Dental Procedures & Techniques- Ch 32/33 Test-COMPLETE

Reception Area

Patients are received, greeted pleasantly, and made to feel welcome

• Reception area is not a waiting room

Things to remember include:

• Keep the area clean

• Ensure adequate seating

• Maintain up-to-date reading material

• Provide place for coats and umbrellas

• Offer a children’s corner

Administrative Area

Runs the management or the business side of the practice

Equipment

• Desk

• A secured area for patient records and business materials

• Telephone system

• Computers

• Photocopier

• Fax machine

Treatment Area

Also referred to as the dental operatory; all clinical treatment is provided here

Design goals

• Provide comfort and mobility for the dental team

• Provide privacy and comfort for the dental patient

• Enhance use of dental equipment through time management and efficient techniques

Central Sterilization

Specific area where instruments are maintained, cleaned, sterilized, and stored for reuse

• Divided into a “contaminated area” and a “clean area”

• Provides extra storage for supplies

• Should be kept organized and clean at all times

Dental Laboratory

Organized area away from patient care where the dentist and dental assistant perform laboratory procedures

Specific items found

• Workbenches

• Storage cabinets

• Model trimmer

• Dental lathe

• Laboratory materials

Dentist’s Private Office

For personal use by the dentist

• Can also be used as a consultation room with patients

Specific items found

• Desk

• Telephone

• Computer

• Extra chairs

Dental Staff Lounge

Designated area for use by clinical and business staff during breaks or lunch time

Specific items found

• Table and chairs

• Small refrigerator

• Microwave

• Locker or locked cabinet for personal belongings

• Coffee or food

Office Environment

Maintaining a dental office throughout the day involves providing a comfortable, organized, and clean environment

Besides daily maintenance, the office should have décor and appearance that is up-to-date

• Temperature and air exchange

• Lighting

• Wall and floor coverings

• Traffic control

• Sound control

• Privacy

Temperature and Air Exchange

It is important to maintain a comfortable temperature for your patients and staff

• Reception area, 72º F

• Clinical area, 68º F to 70º F

Air exchange should remain constant throughout the office

• Odors can be offensive if air circulation is not adequate

Lighting

All areas of the office must have appropriate lighting for the task to be completed

• Reception area: Table and floor lamps

• Business, clinical, laboratory, and sterilization areas: Fluorescent lighting

• Clinical area: Additional lighting for procedures

Wall and Floor Coverings

Colors should be calming, relaxing, and not too “busy”

• The wall covering may consist of paint, wallpaper, or both

Floor covering

• Durable high-traffic carpet in reception, administrative, and private office areas

• A more suitable material for infection control, such as linoleum or tile, is more appropriate in clinical and laboratory areas

Traffic Control

The reception area, front desk, and hallway should be arranged so that traffic flow is efficient to all areas of the office

• Separate areas of the front desk should be available for patients to check in and check out

• In the “back,” the clinical, sterilization, and laboratory areas should be designed for easy entry into and out of areas by dental team members

Sound Control

Specific sounds associated with a dental office can present a negative association

• The reception area, business office, and clinical areas should be arranged so that minimal sound is carried from one room to the other

Provide distraction from dental sounds with the use of music

Privacy

Certain areas in the office require privacy between a patient and staff member

Administrative area

• Important for discussion of financial matters

Clinical areas

• Require privacy in order to provide an area in which to complete treatment and talk in privacy without interruption

Dentist’s office

• Privacy away from patient flow

Clinical Equipment

The basic equipment found in each operatory includes:

• Patient dental chair

• Operator’s stool

• Dental assistant’s stool

• Dental unit

• Oral evacuation equipment

• Curing light

• Amalgamator

• Dental radiography unit

Patient Dental Chair

Features should be designed for patient comfort and aid in a neutral position for the operator

Patient chairs are designed to be seamless, with few visible mechanical parts for easy cleaning and maintenance

Specific features

• Full support for patient’s knees, bottom, lumbar region of the back, and head

• Headrest can be adjusted to accommodate positioning and height of the patient

• Comfortable, movable chair arms

• Either a finger- or foot-operated control system to adjust the chair for treatment

Controls for adjusting the patient’s position

• Upright position: The back of the chair is upright at a 90-degree angle

• Supine position: The patient is lying down and his or her head and knees are at approximately the same level

• Subsupine position: The patient’s head is lower than his or her feet

Operator’s Stool

Type of stool designed to support the body for a prolonged period of fixed muscular activity

Specific features

• Large seat and back

• Easy adjustment for back support

• A seat that is easy to lower and raise

• Casters to make it easy to move around the patient

Dental Assistant’s Stool

Type of stool that must provide stability, mobility, and comfort, allowing a proper fatigue-reducing posture

Specific features

• Twists and turns to help the assistant reach countertops and shelves

• Provides an adjustable foot platform or foot ring

• Firm, secure cushioning in the seat

• Abdominal bar positioned for support of the upper body and arm

• Casters on which the chair moves easily

Dental Unit

Provides the necessary electrical and air-operated mechanics to the hoses, attachments, and working parts of the unit

The type of unit selected depends on:

• The space available

• The operator’s preferred method of delivery

• Whether the operator is left-handed or right-handed

• Whether the operator works primarily with or without a chairside assistant

Delivery Systems

The dental unit can be mounted on the floor, the wall, or, most often, the side of the dental chair

• Front delivery: Positioned over the patient’s lap

• Side delivery: Positioned at either side of the patient’s chair

• Rear delivery: Positioned behind the dental chair

Rheostat

A foot-controlled device placed on the floor near the operator to control the function of the dental handpieces

With foot pressure, slow-speed and high-speed handpieces are controlled

Waterlines

A dental unit is designed with waterlines that carry the water through the air-water syringe and dental handpiece

The use of water during a dental procedure is crucial for keeping the tooth clean and cooled against the heat caused by mechanical removal of tooth structure

Maintenance and cleanliness are high priorities in the use of waterlines

Air-Water Syringe

Attached to the dental unit, essential for every procedure

Functions in three ways

• Delivers a stream of water

• Delivers a stream of air

• Delivers a combined spray of air and water

The tip of the air-water syringe is classified as semicritical equipment and is to be replaced after every procedure

• The handle and the tubing are to be covered with a plastic barrier

Operating Light

Used to illuminate the oral cavity during a dental procedure

• Halogen bulbs are used in most operating lights

• The light is very bright, and care is taken to avoid shining it into the patient’s eyes

• The light is attached to a flexible arm that is track-mounted from the ceiling or attached to the wall or post-mounted on the dental chair

Once the patient is seated and the assistant gloved, the assistant will position the light on the patient’s chest approximately 25 to 30 inches below the patient’s chin

• The light is turned on and then is slowly adjusted upward to illuminate the oral cavity

The light is cleaned only when it has cooled

If the bulb needs to be replaced, turn off the light and allow the old bulb to cool before removing it

• Halogen bulbs are to be replaced with a gloved hand

Oral Evacuation System

A means of removing water, saliva, blood, and other fragments during a dental procedure

Two types of evacuation systems:

Saliva ejector

• Provides removal of the patient’s excess fluids from the mouth

High-volume evacuator (HVE)

• More powerful than the saliva ejector and helps to maintain a “clear field”

Curing Light

A wandlike attachment used to “harden or cure” light-sensitive dental materials

Components include the protective shield handle and the trigger switch

Light-curing units can use halogen-based, light-emitting diode (LED), plasma-arc, or laser technology

Many factors can affect the curing of a dental material

• Keep the light tip clean and free of scratches

• Position the light tip at a correct distance from and the correct orientation to the material

• Maintain the bulb and filter in good working order

• Establish appropriate curing times for each material used in the dental office

Amalgamator

An electrical machine used to triturate dental materials by means of vigorous shaking of the capsule that holds the ingredients

• The amalgamator can be mounted under a countertop or the edge of a mobile cabinet or stored in the top drawer of a mobile cabinet

• Specific settings on the amalgamator will correspond to the manufacturer’s directions regarding mixing of that specific dental material

Dental Radiography Unit

The master switch of the unit may be turned on safely at the beginning of the day and may be left on throughout the day

If the radiography unit requires maintenance, it first must be disconnected from its electrical source

Computer Monitor

LCD monitors

• Allow for dentists or dental team member to enter information in a patient record; schedule a follow-up appointment

• Provide a means for treatment planning, patient education, and showing dental images

• Act as a patient hub to display movies or TV shows and play music

Follow proper infection control methods with monitor properly covered and cleaned and disinfected after use

Care of Dental Equipment

Dental equipment is expensive, complex, and delicate

• It must be used carefully and maintained properly according to the manufacturer’s instructions

• Dental assistants who work in the clinical area share responsibility for routine care in this area of the office

• Larger practices may contract to have maintenance personnel provide this service

Central Vacuum Compressor

Provides the suction needed for the oral evacuation systems

Consists of two parts

• Compressor, which creates the flow of air

• Vacuum tank, which screens the flow of air to create suction

Central Air Compressor

Provides compressed air for the air-water syringe and air-driven handpieces

• Because of the noise level and for safety reasons, the compressor is placed away from the clinical setting

Maintenance includes changing filters and occasionally checking for condensation in the lines

• Disposable traps provide a filtering mechanism for the saliva ejector and HVE

Morning Routine for Dental Assistants

Arrive 30 minutes before the first scheduled patient of the day

Turn on the master switches for the central air compressor and vacuum units

Ensure that the dental treatment rooms are ready for patient care

Recheck the appointment schedule

Set up the treatment room for the first patient

Evening Routine for Dental Assistants

Complete the operatory exposure-control cleanup and preparation protocols

Wear appropriate PPE when emptying waste bins

Turn off all equipment

Ensure that treatment rooms are adequately stocked for the next day

Post appointment schedules for the next day

Ensure that instruments, patient records, and laboratory work are ready for the next day and that the sterilization center has been cleaned

Ensure that the treatment rooms are ready for use

Place soiled protective clothing in appropriate container

Know Your Patients

One of the best ways to know your patients and to be better prepared for the day is to have a brief meeting or review of the day before your patients arrive

Discuss:

• Change in schedule or procedure

• Change in the patient’s health that could alter dental treatment

• Additional supplies or equipment that may be needed

• Preparation for the apprehensive patient

• Assignment of expanded functions

Reviewing the Patient Record

Several sections of a patient record are reviewed at each patient visit

Administrative staff

• Check for changes in personal information, such as address or phone number change

Clinical staff

• Check for health problems that may alter dental treatment

• Look for medical alerts

• Review progress notes for the planned treatment for the day

Preparing the Treatment Area

Treatment room clean, disinfected, and ready for the next patient

Patient records, radiographs, and laboratory results in place

Sterile preset tray and other supplies in place

Dental chair positioned to seat the patient

Additional equipment moved out of the way for the patient and dental team

Greeting and Seating the Patient

Pleasantly greet the patient by name in the reception area

Escort the patient to the treatment area

Place the patient’s personal items in a safe place, out of the way of the procedure

Initiate conversation with the patient

Ask whether the patient has any questions about the treatment for the day that you might be able to answer

Team Dentistry

Basic goals of this type of coordination

• To use ergonomically correct dental equipment

• To use preset trays during dental procedures

• To minimize stress and fatigue during dental procedures

• To follow principles of motion economy during transfer of instruments and dental materials

• To use appropriate moisture control techniques

• To delegate expanded functions of practice as legally defined within the state

Principles of Team Positioning

The dentist and dental assistant should develop positioning habits that allow access to and visualization of all areas of the oral cavity

• Whenever the dentist and the assistant must stretch to reach for an instrument or gain access to an area of the mouth, stress is placed on the body

• Accumulated strain contributes to lower back pain, circulatory problems, and muscle aches and pains

Positioning the Patient

Once the patient has been escorted to the treatment area and seated, he or she is:

• Lowered to the supine position

• Asked to slide up in the chair until the top of the head is even with the top of the headrest

• Asked to turn his or her head to the right or the left to allow easier access to a specific area of the mouth

The operator makes final adjustments to the chair to establish proper working distance

• The correct distance should be approximately 12 to 14 inches

Positioning the Operator

Seated as far back as possible

Thighs parallel to the floor or knees slightly lower than the hips

Feet flat on the floor

Backrest of the chair positioned to support the lower portion or small of the back

Operator’s forearms bent at the elbow and parallel to the floor

Positioning the Dental Assistant

Seated well back on the stool

Feet on the base or foot ring of the stool

Positioned as close as possible to the dental chair

Legs parallel to the patient’s chair

Eye level 4 to 6 inches above the eye level of the operator

Motion Economy

Classification of motions: 5 categories according to extent of movement

• Class I: Movement of fingers only

• Class II: Movement of fingers and wrist

• Class III: Movement of fingers, wrist, and elbow

• Class IV: Use of the entire arm and shoulder

• Class V: Use of the entire upper torso

Operating Zones

Basic concept required for the efficient, comfortable practice of team dentistry

• Operator’s zone

• Transfer zone

• Assistant’s zone

• Static zone

Grasping an Instrument

Three basic grasps

• Pen grasp: The instrument is held in the same manner as a pen

• Palm grasp: The instrument is held securely in the palm of the hand

• Palm-thumb grasp: The instrument is held in the palm of the hand and the thumb is used to stabilize and guide the instrument

Instrument Transfer

An ergonomically sound way to practice dentistry using the skills of the dental assistant while including work simplification techniques

Dentist relies on the clinical assistant to have the supplies, instruments, and dental materials ready for transfer into the dentist’s hands

Requires coordination, communication, and practice between the dentist and the dental assistant

Objectives of Efficient Instrument Transfer

Understand sequence of procedures and anticipate when instrument transfer is required

Transfer dental instruments and dental materials with the left hand

Transfer of instruments should be accomplished with a minimum of motion, involving only the fingers, wrist, and elbow

Instruments are transferred in their position of use

Instrument is transferred so that dentist can grasp the instrument for its appropriate use

An instrument being transferred must be positioned firmly in the dentist’s hand

Transfer Technique

Dental assistant uses a specific, single-handed technique for efficiency

Applies to hand instruments, dental handpieces, and air-water syringes

Variations in Instrument Transfer

Mirror and explorer

Cotton pliers

Handpiece

Instruments with hinges

The Expanded-Functions Dental Assistant (EFDA)

Expanded function refers to specific intraoral procedures, or part of a procedure, performed by the clinical dental assistant that have been delegated by the dentist

Advantages

• Increased productivity

• Less stress on the dentist

• More patients seen

• Each team member can focus on specific tasks

• Increased job satisfaction

Dental Supervision

Direct supervision

• The dentist must be in the same treatment area as the EFDA for the assistant to perform the function

Indirect supervision

• The dentist must be in the dental office area but not necessarily be present in the same treatment room as the EFDA

Working as the Operator

Operator positioning

Developing mirror skills

• Establishing a working position

• Establishing preferred mirror-to-tooth position

Using a fulcrum

Understanding dental anatomy

Understanding cavity preparations

Adapting instrumentation

Applying dental materials

Evaluation of expanded functions

Operator Positioning and Developing Mirror Skills

Operator positioning

• Follow all guidelines and avoid curving the spine and slumping

Mirror skills

• Maintain posture, reduce eyestrain, and complete specific functions

• Position yourself to gain a “straight-on” visual effect

• Mirror must be kept parallel to the working surface

Using a Fulcrum

Fulcrum: A “finger rest” that stabilizes the hand

• Stabilizing the hand reduces possibility that slipping or traumatizing of tissues in mouth will occur

• Good fulcrum should provide stable resting area for hand and should allow operator to use wrist-forearm movement

• Intraoral fulcrum: a fulcrum that is established within the mouth

Understanding Dental Anatomy and Cavity Preparations

Knowledge of dental anatomy must be attained if you are to gain an understanding of a dental procedure and a delegated function

To know where to place a dental material and how to apply a matrix band and wedge, it is important for the assistant to understand specific cavity terms and classifications

Adapting Instrumentation

You must be able to adapt the working end of the instrument to the tooth surface and then to go one step further by correctly moving the instrument

• By moving the hand, wrist, and forearm as a single unit for enhanced strength

• By moving the fingers back and forth in a more confined or precise area

Application of Dental Materials

When you take on the function of placing a dental material into the mouth or cavity preparation, you also need to know the application process

Each dental material is unique in how it is used and where it is placed in the mouth

Evaluation of Expanded Functions

You are accountable for your skills

You must attain the knowledge and skill needed for an expanded function through mastery of course material and also by talking with the dentist with whom you practice