. They do not need to be registered and continuing education is not mandatory.

Number of CDTs 1 or 2

Percentage who are male 100%

CDTs work in private practice.

Dental surgery assistants (DSAs)

The title is not protected. They train at the workplace. They do not need to register and there is no continuing education requirement.

Number of Assistants Not given

Percentage of Assistants who are male 5%

17

Australia

CDA region: Pacific and Australasia Located in Oceania, as a continent between the Indian and South Pacific Oceans. A constitutional monarchy, independent since 1901, federal system.

Population: 20,264,082 (2006)

The majority of adult patients are seen in a private system. People on low-incomes are eligible for public services, some of which charge a small fee. Children (under 18s) are seen free through the school dental program. Australia has an oral health policy.

There is an Australian Dental Association and also a dental association for each state [FDI figures in 2006 for the ADA: 8,560 members].


There are 6 dental schools and education and training lasts for 5 years. There is no post-qualification vocational training and continuing education is compulsory in one state only (Victoria). Registration is with state boards

Number of registered dentists 10,609

Number of active dentists 8,991



Percentage of dentists working in public salaried service 83%


Specialists (2003)

Specialist training is given in Australia and lasts for 2 to 5 years, depending upon the specialty

Orthodontists 455


Periodontists 102

Endodontists 84

Prosthodontists 133

Paedodontists 51

Oral pathologists 21

Dento-maxillofacial radiologists 2

Others 9

18

Dental Care Professionals (Auxiliaries) 2003 Australia

Hygienists

Normally train in Technical and Further Education (TAFE) colleges. There are 8 of these across Australia. They receive a diploma, but there is movement towards degree qualifications. Training is usually for 2-3 years. To work they need to be registered with the state board, as their title is restricted. Continuing education is not mandatory

Number of registered hygienists 375



Hygienists normally work in general (private) practice and a dentist must be on the premises.

Therapists

Normally train in TAFE colleges. There are 7 of these across Australia. They receive a diploma, but there is movement towards degree qualifications. Training is usually for 2-3 years. They must register with the relevant state board, as their title is restricted. Continuing education is not mandatory

Number of registered therapists 1,388

Dentist to therapist ratio 8

Percentage of therapists who are male 2.4%

Therapists mostly in the public sector, however, some states allow therapists to work in private practice.


Normally train in TAFE colleges. There are 3 of these across Australia. They receive a diploma, but there is movement towards degree qualifications. Training is usually for 2 years. To work they must be registered with the Dental Technicians Registration Board or the Dental Registration Board of the state in which they intend to work, as their title is restricted. Continuing education is not mandatory

Number of registered technicians 1,400

Dentist to technician ratio 7.5

Percentage of technicians who are male Not known

Where technicians work was not described

Prosthetists (Clinical dental technicians)

Their education at colleges in Sydney and Melbourne has been � rivate� ized by the Australian National Training Authority to an Advanced Diploma Level. Both colleges provide distance education to states that do not have training facilities. Courses are being offered by TAFE NSW to allow Technicians and Prosthetists to upgrade to Diploma and Advanced Diploma levels respectively. To work they must be registered with the Dental Technicians Registration Board or the Dental Registration Board of the state in which they work, as their title is restricted. Continuing education is not mandatory

Number of registered prosthetists approx 1,000

Percentage of prosthetists who are male 91%

Prosthetists normally work in private practice

Dental (chairside) Assistants

Their education is at TAFE colleges for one year and they train at the workplace. They receive a certificate on qualification but do not need to register. The title is protected. There is no continuing education requirement.


Percentage of Assistants who are male Not known

Bahamas

CDA region: Caribbean and Canadian A chain of islands in the Atlantic Ocean, southeast of Florida, northeast of Cuba. A constitutional monarchy, independent since 1973

Population: 303,770 (2006)

The Bahamas does not have an oral health policy. Patients are seen in a private system or private insurance. Children (under 16s) are seen through their schools free of charge or privately.

There is a Bahamas Dental Association (BDA) [FDI figures 2006: 60 members].

19


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Mandatory continuing education is 30 hours every 2-year period. Registration is with the Bahamas Dental Council.







Specialists (2006)


Orthodontists 3


Periodontists 3

Paediatric dentists 1

Dental Public Health 1

20

Dental Care Professionals (Auxiliaries) 2006 Bahamas

Hygienists

Dental hygienist is a protected title. Education and training normally takes place in the USA, for 2 years (leading to an Associate Degree. Registration is mandatory – with the Bahamas Dental Council) and continuing education is also mandatory – 8 hours every 2-year period.


Dentist to hygienist ratio 3.5


Hygienists may work in either private practice or government service. They may work without a dentist on the premises.

Therapists/Dental Nurses

Dental therapist/nurse is a protected title. Education and training is undertaken overseas. The only currently registered therapist qualified in Jamaica, under their dental nurse scheme. Registration is mandatory – with the Bahamas Dental Council and continuing education is also mandatory – 8 hours every 2-year period.



Percentage of therapists who are male 0%

Work is limited to government service.


Dental technology is not a protected title. They train overseas, mainly in the USA. They receive a diploma on qualification. Training is usually for 18 months to 2 years. To work they must be registered with the Bahamas Dental Council and continuing education is also mandatory – 8 hours every 2-year period.




Technicians may work in either private practice or government service.


It is reported that there are CDTs in the Bahamas, but they are not formally recognized. Training is at the workplace and there is neither registration nor continuing education.

Number of registered CDTs Not known

Percentage who are male

CDTs work only in private practice


The title is not protected. They train at the workplace, there is no qualification and they do not need to register. There is no continuing education requirement.

Number of Assistants (est 2004) 140


21


There are 9 dental colleges (3 government and 6 private) and training leading to a BDS degree is for 4 years. There is no post-qualification vocational training and no mandatory continuing education. Registration is with the Bangladesh Medical and Dental Council.


Number of active dentists Not known


Percentage of dentists working in general practice Not given

Percentage of dentists working in public salaried service Not given

Dentist to population ratio:

Specialists (2006)

Specialist training is from 1 to 5 years. It is not mandatory for them to register, so their numbers are not known. There are several different disciplines.

Orthodontists

Oral and maxillofacial surgeons

Bangladesh

CDA region: South East Asia Southern Asia, bordering the Bay of Bengal, between Burma and India In 1947, West Pakistan and East Bengal jointly became the new country of Pakistan. East Bengal became East Pakistan in 1955, but East Pakistan seceded from its union with West Pakistan in 1971 and was renamed Bangladesh.

Population: 147,365,352 (2006)

Patients are seen in private practice or in government hospitals/public clinics, where the treatment cost is very small. There is no national health or insurance system. Children are counted as such to 12 years of age. Bangladesh does not have an oral health policy.

There is a Bangladesh Dental Association [FDI figures 2006: 800 members].

22

Dental Care Professionals (Auxiliaries) 2006 Bangladesh

Hygienists


Dentist to hygienist ratio

Percentage of hygienists who are male

Therapists




Dental Technologists (Laboratory Technicians)

Dental technology is a protected title. Training is in one of the 18 Institutes of Dental Technology. Length of training was not supplied. They need to be registered with the Bangladesh Medical and Dental Council and continuing education is not mandatory.

Number of registered technologists 643

Dentist to technician ratio 4:1


Technicians work in private practice and public clinics.


Number of registered CDTs 0



Number of Assistants Not known

Percentage of Assistants who are male

Barbados

CDA region: Caribbean and Canadian Caribbean, island in the Atlantic Ocean, northeast of Venezuela. A constitutional monarchy, independent since 1966.

Population: 279,912 (2006)

Patients are seen in a private system or private insurance. There is a small public service. Children (under 18s) are seen through their schools free of charge or privately. Barbados has

23


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is with the Barbados Dental Council.



Percentage of active dentists who are male 51.5%


Percentage of dentists working in public salaried service9 12.5%


Specialists (2006)


Orthodontists 4


Periodontists 3


9 All the public service dentists also work part-time in private practice

an oral health policy, although details have not yet been published.

There is a Barbados Dental Association (BDA).

24

Dental Care Professionals (Auxiliaries) 2006 Barbados

Hygienists

Dental hygienist is a protected title. Education and training normally takes place in the USA, UK or Jamaica. Registration is mandatory – with the Barbados Dental Council and continuing education is not mandatory.




Hygienists only work in private practice. They may not work without a dentist on the premises.

Therapists





Dental technology is not a protected title. Whilst previously training was at the workplace, now they train overseas, mainly in the USA (for 2 years). They must receive a diploma on qualification and to work they must be registered with the Barbados Dental Council; continuing education is not mandatory.









The title is not protected. They train at the workplace, or at the Barbados community college. They do not need to register and there is no continuing education requirement.



25

Belize

CDA region: Caribbean and Canadian Central America, bordering the Caribbean Sea, between Guatemala and Mexico. A constitutional monarchy, independent since 1981.

Population: 287,730 (2006)

Patients are seen in a private system or private insurance (the insurance company pays 80%). Children (under 16s) are seen through their parents’ insurance. Belize has an oral health policy.

Have a combined Belize Medical and Dental Association (BMDA).


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. The Registration authority is the Belize Medical and Dental Council.







Specialists (2006)


Orthodontists 6


Periodontists 0

Endodontists 1

Prosthodontists 1

Paedodontists 0

Oral pathologists 0

Dento-maxillofacial radiologists 0

Public Health 2

26

Dental Care Professionals (Auxiliaries) 2006 Belize

Hygienists

Number of registered hygienists None



Therapists

Number of registered therapists None




They train in other countries of Central America and the USA They receive a diploma on qualification. Training is usually for 1 to 2 years. To work they need not be registered for the time being, but change has been proposed. Continuing education is not mandatory




Technicians normally work in private practice


Number of registered CDTs None



They train at the workplace. There is no qualification and they do not need to register. The title is not protected and there is no continuing education requirement.

Number of Assistants 38


“Jamaica-type” auxiliaries

These auxiliaries are trained in Jamaica for 2 years and receive a diploma on qualification. They register with the government and work in governmental dental clinics. There is no continuing education requirement.

Number of Auxiliaries 2

Percentage male 0%

27

Botswana

CDA region: East and South Africa Southern Africa, north of South Africa. A republic, independent since 1966.

Population: 1,639,833 (2006)

Botswana has no oral health policy but had a national dental plan from 1983 to 2000. Patients are seen privately or in government clinics. Children are the under 16s.

There is a Botswana Dental Association [FDI figures 2006: 60 members]. .


There are no dental schools and education and training takes place abroad. There is a 12 months post-qualification internship programme but no mandatory continuing education. Registration is with Botswana Health Professions’ Council







Specialists (2005)


Orthodontists 2



28

Dental Care Professionals (Auxiliaries) 2006 Botswana

Hygienists




Therapists

Dental therapists train locally for 3 years in the Institute of Health Sciences, following which they receive a diploma. The title is protected and they must register with the Botswana Health Professions’ Council. Continuing education is not mandatory.


Dentist to therapist ratio 1:1


Therapists must work in public hospitals and a dentist must be present on the premises, although dentist shortages sometimes make this impossible.


All technicians train abroad – usually in the UK or Ireland, where they receive degrees after 4 years. Otherwise, they receive a diploma on qualification. To work they must be registered with the Botswana Health Professions’ Council, as the title is protected. Continuing education is not mandatory




Technicians normally work in hospitals and private practice




Dental (chairside) Attendants

They train at the workplace. There is no qualification although some receive certificates after 6 months. They do not need to register and the title is not protected. There is no continuing education requirement.



29

Brunei Darussalem

CDA region: South East Asia On the island of Borneo, bordering the Indonesia and Malaysia In 1888, Brunei became a British protectorate; independence was achieved in 1984

Population: 379,444 (2006)

There is no information about health systems. Children are counted as such to the age of 16 years. Brunei has an oral health policy.

Dental Association: None


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Mandatory continuing education is 30 hours annually. Registration is with the Brunei Dental Council.




Percentage of dentists working in general practice 18.75%

Percentage of dentists working in public salaried service 81.25%


Specialists (2006)


Orthodontists 3


30

Dental Care Professionals (Auxiliaries) 2006 Brunei

Hygienists


Therapists

Dental therapists trained in Malaysia and Singapore for 2 years. The last intake was 7 years ago – around 5 dental therapists, following which they receive a diploma. The title is protected and they must register with the Brunei Ministry of Health. Continuing education is mandatory – 20 hours annually




Therapists must work in public clinics and a dentist need not be present on the premises.


All technicians train abroad – usually in the UK or Malaysia, where they receive degrees (3 years) or diplomas (2 years) on qualification. To work they must be registered with the Brunei Ministry of Health, as the title is protected. Continuing education is mandatory – 15 hours annually


Dentist to technician ratio 3.5:1


Technicians normally work in hospitals, public clinics and private practice



Dental Surgery Assistants

They train at the workplace. There is no qualification they receive certificates after 2 years part-time (2 days a week) training. The title is not protected and they need to register with the Brunei Ministry of Health. There is no continuing education requirement.



Dental Attendants

They train at the workplace. There is no qualification and the title is not protected nor do they need to register. There is no continuing education requirement.

Number of Attendants Not given


31

Cameroon

CDA region: West Africa Western Africa, bordering the Bight of Biafra, between Equatorial Guinea and Nigeria. A republic formed from the former French Cameroon and part of British Cameroon, merged in 1961 to form the present country (the northern part of English speaking Cameroon joined Nigeria).

Population: 17,340,702 (2006)

Cameroon does not have an oral health policy. There is no information about health systems

Dental Association: Yes [FDI figures 2006: 47 members].


There are no dental schools and education and training takes place abroad. However, two schools are planned for 2008 – one in the English speaking part (Bue, with 15 dental students) and one in the French (Yaunde). There is no post-qualification vocational training or mandatory continuing education. Registration is with the Cameroon Dental Council.







Specialists (2006)


Orthodontists 2



Stomatologists 39

32

Dental Care Professionals (Auxiliaries) 2007 Cameroon

The new dental school in Bue University, due to open in October 2008 will enroll annually 10 student hygienists, 10 assistants and 10 technicians – as well as dental students.

Hygienists




Therapists

Currently there are no formally trained therapists but there are approximately 30 informally trained. A new (private) training school opened in St Louis in 2005, with 25 students enrolled annually, so 25 will graduate in 2008.




Technicians

There is no information about the current training and registration of dental technicians



Percentage of technicians who are male

Clinical dental technicians (Denturists)

Number of denturists 8



Number of Assistants Approx 20


33

Canada

CDA region: Caribbean and Canadian North America, second-largest country in world (after Russia) in land area. A constitutional monarchy, independent since 1867, federal system.

Population: 33,098,932 (2006)

Canada has an oral health policy. 95% private (insurance and self-pay), 5% public health system. Some provinces cover oral health care for children(variable age), varying significantly from province to province

There is a Canadian Dental Association (CDA) and also a dental association for each province. [FDI figures 2006 for CDA: 11,315 members].


There are 10 dental schools and education and training lasts for 4-5 years (following general tertiary education). There is no post-qualification vocational training. Continuing education is compulsory, variable by province. Registration is with provincial/territory boards







Specialists (2006)

Specialist training is given in Canada and lasts for 2 to 5 years, depending upon the specialty

Orthodontists 633


Periodontists 298

Endodontists 186

Prosthodontists 166

Paedodontists 200

Public health 48

Oral radiologists 11

34

Dental Care Professionals (Auxiliaries) 2006 Canada

Hygienists

Dental hygienists (RDHs) must successfully complete a dental hygiene diploma or bachelor post-secondary program in order to legally practice. Length of training varies – 2 are university degree programs (4 years) and 31 are diploma programs (average 2 years). In order to practice in Canada, dental hygienists must be registered or licensed by the appropriate provincial or territorial dental hygiene regulatory authorities. Requirements for registration or licensure vary by province or territory, including differences in clinical experience, examinations required, and continuing education requirements. Once dental hygienists are in practice, they must also meet ongoing quality assurance requirements. In most provinces, hygienists are required to take a certain number of continuing education courses every year. This varies greatly from province to province.

Number of registered hygienists 17,231



Registered dental hygienists (RDHs) may pursue careers in both community and clinical practice. In clinical practice, dental hygienists most often work with general practitioner dentists or specialty practice dentists. In one province, British Columbia, RDHs may have an independent hygiene practice. A dentist must be on the premises.

Therapists

Dental therapists are trained by the National School of Dental Therapy in Prince Albert, Saskatchewan for 2.5 years, when they receive a diploma. To work they need to be registered with the relevant provincial board, as their title is restricted. Continuing education is not mandatory



Percentage of therapists who are male <5%

Dental therapists provide limited dental services in First Nations and Inuit communities where no dentists are available. In some provinces they work in private practice. They may work without a dentist being present.


Normally train in Community colleges. The number of these is unknown. Training is usually for 3 years, following which they receive a diploma. To work they must be registered in four provinces. Continuing education is mandatory in these provinces.




Technicians work mostly in private laboratories, but some are in dental clinics.

Denturists (Clinical dental technicians)

Train in Community colleges. The number of these is unknown. Training is usually for 2 years, following which they receive a diploma. They must register with their provincial regulatory authorities. They are self-regulated in almost all provinces. Continuing education is not mandatory.

Number of registered denturists approx 2,000

Percentage of denturists who are male 50%

They normally work in private (denturist) practice


Train in Community colleges. The number of these is unknown. Training is usually for up to 1 year, following which they receive a diploma. The title is protected in some provinces only. There is no continuing education requirement.

Number of Assistants Approx 28,000

Percentage of Assistants who are male <5%

35

Cyprus

CDA region: Europe An island in the Eastern Mediterranean Sea, between Turkey and Syria (to the East). A republic, independent since 1960.

Population: 784,301 (2006)

There is no oral health policy, but dental services are governed by parliamentary law. Most treatment is provided privately but there is a small public service.

There is a Cyprus Dental Association. Membership is mandatory. [FDI figures 2006: 624 members].


There are no dental schools and education and training is undertaken overseas. There is no post-qualification vocational training. Continuing education is compulsory, variable by province. Registration is with the Dental Council.







Specialists (2006)

Specialist training is given overseas.

Orthodontists 25


36

Dental Care Professionals (Auxiliaries) 2001 Cyprus

Hygienists

Dental hygienists are trained abroad and there is no registration or regulation in Cyprus. Thus there is also no mandatory continuing education.



Percentage of hygienists who are male Not given

There is no information about where they work

Therapists





Normally train in Greece, the UK/EU or USA. Training is usually for 3 years. To work they must be registered with the Technicians’ Dental Council. Continuing education is not mandatory.



Percentage of technicians who are male Not given

Technicians work in private laboratories.


Number of registered denturists 0

Percentage of denturists who are male


There is no reported formal training. They may work in the private or public sector.


Percentage of Assistants who are male Not given

37


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is conducted by the Medical Board with is constituted by the Minister for Health

Number of registered dentists NK




Percentage of dentists working in public salaried service10 45%

Dentist to population ratio: 1:6265

Specialists (2006)

Specialist training is obtained abroad.

Orthodontists 2

Oral and maxillofacial surgeons. 0

Others 0

10 these dentists also work part time in private general practice

Dominica

CDA region: Caribbean and Canadian Caribbean island about half way from Puerto Rico to Trinidad. A republic, independent since 1978.


Patients are seen under the public health system of the Ministry of Health. Everyone may access this public health system. Adults (anyone over 18) have to pay fees (eg EC$10 for an extraction, $20 for prophylaxis) but treatment for patients under 18 is completely free. There is no oral health policy.

Dentists are part of the Medical Association.

38

Dental Care Professionals (Auxiliaries) 2006 Dominica

Hygienists

The Dental Act does not allow for the registration of Dental Hygienists and consequently there are no hygienists working on the island.


Dentist to hygienist ratio -

Percentage of hygienists who are male -

Therapists

Therapists are allowed to work in the public service. They are allowed to treat patients up to 12 years old. The therapists were trained in Canada, New Zealand and Jamaica





There are no independent laboratory technicians in Dominica. One dental practice employs a dental technician who was trained in Cuba. There are no registration requirements for dental technicians. Most work is sent overseas.

Number of technicians 1

Dentist to technician ratio




Percentage who are male -





39

Fiji

CDA region: Pacific Located in Oceania, an island group in the South Pacific Ocean, about two-thirds of the way from Hawaii to New Zealand. A republic, independent since 1970.

Population: 905,949 (2006)

Fiji does not have an oral health policy. Young persons under 18 are counted as children but only receive free treatment until 15 years. No information given about healthcare for adults.

There is a Fiji Dental Association [FDI figures 2006: 70 members].


There one dental school and education and training lasts for 5 years. It is conducted in a modular method. All the workforce train together in year one, then technicians, hygienists and therapists undertake their own training at various stages from year two. Students who train for 5 years but do not satisfactorily complete their courses may qualify as therapists. There is no post-qualification vocational training and there is no compulsory continuing education. Registration is with the Fiji Dental Council.



Percentage of active dentists who are male Approx 60%




Specialists (2006)

There is no specialist training in Fiji.

Orthodontists 1


Dental Public Health Not given

40

Dental Care Professionals (Auxiliaries) 2006 Fiji

Hygienists

Dental hygienists must successfully complete a 2-year dental hygiene certificate course in the dental school to legally practice. Whilst the title is protected, they do not have to register. Continuing education is not mandatory




Hygienists can work in Ministry of Health clinics and private practice (although currently there are none in private practice). It is unclear whether a dentist must be present on the premises.

Therapists

Dental therapists must successfully complete a 3-year dental therapy diploma course in the dental school to legally practice. Whilst the title is protected, they do not have to register. Continuing education is not mandatory

Number of therapists 70

Dentist to therapist ratio 1.5


Therapists work in Ministry of Health clinics, although 2 work in private practice. It is unclear whether a dentist must be present on the premises.


Dental technicians must successfully complete a 3-year dental technology diploma course in the dental school to legally practice. Whilst the title is protected, they do not have to register. Continuing education is not mandatory




Technicians work mostly in dental clinics but a few work in private laboratories.




Dental (surgery) Assistants

All currently trained DSAs in Fiji are hygienists, who spent one year training as DSAs then one-year as hygienists, in the Fiji Dental School. They all work in government clinics. Some DSAs work in private practice but there is no formal training and no information about numbers.



41

INFORMATION TAKEN FROM FDI & OUT OF DATE

Gambia

CDA region: West Africa Western Africa, bordering the North Atlantic Ocean and Senegal. A republic independent since 1965.

Population: 1,641,564 (2006)

The Gambia does not have an oral health policy. There is no information about health systems

Medical and Dental Association: [FDI figures 2006: 20 members].


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Medical and Dental Council.







Specialists (2000)


Orthodontists


42

Dental Care Professionals (Auxiliaries) 2000 Gambia

There is no information about the education, training and registration of dental auxiliaries

Hygienists




Therapists




Technicians





Number of clinical dental technicians None





43

Ghana

CDA region: West Africa Western Africa, bordering the Gulf of Guinea, between Cote d’Ivoire and Togo. A republic, independent since 1957.

Population: 22,409,572 (2006)

Ghana has an oral health policy in draft form only (2006). Payment for treatment is a mixture of NHS, private fee for service, and other insurance options. These options apply in the public and private facilities. Thus if a client has not registered with the National Health Insurance and presents for dental treatment, either in a public or private clinic, then the client has to pay directly for the service (fee for service), or must have other insurance. Also not all services are covered by the Health Insurance and here again one has to pay directly for these services. Currently in public institutions there is no provision for clients to be seen privately. Children are counted as such to the age of 18 years.

There is a Ghana Dental Association [FDI figures 2006: 95 members].


There is one dental school and education and training takes 7 years. The period of training for those studying dentistry and medicine includes the first 3 years doing a bachelor of health sciences degree (that involves the basic sciences), before proceeding to do 4 years clinical sciences. Students are admitted from the Senior Secondary level into the University to study dentistry, medicine or any other course. There is a 2-year post qualification “housemanship” training, which is undertaken in certain health facilities accredited by the Ghana Medical and Dental Council. The period was 1year but has just been extended to 2 to address certain issues particular to Ghana. There is no mandatory continuing education. Registration is with the Ghana Medical and Dental Council.







Specialists (2005)

Specialist training is often obtained abroad but some is available with the Ghana College of Physicians and Surgeons and the West African College of Surgeons, both leading to a fellowship in the various dental specialties.

Orthodontics 3

Oral and maxillofacial surgery 8

Public Dental Health 9

Forensic Dentistry 1

Restorative Dentistry 5

Paedodontists 0

44

Dental Care Professionals (Auxiliaries) 2006 Ghana

Hygienists


Therapists

Current dental therapists train in New Zealand in the 1970s for 2 years, following which they receive a diploma. The title is protected although they do not need to register with the Medical and Dental Council. Continuing education is not mandatory.




Therapists usually work in public clinics but may work in private practice and a dentist need not be present on the premises.


There is one dental technicians’ training school (a certificate is awarded after 3 years). Some technicians train abroad (Nigeria 4 years) and Cuba (3 years) in the main. The title is not protected and they do not need to register. Continuing education is not mandatory




Technicians normally work in public clinics and private practice



Dental (chairside) Attendants

They train at the workplace. There is no qualification although some receive certificates after 2 years. They do not need to register and the title is not protected. There is no continuing education requirement.



Community Oral Health Officers (COHO)

The COHO is a new concept, introduced to try and cater for areas that may not have access to a dentist. They train in Kintampo, Ghana for 18mths followed by 12mths internship, after which they receive a Diploma. The programme is run alongside the Medical Assistants programme, which means that these are nurses who on graduation can double as medical assistants. However, in future, the plan is to admit direct Senior Secondary school leavers to training. The COHO is somewhere between the dentist and the therapist, with some freedom to do certain procedures but more importantly as a community oral health person, who will be able to handle the public health aspect. That programme has been accepted and career progression is not a problem as it has been successfully tagged on to the medical assistants (MA) programme. The COHOs currently have no regulatory body.

Number of COHOs 16

Percentage of COHOs who are male 52%

COHOs normally work in public clinics but may work in private practices

45

INFORMATION TAKEN FROM FDI & OUT OF DATE

Grenada

CDA region: Caribbean and Canadian Caribbean, island between the Caribbean Sea and Atlantic Ocean, north of Trinidad and Tobago. A constitutional monarchy, independent since 1974.

Population: 89,703

Everyone is entitled to oral health care in public clinics but priority is given to children aged 3-18 for restorative dentistry, adults to a lesser extent. (5% of child care is given in public clinics. All employees who pay fees to the national insurance scheme are entitled to care under national health (insurance) system. It is not known whether Grenada has an oral health policy.

There is a Grenada Dental Association


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Grenada Medical Board.







Specialists (2000)


Orthodontists 1


46

Dental Care Professionals (Auxiliaries) 2000 Grenada


Hygienists




Therapists




Technicians








They train at the workplace. There is no qualification but do not need to register. The title is not protected. There is no continuing education requirement.



47

Guyana

CDA region: Caribbean and Canadian South America, bordering the North Atlantic, between Suriname and Venezuela. A republic, independent since 1966.

Population: 767,245 (2006)

Guyana has an oral health policy. Adult patients are seen in a private system or in the public service under the National Insurance Scheme. Children (under 18s) are usually seen through the public system but some are seen privately.

There is a Guyana Dental Association.


There is one dental school and education and training takes 5 years. There is no post-qualification vocational training or mandatory continuing education. The Registration authority is the Guyana Dental Council.







Specialists (2006)


Orthodontists 1


Implantology 1

48

Dental Care Professionals (Auxiliaries) 2006 Guyana

There appears to be a confused situation in Guyana as there are a number of “quack dentists” who are not formally trained, or are trained dental technicians who illegally practice directly to patients.

Hygienists


Therapists

Therapists train at the “Dental Auxiliary Training Programme” a state-run institution. The training duration is 2½ years, with a batch of 12 qualifying every alternate year. They receive a completion certificate. After, they must register with the Dental Council. There is no mandatory continuing education, but they receive 2 x 4 hours of training annually, organised by the Ministry of Health.




They may only work in government clinics and under the direct supervision of a dentist.

Community Dental Therapists (CDTs)

These therapists train at the “Dental Auxiliary Training Programme” for 15 months. They receive a completion certificate. After, they must register with the Dental Council. There is no mandatory continuing education, but they receive refresher courses on, for example, Infection Control, offered by the Ministry of Health.

Number of registered community therapists 26


They work in schools, health centres and in mainly rural areas and hinterlands. They may not work in private practice.


They train at the workplace and the title is not protected. To work they need to be registered with the Dental Council (since 1998) – when they receive a certificate after an examination – but large numbers do not register. Continuing education is not mandatory




Technicians normally work in private practice or in dental practices.


Number of CDTs None

Dental Aides

They train at the workplace. There is no qualification and they do not need to register. A formal training programme was projected for November 2006, at the Dental Auxiliaries’ school The title is not protected and there is no continuing education requirement. However, refresher courses on, for example, Infection Control are offered by the Ministry of Health.



49

India

CDA region: South East Asia A large country in Southern Asia, bordering the Arabian Sea and the Bay of Bengal, between Burma and Pakistan. By far the largest Commonwealth country, in population terms. A republic, independent since 1947.

Population: 1,095,351,995 (2006)

India has an oral health policy. Affluent patients, irrespective of being adults or children prefer to receive dental treatment in private clinics and better equipped hospitals (private or government). Employees of state governments and state undertakings normally take advantage of government and private hospitals, besides private clinics depending upon their paying capacities. Central government employees utilise the benefits available under Central Government Health Services Scheme (CGHS) or better equipped private clinics and hospitals of their choice. Private Sector employees covered under Employees State Insurance Scheme (ESI) utilise the benefits available in ESI designated hospitals or private clinics/doctors attached to the ESI Scheme. Finally, in non-urban areas, people in general take advantage of Primary Health Care Centres run by the government, but some will utilise private clinics or hospitals depending upon their financial capacities.

There is an Indian Dental Association [FDI figures 2006: 12,000 members].


There are 224 dental schools and education and training lasts for 5 years. There is no post-qualification vocational training and there is no compulsory continuing education. Registration is with the Dental Council of India.


Number of active dentists Not known

Percentage of active dentists who are male Estimated 60%




Specialists (2005)

Specialist training is given in India – usually 3 years. There are 1,765 registered specialists.

Orthodontists 256


Prosthodontics 285

Periodontics 225

Paediatrics 146

Conservative dentistry 248

Oral pathology 144

Oral medicine and radiology 145

Community dentistry 62

50

Dental Care Professionals (Auxiliaries) 2006 India

Hygienists

Dental hygienists must successfully complete a 2-year dental hygiene diploma course in one of the 43 hygienist and technicians’ schools to legally practice. They must register with the Dental Council of India (DCI). Continuing education is not mandatory

Number of registered hygienists Not given



Registered dental hygienists may pursue careers in both community and private practice. A dentist must be present on the premises.

Therapists

Number of registered therapists Not known




Dental technicians must successfully complete a 2-year technology diploma course in one of the 43 hygienist and technicians’ to legally practice. They must register with the Dental Council of India. Continuing education is not mandatory

Number of registered technicians Not given








The Dental Operating Room Assistant’s Course (Dental Chairside Assistant) is not currently approved by the DCI in any Institution. However, a proposal has been received from the Army Dental Corps which is under consideration with the DCI/Government of India and if approved will be implemented accordingly.



51

Jamaica

CDA region: Caribbean and Canadian An island in the western Caribbean Sea, south of Cuba. Jamaica is a constitutional monarchy under QE 2nd. It joined other British Caribbean colonies in 1958 in forming the Federation of the West Indies but gained full independence when it withdrew from the Federation in 1962.

Population: 2,758,124 (2006)

Jamaica does not have an oral health policy. Dentistry in general practice is provided for adults in the public sector on a “first come, first served basis” and is limited in scope by dental materials and equipment constraints. Principally extractions, limited fillings and cleanings are provided at a nominal publicly set fee. However, privately the full range of services is provided for all, largely by appointment. Children are described as such to the age of 19 and are treated publicly, mainly by appointment, by dental nurses, without cost. This is limited to cleaning, fillings and extractions. Public, salaried dentists work part time in government hospitals and clinics and charitable health institutions. Most also have part time private practices.

There is a Jamaican Dental Association [2006: 123 members]


There are no dental schools so education and training takes place abroad. There is no post-qualification vocational training or compulsory continuing education. Registration is with the Jamaican Dental Council.







Specialists (2006)

All specialist training is taken abroad.

Orthodontists 8


Periodontics 2

Paedodontics 4

Endodontics 1

Oral pathology 1

52

Dental Care Professionals (Auxiliaries) 2006 Jamaica

Hygienists

Dental hygienists must successfully complete a 3-year dental hygiene certificate course in one of the 2 (dedicated) hygienist schools, or qualify abroad to legally practice. The schools started hygienist courses 4 years ago (and only one of them is a dedicated hygienist school, the other being the dental auxiliaries’ school). They must register with the Dental Council. Continuing education is not mandatory

Number of registered hygienists Est 18



Registered dental hygienists may pursue careers in both public and private practice. A dentist must be present on the premises.

Dental Nurses (Therapists)

The Jamaica dental nurses must successfully complete a 3-year certificate course in the special school to qualify. They must register with the Dental Council. Continuing education is not mandatory

Number of registered dental nurses Not given

Dentist to dental nurses ratio

Percentage of dental nurses who are male 0%

Registered dental nurses may only work in public clinics. A dentist does not need to be present on the premises at all times.


Dental technicians do not need to be formally trained to legally practice. However, there is a 3-year certificate course in the dental auxiliaries’ school, which offers all courses. They must register with the Dental Council. Continuing education is not mandatory




Technicians work mostly in private laboratories, but some are in dental clinics linked to hospitals.


Clinical dental technicians do not need to be formally trained to legally practice. However, there is a 3-year certificate course in the dental auxiliaries’ school. They should register with the Dental Council but most lack formal training so do not (it is estimated that there are over 300 unregistered). Continuing education is not mandatory



Clinical dental technicians work only in private practice


Assistants train informally in the workplace but there is a dental auxiliaries’ school in which they can receive formal training for 2 years. They do not register with the Dental Council to work as “qualified” as the title is not protected and anyone can work as such. There is no mandatory continuing education.



53

Kenya

CDA region: East and South Africa Eastern Africa, bordering the Indian Ocean, between Somalia and Tanzania. A republic, independent since 1963.

Population: 34,707,817 (2006)

Kenya has an oral health policy. Dentistry in general practice is provided privately, although some institutions make private arrangements for their employees. Children are described as such to the age of 18. Public salaried dentists work in government hospitals and clinics and charitable health institutions.

There is a Kenyan Dental Association [2006: 200 members].


There is one dental school and education and training lasts for 4 years, leading to a BDS. There is no post-qualification vocational training or compulsory continuing education. Registration is with the Medical Practitioners’ and Dentists’ Board.




Percentage of dentists working in general practice Not known



Specialists (2005)

Most specialist training is taken abroad – usually for 3 to 4 years.

Orthodontists 5

Oral and maxillofacial surgeons (1) 19

Prosthodontics 4

Periodontics 5

Paediatric dentistry (1) 10

Restorative dentistry 8

Biomaterials 5

Community and preventive dentistry (1) 2

Dental radiology 1

(1) Training for these specialties has been offered in Kenya since 2002

54

Dental Care Professionals (Auxiliaries) 2006 Kenya

Hygienists

Hygienist is not a protected title in Kenya; there is no institution that trains hygienists locally. Further, there is no registration board for dental auxiliaries in Kenya. The (currently) one hygienist was trained in the USA for 3 years, completing a diploma. She has registered with the Nursing Council. Postgraduate education is not compulsory.




The hygienist works in a government hospital and clinic, but may work in private practice.

Community Oral Health Officers (Therapists)

COHOs must successfully complete a 3-year diploma course at the Dental Training College, Nairobi. The title is not protected, and they do not have to register. Continuing education is not mandatory.

Number of COHOs 130



They work in Ministry of Health Government Dental Clinics but they can work in private practice. They are allowed to undertake whatever they have been trained for, but there are no specific regulations guiding such practise.


Technicians must successfully complete a 3-year diploma course at the Dental Training College, Nairobi. The title is not protected, and they do not have to register. Continuing education is not mandatory.




They work in Ministry of Health Government Dental Clinics but they can work in private practice


Number of CDTs 0


Dental Surgery Assistants (DSA)



There are some dental nurses who are trained at the workplace. There are three who at some time went to the University of London, Guy’s Hospital, to “sharpen their skills” in giving assistance to dentists.

55

INCOMPLETE INFORMATION

Kiribati

CDA region: Pacific and Australasia Formerly the Gilbert Islands, independent since 1979, is a parliamentary republic


There is no information about health systems

Dental Association: None.


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is not known


Both work in the public sector


Specialists (2006)


Orthodontists


56

Dental Care Professionals (Auxiliaries) 2005


Hygienists

Therapists 2

Technicians

Clinical dental technicians (Denturists) 2

Dental (chairside) Assistants 3

57


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Medical, Dental and Pharmacy Council.







2 dentists from the public service also work in private practice.

Specialists (2007)


Orthodontists


Public health 2

Lesotho

CDA region: East and South Africa Southern Africa, an enclave of South Africa Basutoland which was a British protectorate was renamed the Kingdom of Lesotho upon independence from the UK in 1966. Is a parliamentary constitutional monarchy.

Population: 2,022,331 (2006)

Oral healthcare is given through a mixture of public and private services. Children are defined as such to 10 years of age and they pay half of the equivalent adult user fee in the public service (which is subsidised by the government). An oral health policy has been developed with the help of the WHO, and is awaiting legislation.

There is a Medical and Dental Association [3 dental members].

58

Dental Care Professionals (Auxiliaries) 2007 Lesotho

Hygienists

Hygienist training was undertaken in South Africa, for 3 years (or with a diploma at 2 years). Registration is mandatory with the Medical, Dental and Pharmacy Council. Continuing education is not mandatory.




The hygienist works supervised in the public service.

Therapists

Lesotho no longer has any therapists, who had been trained in overseas





The technicians trained overseas, in Cuba, for between 3 and 4 years – receiving a diploma. Registration is mandatory with the Medical, Dental and Pharmacy Council. Continuing education is not mandatory.




They work in public service


Number of CDTs 0


Dental Chairside Assistants

Training is at the workplace, although it is thought that some have a diploma obtained overseas. Registration is mandatory with the Medical, Dental and Pharmacy Council. Continuing education is not mandatory.



59

Malaysia

CDA region: South East Asia Southeastern Asia, peninsula bordering Thailand and northern one-third of the island of Borneo, bordering Indonesia, Brunei, and the South China Sea, south of Vietnam. The Federation of Malaya became independent in 1957. Malaysia was formed in 1963 when the former British colonies of Singapore and the East Malaysian states of Sabah and Sarawak joined the Federation. Singapore seceded from the Federation in 1965. Malaysia is a constitutional monarchy.

Population: 24,385,858 (2006)

Malaysia has an oral health policy. Most dentistry is provided privately. Children are described as such to the age of 16.

There is a Malaysian Dental Association [FDI figures 2006: 2,193 members].


There are 5 dental schools and education and training lasts for 5 years. There is no post-qualification vocational training and no compulsory continuing education. Registration is with the Malaysian Dental Council.







Specialists (2006)

Specialist training for orthodontics is given in local universities, the University of Malaya and University Kebangsaan. Some seek training overseas.

Orthodontists Not given

Oral and maxillofacial surgeons Not given

60

Dental Care Professionals (Auxiliaries) 2006 Malaysia

Hygienists




Therapists

Dental therapists must successfully complete a 2-year dental therapy diploma course at the Dental Training College, Pulau Pinang, Malaysia. The title is protected, but they do not have to register. Continuing education is mandatory for 7 days per year or 20 credit points

Number of registered therapists 2,066


Percentage of therapists who are male None

They work in Ministry of Health Government Dental Clinics. They cannot work in private practice


Technicians train in the Dental Training College, Penang. Training duration is 3 years. No registration needed after qualification and continuing education is not mandatory.




They work in public and private sectors, serving 2,392 clinics.


Number of CDTs 0



DSAs train in the Dental Training College, Penang. Training duration is 2 years. No registration needed after qualification and continuing education is not mandatory.

Number of Assistants 2,463


61

INFORMATION INCOMPLETE

Maldives

CDA region: South-East Asia Southern Asia, group of atolls in the Indian Ocean, south-southwest of India. A republic since 1968, three years after independence.

Population: 359,008 (2006)

All are entitled to subsidised dental care in the public clinic but there is no health insurance scheme or national health service. About 50% receive their care in public clinics, but payment (even for children) is necessary. There is no known oral health policy.

There is no dental association


There are no dental schools and education and training takes place abroad, mainly in Sri Lanka. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Ministry of Health.


4 dentists work in private practice and 8 in the public service (6 of these are female)


Specialists (2006)

There are no specialists.

62

Dental Care Professionals (Auxiliaries) 2006 Maldives

The education and training of dental auxiliaries is carried out overseas

Hygienists




Therapists





Technicians train overseas No registration needed after qualification and continuing education is not mandatory.





Number of CDTs 0



There is no information about DSAs

Number of Assistants


63

Malta

CDA region: Europe A country of two small islands in the Mediterranean Sea, between Italy and Tunisia A republic, independent since 1964.

Population: 400,214 (2006)

Malta has an oral health policy. Most adult dentistry is provided privately but most children’s dentistry (under 16) is provided by a (free) public service.

There is a Malta Dental Association [FDI figures 2006: 102 members].


There is 1 dental school and education and training lasts for 5 years, with about 6 graduating per annum. There is no post-qualification vocational training and there is no compulsory continuing education. Registration is with the Medical Council of Malta.







Specialists (2006)

Specialist training is not given in Malta.

Orthodontists 3


Prosthodontics 4

Periodontics 1

Paediatrics 2

Community 1

Endodontics 1

Radiology 1

Others 6

11 Most Public Health dentists also work in General Practice

64

Dental Care Professionals (Auxiliaries) 2006 Malta

Hygienists

Oral hygiene is a protected title. Training is for 3 years in a government hospital, following which they receive a qualification – which is registered by the Board for Professions Supplementary to Medicine. Continuing education is not mandatory.




Hygienists work in both public and private practice, under the direct supervision of a dentist.

Therapists





Dental Technology is a protected title. Training is for 3 years in a government hospital, following which they receive a qualification – which is registered by the Board for Professions Supplementary to Medicine. Continuing education is not mandatory.




Technicians work in private laboratories (about 35%) and in dental clinics (65%).


Number of CDTs 0



Train in the workplace and there is no diploma or qualification. To work, do not have to be registered and continuing education is not mandatory.



65

Mauritius

CDA region: East and South Africa A small island in the Indian Ocean to the East of Madagascar. A republic, independent since 1968.

Population: 1,240,827 (2006)

Mauritius has an oral health policy. Much dentistry is provided privately. Children are deemed as such until the age of 12 years and receive free care from the public dental service, in which there are 46 dental clinics.

There is a Mauritius Dental Association [FDI figures 2006: 80 members].


There are 2 dental schools and education and training lasts for 4 years, with about 25-40 graduating per annum from 2007. There is no post-qualification vocational training and there is no compulsory continuing education. Registration is with the Medical and Dental Council.







Specialists (2006)

Specialist training is undertaken over 3 to 5 years, depending upon the specialty.

Orthodontists 7


Paediatrics 1

Public Health 1

Endodontics 1

66

Dental Care Professionals (Auxiliaries) 2006 Mauritius

Hygienists




Therapists





Dental technicians train overseas, mainly in Europe or South Africa, for a period of at least 3 years. They do not have to register. Continuing education is not mandatory.






Number of CDTs 0



Train in the workplace and there is no diploma or qualification. To work, they do not have to be registered and continuing education is not mandatory.



67

Mozambique

CDA region: East and South Africa Southeastern Africa, bordering the Mozambique Channel, between South Africa and Tanzania. Almost five centuries as a Portuguese colony came to a close with independence in 1975, as a republic. Subsequently joined the Commonwealth as the only country not formerly in the British sphere of influence.

Population: 19,686,505 (2006)

Oral healthcare is given by a mixture of public (NHS) and private providers. Some patients will have insurance. Child patients, to the ages of 12 to 17 (not standard) may receive free public care. There is an oral healthcare policy.

There is no dental association


There is one dental school and education and training lasts for an unidentified number of years. There is one-year post-qualification vocational training and there is no compulsory continuing education. Registration is with the Ministry of Health



Percentage of active dentists who are male Approx 50%

Percentage of dentists working in general practice Approx 80%

Percentage of dentists working in public salaried service Approx 19%


Specialists (2006)

Specialist training is undertaken over 3 to 5 years, depending upon the specialty.

Orthodontists 1


Periodontics 1

Prosthodontics 1

68

Dental Care Professionals (Auxiliaries) Mozambique

Hygienists




Therapists (2007)

Dental therapy is a protected title. Training takes place in Beira Therapists School for one and a half years, following which they receive a diploma. They must register with the Ministry of Health to work. They are required to attend at least an annual seminar.




Therapists may work in private practice or the National Health Service and a dentist does not need to be on the premises

Laboratory Technicians (2007)

DLT is a protected title. They train overseas, for a period of at least 3 years. They must register with the Ministry of Health. They are required to attend at least an annual seminar.




Technicians work in private laboratories and the NHS.


CDT is a protected title. Training takes place in Beira Technicians School for 3 years, following which they receive a diploma. They must register with the Ministry of Health to work. They are required to attend at least an annual seminar.

Number of CDTs 71


CDTs work in private practice and the NHS


There is no available information about dental chairside assistants



69

Namibia

CDA region: East, Central and South Africa Southern Africa, bordering the South Atlantic Ocean, between Angola and South Africa. A republic, independent since 1990.

Population: 2,044,147 (2006)

It was reported that children at state funded government schools are entitled to free screening and oral hygiene, as are pensioners and the unemployed. However, due to financial and personnel constraints this service is provided at very irregular intervals. All government employees are entitled to care under national health (insurance) system and all treatment whether done at state clinics or private clinics is covered. There is an oral health policy programme called “Vision 2030”.

There is a Namibia Dental Association [FDI figures 2006: 63 members].


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Dental Board of Namibia.







Specialists (2001)


Orthodontists 3


Periodontists 2

70

Dental Care Professionals (Auxiliaries) 2006 Namibia

Hygienists

Oral hygienists are trained overseas, mainly in South Africa, on a 2-year diploma course in a dental faculty. They must register with the Health Professions Council of Namibia. Continuing education is to become mandatory in the next 2 years.


Dentist to hygienist ratio 3:1


They work in private practices with a limited number in public (government) clinics. They work only under the direct supervision of a dentist

Therapists




Technicians

Dental technicians are trained overseas, mainly in South Africa, on a 4-year diploma course in a technical college. They must register with the Health Professions Council of Namibia. Continuing education is to become mandatory in the next 2 years.


Dentist to technician ratio 2.5:1


Technicians work on their own in commercial laboratories.


Number of denturists None



Chairside assistants train in the workplace, but some technical colleges in South Africa offer 1-year diploma courses.



71

New Zealand

CDA region: Pacific and Australasia Two main and several smaller islands in the South Pacific, south east of Australia. A constitutional monarchy under QE 2nd, independent since 1907.

Population: 4,076,140 (2006)

New Zealand has an oral health policy. The system of oral healthcare for adults is � rivate – fee paying. Some very limited government funding available for the disadvantaged. It is estimated as 90% private, 10% public. For the under-18s oral healthcare is free may be provided privately under government subsidy but 90% is provided in public school clinics.

There is a New Zealand Dental Association [FDI figures 2006: 1,662 members].


There is 1 dental school and education and training lasts for 5 years. There is no post-qualification vocational training. Continuing education is compulsory, 160 hours every four years. Registration is with NZ Dental Council.







Specialists (2006)

Specialist training is given in New Zealand and lasts for 2 to 5 years, depending upon the specialty

Orthodontics 83

Oral and maxillofacial surgery 38

Oral Medicine, Oral Pathology and Oral Surgery Specialists 13

Restorative Dentistry Specialists 13

Special Needs Dentistry Specialists 6

Paediatric Dentistry Specialists 10

Periodontic Specialists 27

Public Health Dentistry Specialists 10

Prosthodontic Specialists 18

72

Dental Care Professionals (Auxiliaries) 2006 New Zealand

Hygienists

Dental hygienists train in one of two accredited tertiary institutions. An earlier qualification was a 2 year diploma but it is now a 3 year combined Bachelor of Hygiene and Therapy, although the first graduates have not yet completed their courses. In order to practice they must be registered with the NZDC. Hygienists are required to undertake 60 hours of continuing education courses every 2 years.




Registered dental hygienists most often work with general practitioners with a dentist not necessarily present – but must practise under the clinical guidance of a dentist.

Orthodontic Auxiliaries

There are about 100 Orthodontic auxiliaries (included in the hygienist numbers). Some current practitioners were ‘grandparented’ in on implementation of new legislation. A training programme is being developed. They have to register and have the same continuing education requirements. They work in private practice.

Therapists

Dental therapists train in one of two accredited tertiary institutions. An earlier qualification was a 2 year diploma but it is now a 3 year combined Bachelor of Hygiene and Therapy, although the first graduates have not yet completed their courses. In order to practice they must be registered with the NZDC. Therapists are required to undertake 60 hours of continuing education courses every 2 years.




Dental therapists usually work for District Health Boards, although a small number can now work in private practices. They may work without a dentist being present, but must have an agreement with a dentist in place for access to advice and guidance.


Dental technicians train in one accredited tertiary institution for 3 years, leading to a degree. In order to work they must be registered with the NZDC. They are required to undertake 60 hours of continuing education every 4 years (to be increased to 80 hours soon).



Percentage of technicians who are male Not given



CDTs train in one accredited tertiary institution for 3 years, leading to a degree and then 1 year Postgraduate Certificate. In order to work they must be registered with the NZDC. They are required to undertake 60 hours of continuing education every 4 years (to be increased to 80 hours soon).


Percentage of denturists who are male Approx 70%

They normally work in private practice


The NZDA offers training a course (at the workplace) over 1 year in a modular format with assessments online, but this is not a requirement. The title is not protected and there is no continuing education requirement.



73

Nigeria

CDA region: West Africa Western Africa, bordering the Gulf of Guinea, between Benin and Cameroon. A republic, independent since 1960.

Population: 131,859,731 (2006)

Nigeria has an oral health policy. Patients are seen in a mixed National Health Insurance Scheme and private systems. In general practice fees may be subsidised by the federal, state or local government. Subsidies may also be from companies and personal insurances. All these public authorities may employ salaried dentists in clinics and hospitals. Children are the under 18s.

There is a Nigeria Dental Association [FDI figures 2006: 3,711 members].


There are 4 dental schools and education and training takes 5 years. About 120 graduate each year. Registration is with the Nigeria Medical and Dental Council. There is a one-year post-qualification vocational training, and mandatory continuing education (introduced in 2001) is for a minimum of 3 days a year.


Number of active dentists Approx 3,600





Specialists (2006)

Specialist training is for between 1 and 6 years. This usually takes place in government hospitals which have been accredited by the National Postgraduate Medical College of Nigeria or the West African College of Surgeons. Some dentists go abroad for their training. Numbers of specialists were not given, except for Periodontics.

Orthodontists


Community dentistry

Periodontics 12

Oral medicine

Paedodontics

Oral pathology and biology

Conservative dentistry

Prosthodontics

Oral radiology

74

Dental Care Professionals (Auxiliaries) Nigeria

Hygienists (2004)

Dental hygienist is a protected title. However, all were converted 15 years ago to therapists and there are none now. Training took place abroad.

Number of registered hygienists Not applicable



Therapists (2004)

Dental therapists must successfully complete a 4-year dental therapy diploma course in one of the 3 therapy schools. The title is protected and they have to register with the Dental Therapists Board, which is funded by the Federal Ministry of Health. Continuing education is organised but not mandatory.

Number of therapists 1,500



Therapists work in publicly owned premises (although they can work in private practice) and a dentist must be present.

Dental Technologists (Technicians) (2004)

Technologists train in a Dental Technology training school and receive a diploma. The title is protected and to work they need to be registered with the Dental Technologist Registration Board. Continuing education is organised but not mandatory.




Technicians work in both public and private practice


Some dental nurses train as CDTs – see below

Dental (chairside) Assistants/Dental Nurses/Clinical Dental Technicians (2004)

They train in 3 training schools, they then receive a certificate, following which they need to register with the Dental Therapists Registration Board, which also organises continuing education. Some dental nurses train as CDTs – the system varies with completion certificate differences in various regions.

Number of Assistants/CDTs 1,540


75

Pakistan

CDA region: South East Asia

Southern Asia, bordering the Arabian Sea, between India on the east and Iran and Afghanistan on the west and China in the north. A republic, independent since 1947.

Population: 165,803,560 (2006)

All individuals are entitled to oral health care in public clinics. However the treatment available is described as “rudimentary”, for the alleviation of pain by medication and extractions. Social welfare departments run hospitals and clinics for industrial workers. The oral health cover is limited to extractions, filling and scaling for a token fee. General dentistry covered under national health system includes fillings, root canal treatment, scaling, extraction and trauma. However, in most facilities the only treatment offered is extraction and temporary fillings. Children are counted as such to 12 years of age. Pakistan does not have an oral health policy.

There is a Pakistan Dental Association [FDI figures 2006: 1,105 members].


There are 19 dental schools and education and training takes 4 years, leading to a BDS degree. Over 500 graduate each year. There is a one-year post-qualification vocational training but no mandatory continuing education. Registration is with the Pakistan Medical and Dental Council.


Number of active dentists Estimated 3,50012


Percentage of dentists working in general practice Approx 70%

Percentage of dentists working in public salaried service13 Approx 30%


Specialists (2006)

Specialist training normally lasts up to 4 years. There are no figures for individual specialities, but overall there are reported to be 410

Orthodontists


12 Large numbers of female dentists trained since 2000 do not currently practice 13 All public service dentists are also allowed to undertake private practice.

76

Dental Care Professionals (Auxiliaries) Pakistan

It has been reported that there are up to 20,000 people practising illegally as hygienists and denturists.

Hygienists (2006)

Dental hygienist is not a formally recognised vocation in Pakistan so the title is not restricted or protected. However, training takes place in 4 institutions for 2 years, following which the 25-30 who complete each year receive a diploma from the Provincial Medical Faculty, which is an accreditation body. Registration is not mandatory, neither is continuing education.

Number of hygienists (in 2001) 252


Percentage of hygienists who are male Estimated 90%

Most of those trained either start up a practice in low-lying areas, posing as dentists and a small percentage work as an assistant to a dentist. Officially a dentist must be present but this does not always happen.

Therapists




The title is not protected. Technicians train in one of 6 dental technician schools for 2 years, following which they receive a diploma. To work they do not need to be registered and continuing education is not mandatory

Number of technicians Approx 600


Percentage of technicians who are male Almost 100%

Technicians work in both public clinics and hospitals as well as private practices

Clinical dental technicians (denturists)

Number of denturists Non legally


Dental (chairside) Assistants (2006)

They train at the workplace, although recently 2 schools have started with a one-year training, following which they receive a certificate. They do not need to register so the title is not protected. There is no continuing education requirement.

Number of Assistants (2001) > 2,500


77

Papua – New Guinea

CDA region: Pacific and Australasia A group of islands including the eastern half of the island of New Guinea between the Coral Sea and the South Pacific Ocean, east of Indonesia. Independent since 1975 and is a monarchy under QE 2nd.

Population: 5,670,544 (2006)

Public oral healthcare is given from hospital dental clinics and private care from private practices. Children are counted as such to the Age of 12. There is no oral health policy.

Dental Association: Yes (formed in 1999, less than 10 members).


There is one dental school where education and training takes 5 years (but see below for therapists). There is a 2-year post-qualification vocational training but then no mandatory continuing education. Registration is with the PNG Medical Board.







The dentists practice in 78 clinics and 10 private practices

Specialists (2006)

Specialist training (over 4 to 5 years) takes place in PNG, but with a short attachment in Australia. One orthodontist commences training in 2007

Orthodontists



78

Dental Care Professionals (Auxiliaries) PNG

Hygienists



Therapists (2007)

Dental Therapy is a protected title and they are trained in the dental school. The course is a 3-year program, when they receive a diploma. They may then “upgrade” their training for 2 more years to dentist, as a (public) dental officer. As therapists they must register with the PNG Medical Board but there is no mandatory CPE.




They may work in the public clinics and a dentist need not be present.


Laboratory technician is a protected title and previously they were trained in the dental school, leading to a diploma. There is a plan to restart training at the school in 2008. They must register with the PNG Medical Board. There is no mandatory CPE.




They normally work in government hospital dental clinics




The title is not protected. They train at the workplace, for 2 to 3 years, following which they receive a diploma. They do not need to register and there is no continuing education requirement.



79


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is with the Ministry of Health and the Environment.






Dentist to population ratio: 1:6,000

Specialists (2006)

Specialist training is obtained abroad. All the orthodontists are visitors from overseas, not resident in St Vincent.

Orthodontists 4


St Vincent and the Grenadines

CDA region: Caribbean and Canadian Caribbean islands north of Trinidad and Tobago. A monarchy (under QE 2nd), independent since 1979

Population: 117,848 (2006)

In the public clinics dental services are free for children under 16 and adults over 60, all other patients pay a minimal cost for procedures ranging from EC$5-20. In private practices patients pay in full or use their personal medical insurance. There is no oral health policy.

There is no dental association and most dentists are members of the St Vincent Medical Association.

80

Dental Care Professionals (Auxiliaries) St Vincent and the Grenadines

Hygienists

Dental hygienist is a protected title. Education and training normally takes place overseas, mainly in the Jamaica. Registration is not mandatory and continuing education is also not mandatory.


Dentist to hygienist ratio 20:1


Hygienists may not work without a dentist on the premises.

Therapists

Dental Therapists/Nurses are trained in Trinidad or Jamaica. The course is a three year program.



Percentage of therapists who are male 0

They may work in the public or private clinics once a Dentist is present.


There are laboratory technicians here who have been trained in Jamaica for three years, registration is not mandatory and they can work on their own. They are, however, limited by resources to only making acrylic dentures and appliances. There are some technicians who have not been trained but also do acrylic work, there are three of these.



Percentage of technicians who are male 0







81


Samoa

CDA region: Pacific and Australasia Was known as “Western Samoa” until 1997. A mix of parliamentary democracy and constitutional monarchy under QE 2nd, independent since 1968

Population: 176,908 (2006)


Dental Association: Yes.




2 are in public service and 6 in private practice. Additionally, there is 1 in a private hospital and 1 volunteer


Specialists (2006)


Orthodontists


82

Dental Care Professionals (Auxiliaries) 2005 Samoa

All the auxiliaries qualify in the National University. There is no other information about the education, training and registration of dental auxiliaries

Hygienists 4

Number of hygienists

Therapists 40

Number of therapists

Technicians

Number of technicians


Number of denturists


Number of assistants

83

Sierra Leone

CDA region: West Africa Situated on the Atlantic Ocean coast of West Africa A republic, independent since 1961.

Population: 5,300,000 (2005 estimated)

Sierra Leone does not have an oral health policy. Patients are seen in a mixed NHS and private system. Children are the under 16s.

There is a Sierra Leone Medical and Dental Association.


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Sierra Leone Medical and Dental Council.







Specialists (2006)


Orthodontists 0



84

Dental Care Professionals (Auxiliaries) Sierra Leone

Hygienists (2003)

Dental hygienist is a protected title. Training takes place abroad (the UK) and registration is mandatory with the Ministry of Health




The hygienists work in publicly owned premises (although they can work in private practice) and a dentist must be present.

Therapists





The title is protected. Technicians train in overseas, mainly in the UK and Russia. To work they need to be registered with the Ministry of Health. Continuing education is not mandatory




Technicians work in both public and private practice





They train at the workplace for 8 weeks, they then receive a certificate, following which they need to register with the Ministry of Health so the title is protected. There is no continuing education requirement.



Dental Nurses (2000)

These auxiliaries were trained in New Zealand, as part of their former scheme, for 2 years and received a diploma on qualification. They register with the Ministry of Health and work in governmental dental clinics. There is no continuing education requirement.

Number of Nurses 5

Percentage male 0%

85

Singapore

CDA region: South East Asia Southeastern Asia, islands between Malaysia and Indonesia. A republic, Singapore joined the Malaysian Federation in 1963 but separated two years later and became independent.

Population: 4,492,150 (2006)

Singapore has an oral health policy. Dentistry in general practice is provided privately, with or without insurance co-payment. Children are described as such to the age of 17. All dentists work in general practice but some also work as public salaried dentists in government hospitals and clinics.

There is a Singapore Dental Association [FDI figures 2006: 1,200 members].


There is one dental school and education and training is undertaken over 4 years. There are about 36 graduates per year. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Singapore Dental Council.



Percentage of active dentists who are male Not known




Specialists (2006)

There is no specialist register at present. Some dentists with advanced degrees restrict their practice to their area of specialization but that is voluntary. Specialist training would normally be for 3 to 4 years.

14 All dentists work for at least part-time in general practice, including those who usually work in the public sector

86

Dental Care Professionals (Auxiliaries) Singapore

Hygienists (2006)

Currently there are no dental hygienists in Singapore but legislation introducing them is expected to be enacted in 2007.




Therapists (2006)

Dental therapy is a protected title in Singapore. There is one training school (polytechnic) and education and training lasts 3 years, following which a diploma is issued. The therapists are all employed by the government and registration is automatic.

Number of registered therapists 200 to 300


Percentage of therapists who are male <10%

Therapists are able to work in government clinics in primary schools only. A dentist does not need to be present.


The title is not protected. Technicians usually train in the workplace although some do so overseas. To work they do not need to be registered and continuing education is not mandatory

Number of registered technicians Not given



Technicians work usually in private practice.




Dental Surgery Assistants (2006)

The title is not protected and they usually they train at the workplace, although two formal training programmes exist, both for less than one year part time. Both award diplomas on completion. They do not need to be registered and there is no continuing education requirement.



87


Solomon Islands

CDA region: Pacific and Australasia Independent since 1978, is a monarchy under QE 2nd

Population: 552,438 (2006)


Dental Association: One being planned.




16 dentists work in the public sector and 3 are private practitioners. All but one dentist are male.


Specialists (2006)

Specialist training is obtained abroad. Currently there are no specialists

Orthodontists


88



Hygienists

Therapists 14

Dental Nurses 2

Technicians 5



89

South Africa

CDA region: East and South Africa Forms the southern part of the continent of Africa. Independent since 1910, a republic since 1961, federal (provincial) system.

Population: 44,187,637 (2006)

South Africa used to have a health policy but now is only a strategy. The system of oral healthcare is private, with some third-party cover. Children are defined as such to the age of 14 years.

There is a South African Dental Association (SADA), with regional branches [FDI figures for SADA 2006: 3,348 members]. .


There are 4 dental schools and education and training lasts for 5 years. There is 1-year post-qualification vocational training and continuing education is compulsory, currently 50 hours per year but soon reducing to 30 hours. Registration is with the Health Professions’ Council of South Africa (HPCSA)


90

Number of active dentists approx 3,300

Percentage of active dentists who are male Not known

Percentage of dentists working in general practice approx 75%

Percentage of dentists working in public salaried service approx 20%


Specialists (2005)

Specialist training is given in South Africa and lasts for 4 years, except for OMFS (5 to 6 years)

Orthodontists 104


Oral medicine and periodontists 43

Endodontists 0

Prosthodontists 44

Paedodontists

Public health (Community) 35


91

Dental Care Professionals (Auxiliaries) 2006 South Africa

Hygienists

Oral hygiene is a protected title. Hygienists train in one of 5 universities and qualify after 2 years (diploma) or 3 years (diploma moving to degree soon- for those with expanded duties). On qualification they must register with the HPCSA. There is no requirement for continuing education yet (although it will be 30 hours soon).



Percentage of hygienists who are male Not known

Registered hygienists (RDHs) may pursue careers in both community and private practice. A dentist must be reasonably available but not necessarily on the premises.

Therapists

Therapists have a protected title. They train in one of two universities for 3 years and qualify with the title BDTh. On qualification they must register with the HPCSA. They work under supervision for 1 year after graduation. There is no requirement for continuing education yet (although it will be 30 hours soon).



Percentage of therapists who are male Not known

Dental therapists can practice independently. They can examine and diagnose. They were originally only to work under the direct supervision of a dentist and be employed by the state, but the state could not provide sufficient posts (or supervision) so their employment expanded first to “parastatals” and then to private practice. They now perform many services for which they have no formal training including orthodontic ‘wiring’.


Technicians train in Technicons for 4-5 years – 4 years for a diploma (called technicians) and 5 years for a degree (called technologists). To work they must be registered with the SADTC. Continuing education is not mandatory.

Number of registered technicians approx 700





The Dental Technicians’ Act makes provision for these but as yet there are none working legally and there is no training available, or registration authority.

Number of CDTs 0


Train in one of 4 Technicons or at the workplace with a common registration exam, leading to a diploma. Since October 2005 they have needed to register with the HPCSA. There is no continuing education requirement.



92

Sri Lanka

CDA region: South East Asia A large island in the Indian Ocean, just off the South East Indian coast. A republic, independent since 1948 (as Ceylon), became Sri Lanka in 1972.

Population: 20,222,240 (2006)

Sri Lanka does not have an oral health policy. About 70% of adult dentistry and 90% of children’s (under 12s) is provided by a (free) public service, the rest in general practice is wholly private.

There is a Sri Lankan Dental Association (SLDA) [FDI figures 2006: 650 members].


There is 1 dental school and education and training lasts for 4 years, with about 75 graduating per annum. There is no post-qualification vocational training. There is no compulsory continuing education. Registration is with the Sri Lanka Medical Council.







Specialists (2006)

Specialist training is given and lasts for 3 to 5 years, depending upon the specialty

Orthodontists 14


Restorative 10

Family dentistry 12

Public health (Community) 24

93

Dental Care Professionals (Auxiliaries) 2006 Sri Lanka

Hygienists




Therapists

Therapists have a protected title. They trained in one school which closed in 1998. They do not work under supervision. There is no requirement for continuing education.




Dental therapists work in public school dental clinics only.


Technicians train in the Faculty of Dental Science (in the one dental school) for two years, but with no diploma on qualification. To work do not have to be registered and continuing education is not mandatory.




Technicians work in private laboratories and in dental clinics.


The Dental Technicians’ Act makes provision for these but as yet there are none working legally and there is no training available, or registration authority.

Number of CDTs 0



Train in the workplace and in the Faculty of Dental Science (in the one dental school) for two years, but with no diploma on qualification. To work do not have to be registered and continuing education is not mandatory.



94

Tanzania

CDA region: East, Central and Southern Africa East Africa, bordering the Indian Ocean, north of Mozambique and south of Kenya. Shortly after achieving independence from Britain in the early 1960s, Tanganyika and Zanzibar merged to form the nation of Tanzania in 1964. A republic.

Population: 37,445,392 (2006)

Dentistry is provided mainly in the private sector. There is also a main referral hospital as well as health centres which are slightly smaller where people can go for treatment, although this may not be totally free – hence they may have to meet some of the costs. When cases cannot be managed at the health centres then they are sent to the major referral hospital. Both the children and the adults are seen in these clinics. There is nothing separate and it is often treatment given on first come first serve basis. Children are those who are under 17. Tanzania has an oral health policy

There is a Tanzanian Dental Association.


There is one dental school and education and training takes place over 5 years. There is no post qualification training nor is there any mandatory continuing education. Registration is with the Dental Council.

Number of registered dentists1 208

Number of active dentists1 200





Specialists (2005)

Specialist training takes 3 years.

Orthodontists 0


Paedodontists 1

Prosthodontists 1

Community Oral Health 3

95

Dental Care Professionals (Auxiliaries) 2006 Tanzania

Hygienists

Number of hygienists None

Therapists

Therapists have a protected title. They train in one of two local schools for 3 years, following which they receive a diploma. They do not need to register and continuing education is not mandatory.

Number of therapists Not given

Dentist to therapist ratio Not given


They may work in government clinics or private practice


Dental technicians are all trained abroad for 2 years, when they receive a diploma. The title is protected but registration is not necessary and continuing education is not mandatory.

Number of Technicians 6

Dentist to Technologists ratio 35

Percentage of Technologists who are male 100%



CDTs are trained locally in the one school for 3 years, following which they receive a diploma. The title is protected but registration is not necessary and continuing education is not mandatory.

Number of registered CDTs Not given



Dental Attendants

They train at the workplace. There is no qualification. They do not need to register and the title is not protected. There is no continuing education requirement.

Number of Assistants Not recorded


96


Tonga

CDA region: Pacific and Australasia Independent since 1978 under a monarchy with a Tongan King

Population: 114,689 (2006)


Dental Association: Yes.




There are 12 dental officers working in the public service and 4 private practitioners (3 of whom are expatriates). All but 3 are male.


Specialists (2006)


Orthodontists


97

Dental Care Professionals (Auxiliaries) 2005 Tonga


Hygienists

Therapists 16

Technicians



All are locally trained

98

Trinidad and Tobago

CDA region: Caribbean and Canadian Islands between the Caribbean Sea and the North Atlantic Ocean, northeast of Venezuela. A republic, independent since 1962.

Population: 1,065,842 (2006)

Trinidad does not have an oral health policy. Adult dentistry is 100% private. Children (under 12s) are also usually seen privately, but 40% are seen in the public dental service. It is reported that there are about 300 dental “quacks” who illegally provide a form of dentistry, but their removal requires action in the criminal courts.

There is a Trinidad Dental Association (SLDA) [FDI figures 2006: 60 members].


There is 1 dental school and education and training lasts for 5 years, with about 25 graduating per annum. There is a one-year mandatory post-qualification vocational training. There is no compulsory continuing education. Registration is with the Trinidad Dental Council.







Specialists (2006)

Specialist training is not given and there is no specialist register

Orthodontists 7


Periodontics 1

Endodontics 2

Paedodontics 2

99

Dental Care Professionals (Auxiliaries) 2006 Trinidad and Tobago

Hygienists




Dental Nurses (Therapists)

Nurses have a protected title. They trained in one school (Government Dental Nurses School) for two years, but it is now closed. They enrolled with the Dental Council.

Number of nurses 50

Dentist to nurses ratio 5

Percentage of nurses who are male

Dental nurses are permitted to treat children (under 12 years old) only and such treatment may only be carried out in facilities or services operated or conducted by the government or under direct or indirect supervision of a dentist in private clinics


Technicians train in the workplace with no qualification, so anyone may undertake technical services. To work they do not have to be registered and continuing education is not mandatory.






Number of CDTs 0


Dental (Chairside) Nurses

Train in the workplace with no qualification. To work do not have to be registered and continuing education is not mandatory.



100


Tuvalu

CDA region: Pacific and Australasia Formerly the Ellis Islands, independent since 1978, as a monarchy under QE 2nd






Number of registered dentists 1 + 1 retired who acts as a locum


Specialists (2006)

Orthodontists


101

Dental Care Professionals (Auxiliaries) 2005 Tuvalu

There is no information about the education, training and registration of dental auxiliaries other than they must train overseas

Hygienists

Therapists 1

Technicians 1



General nurses are trained to undertake some care, such as extractions

102

Uganda

CDA region: East, Central and Southern Africa Completely landlocked, situated in east Africa, north west of Tanzania and west of Kenya. A republic, independent since 1962.

Population: 28,196,000 (2006)

Dentistry is provided mainly in the private sector. There is also a main referral hospital as well as health centres which are slightly smaller where people can go for treatment, although this may not be totally free – hence they may have to meet some of the costs. When cases cannot be managed at the health centres then they are sent to the major referral hospital. Both the children and the adults are seen in these clinics. There is nothing separate and it is often treatment given on first come first serve basis. Children are those who are under 17. Uganda has an oral health policy.

There is a Uganda Dental Association [FDI figures 2006: 60 members].


There is one dental school and education and training takes place over 5 years. There is 12 month post qualification training which is also called “internship”. It is undertaken in three main centres – two are based within the major referral hospital Mulago (mainly surgery and trauma), while the third one is in Mengo hospital (mainly prosthetics and conservative treatment) There is 56 hours’ mandatory continuing education each year. Registration is with the Uganda Dental Council, renewable every year.

Number of registered dentists1 200

Number of active dentists1 150

Percentage of active dentists who are male1 65%

Percentage of dentists working in general practice 1 60%

Percentage of dentists working in public salaried service 1 40%

Dentist to population ratio: 1:166,000 1 All figures are estimates

Specialists (2005)

Specialist training takes place abroad, especially in South Africa, although some is done in the UK.

Orthodontists 1


Dental pathology 2

Conservative dentistry 3

Prosthodontists 3

Oral radiologists 2

Oral medicine 1

Public Health 8

103

Dental Care Professionals (Auxiliaries) 2006 Uganda

Hygienists

Dental hygienist is not a recognised title in Uganda. Their work is undertaken by Public Health Dental Assistants (see below).

Therapists

Dental therapist is not a recognised title in Uganda. Their work is undertaken by Public Health Dental Assistants (see below).

Public Health Dental Assistants (PHDA)

They train in a school for para-medicals for 3 years, following which they must register with the Allied Professionals Council. There is no mandatory continuing education.

Number of PHDAs 300 to 450

Dentist to PHDA ratio 0.5

Percentage of PHDAs who are male Estimated at 75%

PHDAs work in government clinics especially manning the health centres in rural areas and hospitals only. A dentist does not need to be present on the premises when they are working. They undertake simple and routine scaling and oral hygiene instruction. They may also place simple fillings. They are also allowed to run private clinics, although work they do here is also supposed to be limited.

Dental Technologists

Dental technologists in Uganda undertake the clinical laboratory work for the dentist. They are all trained abroad. They do not need to register and continuing education is not mandatory.

Number of Technologists Estimated at 8

Dentist to Technologists ratio 20:1

Percentage of Technologists who are male Approx. 90%





They train at the workplace. There is no qualification. They do not need to register and the title is not protected. There is no continuing education requirement.

Number of Assistants Not recorded

Percentage of Assistants who are male Estimated at 20%

104

United Kingdom

CDA region: Europe Western Europe, islands including the northern one-sixth of the island of Ireland between the North Atlantic Ocean and the North Sea, northwest of France. A constitutional monarchy. There are devolved assemblies in Wales, Scotland and Northern Ireland.

Population: 60,609,000 (2006)

The UK has an oral health policy. Many adult patients are seen in a state-funded NHS (with co-payments by some) and people on low-incomes are eligible for free treatment. A significant number are seen in private systems (including insurance based). Children (under 18s) are usually seen in the NHS – free of charges. There is a publicly funded Community service which undertakes care for the vulnerable and epidemiological surveys.

There is a British Dental Association [FDI figures 2006: 18,793 members].


There are 13 dental schools and education and training lasts for 5 years. A new school will open in 2007, which will offer graduate training (over 4 years). There is post-qualification vocational training for 12 months for working in the NHS. Continuing education is compulsory – 75 hours of formal courses over 5 years with 250 hours of non-formal education. Registration is with the General Dental Council (GDC).



Percentage of dentists who are male 63%

Percentage of dentists working in general practice15 75%



Specialists (2003)

Specialist training is given in the UK and lasts for 3 to 5 years, depending upon the specialty

Orthodontists 1,125

Oral surgeons 234

Dento-maxillofacial surgeons 23

Surgical dentists 727

Periodontists 275

Endodontists 185

Prosthodontists 372



Restorative Dentistry 287

Oral medicine 84

Oral microbiologists 6


15 Many general dental practitioners also work part-time in public salaried service.

105

Dental Care Professionals (Auxiliaries) 2006 UK

Hygienists

Oral hygiene is a protected title. In schools of hygiene for 24 to 36 months. They qualify with a diploma or degree. In 2006 there are just 6 hygiene only programmes; many other schools offer hygiene within a therapy programme. On qualification they must register with the GDC. There is no requirement for continuing education, except as an ethical demand.

Number of registered hygienists 4,737



Registered hygienists may pursue careers in all branches of practice, in or outside the NHS. Some practice independently but a dentist must prescribe the treatment and need not be on the premises.

Therapists

Therapists have a protected title. They train in schools of therapy for up to 36 months. They qualify

with usually diploma but some with a degree. There were 16 therapy schools in 2006, some offering only hygiene to therapy conversion courses. On qualification they must register with the GDC. There is no requirement for continuing education, except as an ethical demand.




Dental therapists can practice independently. They may pursue careers in all branches of practice, in or outside the NHS. A dentist must prescribe the treatment but need not be on the premises. From July 2006 Orthodontic therapists have been permitted, with their own special training programme.


Technicians train in Further Education colleges, dental hospitals and at the workplace. Training lasts 4 years – usually with an award of a diploma but some with a degree. In 2006 there were 4 degree programmes, one of which is delivered at four colleges. To work they must be registered with the GDC. Continuing education is not yet mandatory.

Number of registered technicians Not yet known





Changes to the Dentists’ Act make provision for these but as yet there are none working legally and there is no training available. They will register with the General Dental Council.

Number of CDTs 0



Usually train at the workplace with part-time colleges. Some train full time in dental schools. There are over 100 courses running in the UK in 2006. Either by examination or by assessment they qualify with a Certificate or Diploma. Since July 2006 they have needed to register with the GDC. There is no continuing education requirement yet.



106


Vanuatu

CDA region: Pacific and Australasia Formerly the New Hebrides, has been independent since 1980 and is a parliamentary republic

Population: 208,869 (2006)


Dental Association: briefly formed in 1999 and planning a new one





Specialists (2006)


Orthodontists


107



Hygienists

Therapists 6

Technicians



108

Zambia

CDA region: East, Central and Southern Africa Completely landlocked, situated in central Africa, North of Zimbabwe and east of Angola. A republic, independent since 1964.

Population: 11,502,010 (2006)

Zambia has an oral health policy. Almost all patients are seen in a state system for oral health care, but about 2% of adults and 1% of children (under 16s) are treated privately.

There is a Zambian Dental Association [FDI figures 2006: 20 members].


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training or mandatory continuing education. Registration is with the Medical Council of Zambia







Specialists (2006)


Orthodontists 0


Prosthodontists 1


109

Dental Care Professionals (Auxiliaries) 2006 Zambia

Hygienists

There is no hygienist training in Zambia. Both current hygienists trained and qualified in Australia with diplomas. They are registered with the Medical Council of Zambia and are not required to undertake continuing education.




They work in dental clinics but may work in private practice. They are not supervised because of the shortage of dentists.

Therapists

Dental therapists train in the Dental Training School for 3 years, following which they qualify with a diploma. Then they must register with the Medical Council of Zambia and are not required to undertake continuing education.




They work in dental clinics but may work in private practice. They are not supervised because of the shortage of dentists.


Dental technicians train in the Dental Training School Zambia for 3 years, following which they qualify with a diploma. Then they must register with the Medical Council of Zambia and are not required to undertake continuing education.




Technicians normally work in private laboratories




Dental Attendants/(chairside) Assistants

They train at the workplace. Previous formal training at the Dental Training School of Zambia ceased in 1990. There is no qualification but they must register with the Medical Council of Zambia and are not required to undertake continuing education.



110

PART 3

Dependencies (not full members of the Commonwealth)


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is with the Bermuda Dental Board and currently is usually limited to dentists with a Bermuda family connection, or to those with specialist qualifications.







Specialists (2006)


Orthodontists 2


Periodontists 1


Bermuda

CDA region: Caribbean and Canadian A group of islands in the North Atlantic Ocean, east of South Carolina (US). A parliamentary; self-governing overseas territory of the UK.


Patients are seen in mainly a private system or private insurance. There is a small public service – children (aged 16 or under) are seen through their schools, free of charge. Bermuda does not have an oral health policy.

There is a Bermuda Dental Association (BDA) and reports having 33 members.

111

Dental Care Professionals (Auxiliaries) 2006 Bermuda

Hygienists

Dental hygienist is a protected title. Education and training normally takes place in the overseas mainly in the USA or UK. Registration is mandatory – with the Bermuda Dental Board and continuing education is not mandatory.




Hygienists only work in private practice. They may work without a dentist on the premises.

Therapists





Dental Laboratory Technician is not a protected title. Whilst previously training was at the workplace, now they train overseas, mainly in the USA (for 2 years). They must receive a diploma on qualification and to work they must be registered with the Bermuda Dental Council; continuing education is not mandatory.









The title is not protected. They train at the workplace, or are Certified Dental Assistants from overseas (about 50%). They do not need to register and there is no continuing education requirement.


Percentage of Assistants who are male 2.5%

112


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is not mandatory. Registration is with the BVI Dental Council.







Specialists (2006)


Orthodontists 1


Trauma patients are treated by a visiting OMF surgeon.


CDA region: Caribbean and Canadian Caribbean islands between the Caribbean Sea and the North Atlantic Ocean, east of Puerto Rico. The islands are an overseas territory of the UK


Patients are seen in mainly a private system or private insurance. A small public service consists of three clinics on four main islands, in which all school aged children, indigents, police officers, prisoners and fire officers are seen free of charge. They also serve as access areas for the entire population, under fee for service.. Policies pertaining to Oral health are not detailed or very specific but are found with in the Medical Act of the BVI.

The BVI Dental Association reports having 5 members.

113

Dental Care Professionals (Auxiliaries) 2006 British Virgin Islands

Hygienists

Dental hygienist is a protected title. Education and training normally takes place in the overseas mainly in the USA. Registration is not mandatory and continuing education is also not mandatory.




Hygienists may not work without a dentist on the premises.

Therapists





There are no laboratory technicians in the BVI and all work has to be sent to other islands/countries or undertaken by the dentist.











114


There are no dental schools and education and training takes place abroad. There is no post-qualification vocational training. Continuing education is mandatory, with 20 CME credits required annually. Dental courses are organised on the islands but many do online internet study. Registration is with the Medical and Dental Council, annually.







Specialists (2006)

Specialist training is obtained abroad.

Orthodontists 3


Periodontics 1

The Cayman Islands

CDA region: Caribbean and Canadian Three island group in Caribbean, south of Cuba and northwest of Jamaica. A self-governing British dependency.


Government employees are treated without charge. Other patients pay cash but most have some insurance cover. There is a children’s service, so children up to high school level may receive free basic care. There is a government insurance scheme which covers those who cannot pay. Cayman schoolchildren with gross malocclusion can get financial help for orthodontics. There is no oral health policy, but there is a regional strategy which the Caymans follow.

There is a Cayman Islands Medical and Dental Association [number of dental members unknown].

115

Dental Care Professionals (Auxiliaries) 2006 Cayman Islands

Hygienists

Dental hygienist is a protected title. Education and training normally takes place overseas, mainly in the UK, Canada and the USA. Registration with the Medical and Dental Council is mandatory and continuing education is also mandatory (20 CMEs per year).

Number of registered hygienists Approx 9


Percentage of hygienists who are male 0

Hygienists may work without a dentist on the premises.

Therapists

Dental therapist is a protected title. Education and training normally takes place overseas, mainly in Trinidad and Jamaica. Registration with the Medical and Dental Council is mandatory and continuing education is also mandatory (20 CMEs per year).



Percentage of therapists who are male 0

Therapists are employed in the public service and may work without a dentist on the premises.


Dental laboratory technician is a protected title. Education and training normally takes place overseas, mainly in the UK, Canada and the USA. Registration with the Medical and Dental Council is mandatory and continuing education is also mandatory (20 CMEs per year).




Laboratory technicians work in commercial laboratories



Percentage who are male 0


The title is protected. They train at the workplace. Registration with the Medical and Dental Council is mandatory and continuing education is also mandatory (20 CMEs per year).

Number of Assistants At least 35


116


Cook Islands

CDA region: Pacific and Australasia The islands are a self-governing dependency of New Zealand



Dental Association: No.




6 dental officers work in the public sector, including in an organised school dental service. 2 dentists are private practitioners.


Specialists (2006)


Orthodontists


117

Dental Care Professionals (Auxiliaries) 2005 Cook Islands


Hygienists

Therapists 6

Technicians



118

Falkland Islands

CDA region: Not allocated Southern South America, islands in the South Atlantic Ocean, east of southern Argentina. A self governing dependency of the UK. A governor exercises authority on behalf of the QE 2nd. There is a small legislature.


The Falkland Islands health service is almost entirely free to the public. Entitled patients of all ages receive free dental check ups and free dental treatment, with the exception of root canal treatment, dentures, crowns, bridges, for which they have to pay a contribution, rather than the full cost.



There are no dental schools and education and training takes place abroad. Registration is with the (UK) General Dental Council, so dentists are subject to the same post-qualification educational rules as UK dentists


The dentists work in public clinics


Specialists (2006)

No orthodontics are provided. This has been explored but the small size of the population and distances involved make it highly unlikely that it will happen. There is a visit every 2 years or so from an oral maxillo-facial specialist. Urgent cases are referred to Chile or UK.

Orthodontists 0


119

Dental Care Professionals (Auxiliaries) 2007 The Falkland Islands

All DCPs train overseas. There is an establishment of 0.5 whole time equivalent therapist/hygienist – who is usually employed for 6 months of the year. Laboratory work is sent to a dental laboratory in the UK.

Hygienists 0

Therapists 0.5

Technicians 0



They will be required to register with GDC when the regulations come into force in 2008.

120

Gibraltar

CDA region: Europe Southwestern Europe, bordering the Strait of Gibraltar, on the southern coast of Spain. Gibraltar was ceded to Great Britain by Spain in 1713 and was formally declared a colony in 1830. Since 1967, Gibraltar has been a British dependency.


The government provides a service for the low income families and emergencies, who are normally seen by salaried dentists in a primary care setting. But private practice serves the majority. Children have an entitlement to free dental treatment until they complete fulltime education. There is no oral health policy.

Dental Association: none – was discontinued some years ago


There are no dental schools and education and training takes place abroad, usually in the UK. Registration is with the Medical Registration Board. There is no post-qualification vocational training; nor mandatory continuing education.






Dentist to population ratio 2,148

Specialists

Specialist training takes place abroad, usually in the UK

Orthodontists 1


121

Dental Care Professionals (Auxiliaries) 2007 Gibraltar

Hygienists

There is just one hygienist who trained abroad, in the UK. There is no training in Gibraltar. The title is restricted but registration is not necessary, nor is continuing education mandatory.




The hygienist works in private practice under direct supervision

Therapists



Technicians train overseas, usually in the UK, receiving degrees or diplomas as appropriate. The title is not protected, they do not need to register and continuing education is not mandatory




The technicians work in private practice



Dental Nurses

The title is not protected and they may be called a number of titles: Nursing Auxiliaries, Nursing Assistants or Dental Nurses. Training is not formal at the workplace.

Number of dental nurses Not given


There is no other information about these workers.

122

Montserrat

CDA region: Caribbean and Canadian Caribbean, island in the Caribbean Sea, southeast of Puerto Rico Is an overseas dependent territory of the UK.


There is a partial public service of oral healthcare, which is open to school children, pregnant women, Ministry of Health officials, police personnel, prisoners, senior citizens (over 60 years) and mentally challenged persons. The service is free and offered in the MoH dental clinic. Others must go to private dentists. There is no oral health policy.

Dental Association - dentists are members of the medical association


There are no dental schools and education and training takes place abroad Dental surgeons/dentists must register with the office of the registrar legal department. There are no mandatory continuing education requirements.


Number of active dentists* 2



Percentage of dentists working in public salaried service** 50%

Dentist to population ratio 3,146

* one of the dentists is on study leave

Specialists

Specialist training takes place abroad.

Orthodontists 0

Oral and maxillofacial surgeons** 1

**The OMF surgeon works in the public service

123

Dental Care Professionals (Auxiliaries) 2007 Montserrat

Hygienists



Therapists

There is no information about the training of therapists, who do not need to register.






Dental chairside assistants

There is no information about the training of therapists, who do not need to register.

Number of dental chairside assistants 3

124


Tokelau

CDA region: Pacific and Australasia Tokelau is a self-administering dependency of New Zealand



Dental Association: No




The dentist works in both private practice and a public clinic


Specialists (2006)


Orthodontists


125

Dental Care Professionals (Auxiliaries) 2005 Tokelau


Hygienists

Therapists

Technicians



126

Turks and Caicos Islands

CDA region: Caribbean and Canadian Two island groups in the North Atlantic Ocean, southeast of the Bahamas, north of Haiti. The islands were part of the UK's Jamaican colony until 1962, when they assumed the status of a separate crown colony upon Jamaica's independence. The governor of the Bahamas oversaw affairs from 1965 to 1973. With Bahamian independence, the islands received a separate governor in 1973. Although independence was agreed upon for 1982, the policy was reversed and the islands remain a British overseas territory.


TCI does not have an oral health policy. Dentistry is provided within both the public sector (in clinics) and private practice. Children are those who are under 16.

The TCI Dental Association has recently been dissolved and no longer exists.


There are no dental schools, so all dentists train overseas. Registration is with the Health Practitioners’ Board. There is no compulsory continuing education.







Specialists (2006)

Specialist training is not given and there is no specialist register

Orthodontists 1


127

Dental Care Professionals (Auxiliaries) 2006 Turks and Caicos Islands

Hygienists

Hygienists train overseas and must register the Health Practitioners’ Board, as the title is protected. Continuing education is not mandatory.




Both hygienists currently work one private practice, but they may work in public clinics. They may work without a dentist on the premises.

Dental Therapists (Nurses)

Therapists train overseas and must register the Health Practitioners’ Board, as the title is protected. Both currently employed therapists trained under the “Jamaica” scheme. Continuing education is not mandatory.

Number of nurses 2

Dentist to nurses ratio 4.5

Percentage of nurses who are male 0%

Both therapists work in government clinics. They may work without a dentist on the premises.


Technicians train overseas, but currently there are none working in TCI. To work they have to be registered with the Health Practitioners’ Board, as the title is protected.and continuing education is not mandatory.




Work has to be sent overseas (usually the USA), to private laboratories.


Number of CDTs 0


Dental (Chairside) Nurses

Train in the workplace with no qualification. To work do not have to be registered and continuing education is not mandatory.



128

PART 4 Commonwealth member countries with no information

Malawi

A landlocked southern African state, west of Mozambique. The British protectorate of Nyasaland became the independent nation of Malawi in 1964. Population: 13,013,926

Nauru

An island in the South Pacific Ocean, south of the Marshall Islands. Independent since 1968 as the world's smallest independent republic Population: 13,287

St Kitts and Nevis

Caribbean islands about one-third of the way from Puerto Rico to Trinidad. A monarchy (under QE 2nd), independent since 1983 Population: 39,129

St Lucia

Caribbean island north of Trinidad and Tobago. A monarchy (under QE 2nd), independent since 1979 Population: 168,458

Seychelles

A group of islands in the Indian Ocean, northeast of Madagascar A republic, independent since 1976 Population: 81,541

Swaziland

A landlocked southern African country, between Mozambique and South Africa The world's last absolute monarchy, has been independent since 1968 Population: 1,136,334

129

PART 5 Dependencies with no information

Anguilla

Caribbean, islands between the Caribbean Sea and North Atlantic Ocean, east of Puerto Rico A self-governing British dependency.

Population: 13,477

Niue

An island in the South Pacific Ocean, east of Tonga. Self-governing in free association with New Zealand since 1974

Population: 2,166

Pitcairn Islands

Islands in the South Pacific Ocean, about midway between Peru and New Zealand. An overseas territory of the UK

Population: 45

St Helena & Dependencies

Islands in the South Atlantic Ocean, about midway between South America and Africa; Ascension Island lies 700 nm northwest of Saint Helena; Tristan da Cunha lies 2300 nm southwest of St Helena. St Helena is a British Overseas Territory consisting of St Helena and Ascension Islands, and the island group of Tristan da Cunha.

Population: 7,502

South Georgia and the South Sandwich

Southern South America, islands in the South Atlantic Ocean, east of the tip of South America. An overseas territory of the UK

No indigenous population

130

ANNEX 1

Further statistical information

For further information please apply directly to the author

[email protected]

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