Dental Procedures & Techniques- Ch 28-27/TEST

Detection

the process of identifying the presence of something, such as teeth imperfection or decay in dentistry.

extraoral

outside the oral cavity

furcation

space or branching between two roots of a tooth

intraoral

located within the oral cavity

Mobility

the ability to move; in dentistry, it refers to the movement of teeth within its bone structure

morphologically, morphologic, morphology

branch of biology that deals with form and structure

palpation

to examine by touch, such as feeling for abnormalities within soft tissue

probing

to explore or examine within the use of an instrument

restoration

bringing something back to its natural or normal state, an example is the use of a dental material to restore a tooth

Why Patients Seek Dental Care

As a new patient to begin dental care

As an emergency patient when in pain or experiencing discomfort

For consultation with a specialist

As a returning patient for continued assessment and care

Dental Assistant Duties

Assist the patient with completion of patient information forms

Take and record vital signs

Chart and record the dentist’s findings during the extraoral and intraoral examinations

Expose intraoral and extraoral radiographs

Take preliminary impressions and fabricate diagnostic models

Take extraoral and intraoral photographs

Organize the patient record

Prepare for the case presentation

Visual Evaluation

The examination always begins with a visual evaluation of the patient’s extraoral and intraoral conditions

Enables the dentist to determine an overall assessment of the type of dental care received previously

Reveals any existing conditions that have not been treated

Specific examination areas include the following:

Face

Lips

Soft tissue within the mouth

Tongue

Tooth structure

Restorations

Missing teeth

Palpation

The examiner uses his or her fingers and hands to feel for:

• Texture

• Size

• Consistency of the hard and soft tissue

This technique is especially useful for detecting extraoral swelling and is the primary way of detecting swollen lymph nodes

Instrumentation

The use of instruments to examine the teeth and surrounding tissues

Type of instruments commonly utilized to examine the teeth: Mouth mirror and explorer

Type of instrument used to examine the gingival tissues: Periodontal probe

Detection: Dentist uses an explorer to detect imperfections in tooth surfaces

Probing: Dentist or dental hygienist uses the periodontal probe to assess the gingiva for the presence of periodontal pockets

Digital Imaging

Caries lesions

Occlusion and TMJ analysis and diagnosis

Digital radiography: Intraoral and extraoral

Patient education

Shade matching

The computer-aided design/computer-aided manufacturing (CAD/CAM) system and intraoral imaging

Digital Photography

A diagnostic tool used for intraoral and extraoral structures

It provides the dentist and patient with a visual means of identifying and understanding specific problems

Recording the Dental Examination

Charting symbols, abbreviations, and color coding can be used in the recording process to indicate various conditions and existing restorations

Specific criteria that must be known before charting include the following:

• Black’s classification of cavities

• Tooth diagrams

• Tooth-numbering systems

• Color coding

• Abbreviations

Tooth Diagrams

Anatomic and geometric designs are the most frequently used dental charting systems

Anatomic diagram: Illustrations resemble the actual crown and root of the tooth

Geometric diagram: Circle represents each tooth

• The circle is divided to represent each tooth surface

Tooth-Numbering Systems

Universal numbering system

• Begins with the maxillary right third molar and concludes at the mandibular right third molar

ISO/FDI system

• Assigns a two-digit number to each tooth

Palmer notation system

• Uses a bracket to designate the four quadrants of the mouth

Color coding

A visual notation to differentiate between treatment that has already been completed and treatment that still needs to be completed

• Black or blue symbols represent dental work that has been completed

• Red symbols indicate treatment that needs to be completed at future dental appointments

Once work has been completed, you will mark over the red with a black or blue notation to indicate that the work has been completed

Black’s Classification of Cavities

Standard classification system is universal to all dentists and is used to describe the location of decay and the best method for restoring a tooth

Black’s original classification included Class I through Class V

Class VI was added at a later date

Abbreviations

For single-surface restorations, charting abbreviations are based on the names of the tooth surfaces

B—buccal

D—distal

F—facial

I—incisal

L—lingual

M—mesial

O—occlusal

In multiple-surface restorations, two or more surfaces are involved

• The combined surfaces become one name on which the abbreviation is based

The rule for combining two surfaces is to substitute the letter “o” for the -al ending of the first surface

• For distal and occlusal, disto-occlusal (DO)

• For mesial, distal, and occlusal, mesio-occlusodistal (MOD)

Charting

Dental charting systems are available in a variety of diagram styles

Symbols are placed on the tooth diagram of the dental record to represent the various treatments and the types of dental material used to restore the tooth or teeth

Important to learn the charting symbols for treatment to be completed as well as for treatment already provided

Clinical Examination of the Patient

Role of the clinical assistant is to escort the patient to the clinical area for the examination process

You will follow a routine protocol for the patient

The patient is seated in the dental treatment area, draped with a patient “napkin,” and positioned for the dentist to begin the examination

Soft Tissue Examination

Involves a complete examination of the cheeks, mucosa, lips, lingual and facial alveolar bone, palate, tonsil area, tongue, and floor of the mouth

This examination requires the use of visual assessment and palpation

• The purpose is to detect any abnormalities in the head and neck area of the patient

Examination and Charting of the Teeth

The dentist examines each surface of each tooth and dictates findings to the dental assistant, who records the findings on the clinical examination form of the patient’s record

It is essential that all entries are recorded correctly and accurately

Examination and Charting of the Periodontium

Overall health condition of gingiva

Signs and location of inflammation

Location and amount of plaque and calculus

Areas of unattached gingiva

Areas of periodontal pockets measuring greater than 3 mm

Presence of furcation involvement

Mobility

The Treatment Plan

Level I: Emergency care, relieves immediate discomfort

Level II: Standard care, restores the patient to normal function

Level III: Optimum care, restores the patient to maximum function

Treatment Plan Presentation

On completion of a thorough clinical examination, an appointment will be scheduled to present the treatment plan to the patient

• Typically, a 30-minute to a 1-hour appointment without interruptions is scheduled for the patient

It is important to have available the diagnostic tools to present the case

• The dentist should have readied the patient chart, radiographs, diagnostic casts, and treatment plans

Other visual aids might include the following:

• Before-and-after photographs

• Diagnostic casts of similar cases

• Models of proposed appliances

The patient is made comfortable, and the dentist takes care to present all information in terms that the patient can understand

After the presentation has been made, the dentist or finance manager will present the fee estimate for each treatment option

The patient is encouraged to ask questions and to discuss the advantages and disadvantages of each plan

When the patient makes a decision and accepts a treatment plan, he or she is giving informed consent for treatment

• The finance manager will explain the payment plans and make necessary financial arrangements with the patient

When these arrangements have been completed, the patient is scheduled for treatment

Label type of tooth issue from 1-6

Class 1- decay on the occlusal surfaces in the pits and curves

Class 2- decay on proximal surfaces of posterior teeth

Class 3- Mesial and distal decay

Class 4- decay is on mesial or distal side that includes incisal edge

Class 5- Gum line decay also known as cervical decay

Class 6- decay that is on the cusp tips

Abbreviations

For single-surface restorations, charting abbreviations are based on the names of the tooth surfaces, which are?

Single Abbreviations:

B—buccal

D—distal

F—facial

I—incisal

L—lingual

M—mesial

O—occlusal

The rule for combining two surfaces is to substitute the letter “o” for the -al ending of the first surface

For distal and occlusal, disto-occlusal (DO)

For mesial, distal, and occlusal, mesio-occlusodistal (MOD)

Soft Tissue Examination

Involves a complete examination of the cheeks, mucosa, lips, lingual and facial alveolar bone, palate, tonsil area, tongue, and floor of the mouth

This examination requires the use of visual assessment and palpation. The purpose is to detect any abnormalities in the head and neck area of the patient

Examination and Charting of the Periodontium

Specific periodontal findings to be recorded include the following:

Overall health condition of gingiva

Signs and location of inflammation

Location and amount of plaque and calculus

Areas of unattached gingiva

Areas of periodontal pockets measuring greater than 3 mm

Presence of furcation involvement

Mobility

The Treatment Plan

Types of treatment plans

Level I: Emergency care, relieves immediate discomfort

Level II: Standard care, restores the patient to normal function

Level III: Optimum care, restores the patient to maximum function

Treatment Plan Presentation

On completion of a thorough clinical examination, an appointment will be scheduled to present the treatment plan to the patient

Typically, a 30-minute to a 1-hour appointment without interruptions is scheduled for the patient

It is important to have available the diagnostic tools to present the case

The dentist should have readied the patient chart, radiographs, diagnostic casts, and treatment plans

Other visual aids might include the following:

Before-and-after photographs

Diagnostic casts of similar cases

Models of proposed appliances

The patient is made comfortable, and the dentist takes care to present all information in terms that the patient can understand

After the presentation has been made, the dentist or finance manager will present the fee estimate for each treatment option

The patient is encouraged to ask questions and to discuss the advantages and disadvantages of each plan

The patient is made comfortable, and the dentist takes care to present all information in terms that the patient can understand

After the presentation has been made, the dentist or finance manager will present the fee estimate for each treatment option

The patient is encouraged to ask questions and to discuss the advantages and disadvantages of each plan

When the patient makes a decision and accepts a treatment plan, he or she is giving informed consent for treatment

The finance manager will explain the payment plans and make necessary financial arrangements with the patient

When these arrangements have been completed, the patient is scheduled for treatment

Factors That Can Affect Vital Sign Readings

1. Emotional factors

• Stress

• Fear

2. Physical factors

• Illness

• Drinking or eating

• Exercise

Temperature

Degree of the hotness or coldness of the body’s internal environment

Metabolism: Process of physical and chemical changes that takes place in the production of the body’s heat

During an illness, a person’s metabolism increases for the purpose of elevating the body’s temperature

Most bacteria and viruses cannot survive in excess heat, and this is the body’s way of defending against such diseases

Temperature Readings

Thermometer is the instrument used to measure body temperature

• Temperature readings are calibrated according to the Fahrenheit (F) or the Celsius (C) scale

Average range of oral temperature of a resting person is 97.6º F to 99º F

• The average body temperature is higher in infants and younger children than in adults

Types of Thermometers

1. Digital

• Battery operated, a timing system shows a digital reading after 30 seconds

• A disposable sheath slides over the probe before insertion

2. Tympanic

• An infrared signal is bounced off the eardrum, and an accurate reading is provided within 2 seconds

3. Temporal scanner

• Uses surface temperature of artery of forehead

4. Glass

• Many states have banned the use of mercury thermometers because of health hazards

pulse

The pulse is the rhythmic expansion of an artery each time the heart beats

The pulse may be taken at various sites

Radial artery: Inner surface of wrist

Brachial artery: Inner fold of the upper arm

Carotid artery: Alongside the larynx

Pulse characteristics

Rate: Number of beats that occurs during the counting period

Rhythm: Pattern of the beats, such as an occasional skipping, speeding up, or slowing down of a beat

Volume: Force of the beat, such as a strong or a weak beat

Pulse readings

Make sure the patient is positioned with his or her arm at the same level or lower than the heart

• The arm should be well supported and extended straight out

Normal pulse rate in resting adults: 60 to 100 beats per minute

• In a child: 70 to 120 beats per minute

It is difficult to detect any possible arrhythmia (irregularity) in the heartbeat in times shorter than 30 seconds

Respiration

The process of inhaling and exhaling, or breathing

Respiration characteristics

• Rate: Total number of breaths per minute

• Rhythm: Breathing pattern

• Depth: Amount of air inhaled and exhaled

Respiration readings

• Adult: 10 to 20 breaths per minute

• Children and teenagers: 18 to 30 breaths per minute

BP

Blood pressure reflects the amount of work the heart has to do to pump blood throughout the body

Two pressures of the heart

• Systolic: Reflects the amount of pressure it takes for the left ventricle of the heart to compress or push oxygenated blood out into the blood vessels

• Diastolic: The heart muscle at rest when it is allowing the heart to take in blood to be oxygenated before the next contraction

BP equipment

The equipment used when taking a patient’s blood pressure are the sphygmomanometer and the stethoscope

Sphygmomanometer

• Includes the blood pressure cuff and meter

• The cuff is a cloth wrap that holds an inflatable rubber bladder

• A rubber bulb is attached to the cuff with rubber tubing

To get an accurate reading, it is important to use the appropriately sized cuff

• Arm circumference 8 to 10 inches—“small adult” cuff

• Arm circumference 10½ to 13 inches—“adult” cuff

• Arm circumference 13½ to 17 inches—“large adult” cuff

• Arm circumference 17½ to 20 inches—“adult thigh” cuff

The stethoscope is used to amplify Korotkoff sounds

• A series of sounds produced by the blood rushing back into the brachial artery, which has been collapsed by the pressure of the blood pressure cuff

• As the pressure in the cuff is slowly released, the stethoscope picks up a distinct thumping sound that grows louder and then softens to a murmur

Five phases of Korotkoff sounds occur during deflation of the blood pressure cuff

An automated electronic blood pressure device is used in many practices today to simplify and speed the taking of blood pressure

Wrist blood pressure monitors can be accurate if used exactly as directed

These devices are extremely sensitive to body position

The arm and wrist must be at heart level, with the patient quiet and still

BP readings

A situation may arise in which it is necessary to take several pressure readings to obtain an accurate or average reading

• If this occurs, allow the deflated blood pressure cuff to remain on the patient for a minimum of 10 minutes before you obtain another reading

• If taken too soon, the reading may be incorrect

Medical considerations

The stress and anxiety of a dental procedure could possibly elevate a patient’s blood pressure

• Many drugs have adverse effects that can interfere with dental treatment

A patient who has been diagnosed with hypertension should be under the care of a physician during a treatment regimen

Advanced Monitoring Procedures

Additional patient monitoring techniques are being introduced into dental surgical procedures as a standard of monitoring a patient’s health status in a noninvasive way

• Monitoring patients during the preoperative, operative, and postoperative phases can occur as an expanded function once the certified dental assistant has completed a board-approved course in these procedures

Pulse oximetry

Pulse oximetry is used for measuring the concentration of oxygen in the blood

• This procedure is of particular importance for monitoring oxygenation and pulse rate throughout anesthesia and during the recovery phase

The pulse oximeter works by passing a beam of red and infrared light through a pulsating capillary bed

• Oxygenated blood is bright red

• Deoxygenated blood is more blue-purple

The oximeter detects the pulse, and then subtracts the intensity of color detected when the pulse is absent

• The remaining intensity of color represents only the oxygenated red blood

A fit, healthy person should have an oxygen saturation level between 95% and 99%

Electrocardiogram (ECG)

A procedure that measures the electrical activity of the heartbeat

• In dentistry, the ECG can be used as a preventive measure when a patient is undergoing general anesthesia or IV sedation in a hospital or outpatient setting

The chest leads are placed on the patient at specific locations

• The machine then amplifies the natural electrical currents generated by the electrical impulses of the heart and the pattern is traced on graph paper

With each beat, an electrical impulse or wave travels through the heart

• The ECG records a series of waves that move above or below a baseline value

This wave causes the muscle to squeeze and pump blood from the heart

• Each deflection corresponds to a particular part of the cardiac cycle

Arrythmias

Sinus arrhythmia: Rate or rhythm is altered

Atrial arrhythmia: The atria contracts before the next cardiac cycle

Atrial flutter: The atria is beating at an extremely rapid rate

Ventricular arrhythmia: The ventricles contract before the next cardiac cycle

Ventricular tachycardia: The ventricles are beating at an extremely fast rate

Ventricular fibrillation: Total electrical dysfunction

Asystole: No heartbeat

Patient Education

It is estimated that 50 million Americans have high blood pressure

Approximately one fourth of that population is not aware of their medical condition

By taking a patient’s blood pressure at every visit, not only are you gathering vital information for the patient’s treatment that day, but you may also be saving that person’s life

antecubital space

small grove or fold in the inner arm, at or “in front of” (ante) the elbow (cubitus)

arrhythmia

abnormally and irregularity in the force or rhythm of the heartbeat

blood pressure (BP)

measurement of the force and rate of the pressure of the blood in the circulatory system

brachial

relating to the upper arm (brachium), as in the brachial artery

carotid

the two major arteries on each side of the neck that carry blood to the head and neck.

diastolic

the last sound heard when taking blood pressure; the normal rhythmic relaxation and dilation of the heart chamber

electrocardiogram

a test that records the electrical activity of the heart and records electrical currents associated with heart muscle activity.

korotkoff

specific sounds heard in the stethoscope during blood pressure measurement.

metabolism

the process by which your body converts what you eat and drink into energy

oximetry

test to measure the oxygen concentration in the blood

palpate

to examine or explore by touching

pulse

the rhythmic beating of the arteries produced by regular contractions of the heart

radial

related to the radius (bone) or forearm (antebrachium), as in the radial artery

rate

a quantity measured, as in breaths and heartbeats

respiration 

the act of haling or exhaling; breathing

rhythm

a sequence or patterns, such as the heartbeat or breathing

sphygmomanometer

an instrument used when measuring blood pressure

stethoscope

an instrument used for listening to sounds produced within the body

systolic

the first sound heard with taking blood pressure, which is the rhythmic contraction of the heart, especially of the ventricles

tachycardia

abnormally rapid heart rate, typically over 100 beats per minute.

temperature

degree of hotness or coldness of a body or an environment 

thermometer

an instrument for measuring temperature 

tympanic

related to or resembling a drum, as in the tympanic membrane, or the eardrum

volume

quantity or amount, as in force of the heartbeat