As a dentist, you are likely aware of the growing need for accessible and affordable dental care in India. With the country’s vast population, especially in rural and remote areas, millions of people struggle to receive basic dental treatments. The dentist-to-population ratio in India is critically low. This shortage has led to widespread oral health issues, worsened by lifestyle habits such as tobacco use. In these underserved regions, the need for innovative solutions to bridge the healthcare gap is more urgent than ever.
Mobile dental vans (MDVs) represent one such solution. These mobile units offer a practical and efficient way to bring dental care directly to those who need it most, regardless of their location. Whether it’s a remote village or an underserved school, MDVs can provide vital dental services to populations that otherwise lack access.
As a dentist, this presents a unique and rewarding opportunity to make a tangible difference in the health and well-being of communities while advancing your career. By stepping into the realm of mobile dentistry, you can help address the critical shortage of dental professionals and shape the future of oral healthcare delivery in India.
In this article, we’ll explore how you, as a dentist, can play an instrumental role in transforming India’s dental healthcare landscape through mobile dental vans. We’ll also walk you through the essential legal guidelines and standards under the Clinical Establishment Act to help you navigate the setup and operation of these mobile units effectively.
What are Mobile Dental Vans?
Mobile dental vans are self-contained, fully equipped vehicles that bring dental care directly to underserved communities. These mobile clinics are designed to overcome common barriers to accessing dental services such as transportation challenges, financial constraints, and geographical isolation.
Mobile dental units are not only a cost-effective alternative to establishing stationary dental clinics but also offer the flexibility of mobility. This makes it possible to provide a wide range of dental services in remote areas and underserved populations, including basic procedures such as oral screenings, fluoride treatments, simple extractions, and restorative services.
As a young dentist, the opportunity to work with mobile dental vans in India opens a new avenue to practice your skills, grow your career, and contribute to the betterment of society.
With the growing demand for dental services in India, MDVs offer an entrepreneurial path for young professionals looking to build a practice while tackling a critical public health issue. Let’s have a look at legal guidelines for mobile dental vans in India.
Legal Guidelines and Clinical Establishment Act Standards for Mobile Dental Vans in India
Before you start operating a mobile dental van, it’s essential to understand the legal and regulatory framework surrounding its operation. The Clinical Establishment Act (CEA) outlines specific standards that mobile dental vans must meet to ensure that the services provided are safe, hygienic, and of high quality. These guidelines ensure compliance with legal requirements and help maintain professional standards in healthcare delivery.
Mobile Dental Van Definition
A mobile dental van is a self-contained vehicle designed to deliver dental care services. These units can be self-propelled or towed and can range from a single-chair setup to a larger, two-chair setup that supports comprehensive treatment. The CEA recommends larger units for full treatment services.
Scope of Services
Mobile dental vans are designed to provide preventive care, dental examinations, and basic treatment services such as fillings, cleanings, fluoride applications, and extractions. These services are intended to be accessible to communities that may otherwise not have access to a stationary dental clinic.
Physical Infrastructure Requirements for MDVs
To operate a mobile dental van, several physical infrastructure standards must be met:
Location: The size and suitability of the mobile dental unit should match the locations it will serve. Each site must have access to basic services like a concrete pad, electricity, clean and waste water, and phone or internet connectivity.
Space Requirement:
- A self-propelled vehicle with two dental chairs needs at least 18 square feet for the treatment area and 7 square feet for the cab, totalling about 30 square feet.
- There must be a designated sterilisation area for cleaning dental instruments, including space for a front-loading autoclave and a small lab for minor prosthetic adjustments, with a washbasin and running water.
- Additionally, there should be a dedicated space to store patient records or maintain electronic health records (EHR).
Outside Signage: This includes the name of the dental/medical college, hospital, charitable institute, or NGO that owns the van.
Inside Signage: It includes
- Name of the dentist in charge.
- Names of the doctors stationed in the van.
- OPD (Outpatient Department) hours.
- List of services provided.
- Charges for the services.
- Emergency contact number.
- Safety signs to inform the doctor of any pre-existing medical conditions the patient may have.
Infrastructure Considerations:
- Medical Gases: Oxygen cylinders should be available if treatments are being provided.
- Floors and Walls: Floors and walls must be smooth, non-porous, and easy to clean, without any carpets.
- Lighting: The van should have natural light or high-intensity, color-corrected artificial lighting.
Fixtures:
- Dental Chairs: At least two dental chairs should be provided.
- Specialist Equipment: The van should be equipped with necessary items like overhead lights, X-ray units, and dental units.
- Hand-Washing Facilities: Elbow-touch or infra-red activated taps for hand washing should be installed.
- Storage: Cabinets for dental supplies and overhead cabinets should be provided.
- Waste Bins: Separate bins for general waste, clinical waste, and sharps should be available.
Personal Hygiene and Protection:
- Hand-Washing: Every dental surgery should have hand-washing facilities, which should not be shared with other sinks used for cleaning or decontaminating instruments.
- Waste Disposal: Ensure safe handling and disposal of waste materials, with hands-free access to bins for waste.
Acoustics: The compressor should not be placed in the working area to avoid noise.
Lighting: The lighting should be color-corrected or natural light.
Specific Considerations for Mobile Dental Vans:
- Chassis: The van should have a strong, watertight, and reinforced floor. It should be insulated to protect against outside temperatures.
- Levelling Jacks: The van should have levelling jacks on all corners to stabilize the vehicle when parked.
- Access: The van should have at least one door for each dental chair.
- Steps: Steps should fold away, lock in position, and have a handrail.
- Windows: Windows should be tinted, with security screens and blinds.
- Services: Essential services include a compressor, evacuator motor, water pump, and base for the dental chairs.
- Mounting Brackets: Mounting brackets are needed for lights, the X-ray unit, and dental equipment.
- Water Supply: Use a dual water system with access to both town water and storage tanks to prevent road damage.
- Water Filter: A filter should be used in the water system for dental units.
- Waste Disposal: The van should have an inbuilt system for collecting wastewater, and waste disposal must meet local guidelines.
- Internal Finishes: The cabinets and surfaces must be easy to clean.
- Sinks: There should be at least one clean sink and one dirty sink.
Equipment: All equipment should be securely mounted to avoid damage from road vibrations and shocks. Power generators should not create excessive noise or vibration, and there should be enough space for the staff to work comfortably.
Human Resources
Mobile dental vans must be staffed with qualified professionals.
- Dentists: A BDS or MDS-qualified dentist should be on-site for full-time treatment.
- Technical Staff: Each mobile dental van must have a Dental Operating Room Assistant. One assistant is required for every two dental chairs. The assistant should have passed at least the 10th grade and must have a minimum of 5 years of work experience under a registered dental surgeon.
- Non-Technical Staff: In addition to technical staff, full-time Grade IV staff should also be employed in the mobile dental van to assist with various operational tasks.
Equipment Standards for Mobile Dental Vans in India
Ensure that your mobile dental van is equipped with the necessary tools to deliver quality care. This includes:
Functional Equipment:
- Stethoscope
- Non-mercury thermometer
- Non-mercury blood pressure apparatus
- Glucometer
- Weighing machine
- Emergency kit and medicines:
- Oxygen cylinder
- Adrenaline
- Diphenhydramine
- Hydrocortisone
- Nitroglycerine
- Salbutamol
- Morphine
- Diazepam / Midazolam
- Aspirin tablets
- Ambulatory bag
- Defibrillator: Either mechanical or automatic
- Consumables: This must be in sufficient quantity
- Face masks
- Sterile and non-sterile gloves
- Cotton rolls
- Gauze
- 2cc and 5cc syringes with needles
- Sutures (Vicryl, Silk)
- Lignocaine 2% (with and without adrenaline)
- Zinc oxide powder and eugenol liquid
- Glass ionomer (powder and liquid)
- Silver-based GIC (powder and liquid)
- Gum paint
Dental Equipment:
- Dental operating unit
- Dental chair: Should have a backrest that can move into Trendelenburg (head down) or reverse Trendelenburg (head up) positions.
- Suction unit: Can be attached to the dental chair or separate; must have an amalgam separator filter.
- Autoclave: Must be office-based, front-loading; can be either automated or manual.
- IOPA machine: Should be approved by the AERB (Atomic Energy Regulatory Board).
- Lead apron and thyroid collar/lead shield for radiation protection.
Further, it is mandatory to maintain a logbook that records the identity of the person being radiographed, the part of the body exposed, the date, and the name and signature of the operator or doctor.
Biomedical Waste Management
Waste should be separated into three types of bags: black, yellow, and blue, right at the source where it is created.
Black Bags:
- Kitchen waste
- Carry bags
- Paper and packaging
- Disposable glasses and plates
- Leftover food
- Bouquets
- Thermocol
Yellow Bags:
- Human tissues
- Histopathology specimens
- Body parts and organs
- Soiled items like swabs, bandages, or anything contaminated with blood
- Microbiology or biotechnology waste
Blue Bags:
- Disinfected catheters
- Tubes and I/V bottles
- Disinfected plastic drains
- Rubber or latex gloves (after being disinfected)
- Other plastic items
Each dental chair should have its own yellow bag. For two chairs, there should be one black and one blue bag. A needle destroyer must be available in the mobile van.
A contract with a company approved by the government must be in place for proper disposal of the waste. There should also be a written contract detailing the costs involved in managing the waste.
A logbook must be maintained, noting the weight of the waste (infected) and the date it was collected.
Record Maintenance
Proper waste management protocols must be in place, including segregating and safely disposing of medical waste. Record-keeping is also essential. Each patient’s details and the services provided must be documented accurately.
Infection Control Guidelines
- Sterilizing and cleaning instruments should not be done in the surgery room.
- There must be a good supply of clean water, with quality pipes that ensure proper water hygiene.
- General cleaning tools and cleaning agents should be stored in a separate area.
- There should be a designated area for cleaning and sterilizing dental instruments, and this space should only be used for this purpose.
- Use a trash bin lined with color-coded plastic bags for medical waste inside the surgery room.
- A needle destroyer must be used for disposing of disposable needles.
- Cleaning tools should always be kept clean before use. The floor sanitizers and cleaning agents should be approved for clinical use.
- It is recommended to have hands-free access to bins for paper and medical waste.
- Use hands-free equipment where possible, such as elbow or knee-operated taps or infrared-activated lights and taps.
- Only liquid soap should be used (no soap bars).
- Do not use cotton or wool fabric curtains in dental clinics.
- Pets and natural plants should not be allowed inside the surgery room.
- Use non-wooden storage cabinets to store cleaning equipment and agents.
- An infection control plan should be in place, based on OSHA’s Bloodborne Pathogen Standard, to minimize or eliminate exposure to infections.
- Protective equipment (PPE), like lab coats, gowns, face masks, and gloves, should always be used.
Sterilisation Facilities
- Use disinfectants like 2% glutaraldehyde, sodium hypochlorite, or chlorhexidine.
- Autoclaves should be well-maintained, self-contained with dryers, and include a proper loading system. Make sure parts are available and the autoclave is regularly checked for validation and calibration.
See Also: How To Set Up A Successful Dental Lab In India: A Comprehensive Guide
Conclusion
By adhering to the Clinical Establishment Act standards, you can establish and operate a mobile dental van that provides high-quality care to underserved populations in India.
Mobile dental vans offer a unique opportunity to make a significant impact on public health while advancing your career. Whether you’re looking to gain experience in rural dentistry or start your own mobile practice, this field offers the potential to transform the future of oral healthcare in India.
The growing demand for accessible dental care combined with the shortage of professionals creates an exciting and impactful career path for dentists.
See Also: How To Start A Dental Clinic In India: The Complete Guide To Legal Compliance And Success
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