Dental Assisting 33-56

Chapter 33: Delivering Dental Care

  • Efficient delivery of dental care is a key responsibility of the dental team (business assistant, clinical assistant, dental hygienist, and dentist).

  • Importance of following a specific routine and being prepared to maintain smooth patient flow.

  • Advance groundwork includes reviewing patient records and knowledge of procedures.

  • Consequences of poor preparation: loss of productivity, patient discomfort, and stress.

Know Your Patients

  • Acknowledge patients immediately upon their arrival at reception.

  • Hold a brief daily meeting to discuss:

    • Changes in schedule or procedure.

    • Patients' physical or psychological conditions affecting treatment.

    • Additional supplies/equipment needed for the procedure.

    • Preparation for apprehensive patients (more time, premedication, nitrous oxide setup).

    • Assignment of expanded functions to the dental assistant.

Reviewing the Patient Record

  • Administrative assistant updates personal information upon the patient's arrival (address, phone, insurance info).

  • Clinical staff reviews medical alerts or changes in medical status and updates health history forms.

  • Clinical assistant checks progress notes for planned treatment.

Preparing the Treatment Area

  • Complete a treatment room checklist before seating the patient:

    • Ensure treatment room cleanliness and proper disinfection.

    • Verify the presence of the patient's record, radiographic images, and laboratory case.

    • Prepare sterile preset tray and materials.

    • Position the dental chair for patient seating.

    • Clear the entry path of additional equipment.

Greeting and Seating the Patient

  • Clinical assistant greets and escorts the patient to the treatment area.

  • Use titles (Mr./Mrs./Ms.) and establish eye contact when addressing patients.

  • Address any questions or concerns from the patient as you escort them.

  • Provide an overview of the planned treatment if needed.

Team Dentistry

  • Four-handed dentistry emphasizes teamwork between the dentist and assistant to enhance care and efficiency.

  • Introduced in the 1960s, focusing on ergonomics and reducing stress/fatigue in dental procedures.

  • Studies show skilled chairside assistance eliminates 92% of non-invasive movements, doubling productivity.

  • Basic goals:

    • Use ergonomic equipment and preset trays.

    • Minimize fatigue through proper positioning.

    • Utilize motion economy principles during instrument transfer.

Principles of Team Positioning

  • Correct positioning essential for access and visualization of all mouth areas.

  • Recommendations for the dentist and assistant:

    • Avoid stretching or twisting to reach instruments to prevent stress injuries.

    • Optimal patient positioning is key (supine for maxillary procedures, semi-supine for mandibular).

Patient Positioning

  • Instruct the patient to slide up in the chair until their head is level with the headrest.

  • Adjust chair height to maintain 12-14 inch distance from the patient's face for operator comfort.

Positioning the Operator

  • Apply the clock concept for visual positioning during procedures.

  • Practice proper seated posture:

    • Sit back against the chair, supporting lower back.

    • Keep feet flat and thighs parallel to the floor.

Positioning the Dental Assistant

  • Maintain a neutral posture, close to the patient's oral cavity.

  • Positioning specifics for right-handed operators focus on comfort and access:

    • Sit back on stool, with feet resting on the base.

    • Eye level slightly above the operator's point.

Motion Economy

  • Motion economy reduces physical strain in the dental workplace.

  • Understanding motion classification helps in ergonomics:

    • Class I: Finger movements.

    • Class II: Finger and wrist movements.

    • Class III: Finger, wrist, and elbow movements.

    • Classes IV and V: Whole arm and torso movements.

Operating Zones

  • Defined by a "clock concept" positioning the operator and assistant during procedures:

    • Operator's Zone: 7 to 12 o'clock for right-handed operators.

    • Transfer Zone: 4 to 7 o'clock, where instruments are exchanged.

    • Assistant's Zone: 2 to 4 o'clock, where the assistant works from.

    • Static Zone: 12 to 2 o'clock, behind the patient.

Instrument Transfer

  • Based on efficient coordination between the operator and assistant:

    • Anticipate instrument needs based on the procedure sequence.

    • Use Class I, II, and III motions for transfers to maintain efficiency.

    • Instruments should be transferred in a position of use to facilitate operator access.

Instrument Grasp Techniques

  • Pen grasp: Holding instrument like a pen.

  • Palm grasp: Holding instrument in the palm.

  • Palm-thumb grasp: Similar to palm grasp but provides additional stability.

Transfer Techniques

  • Ensure instruments are transferred efficiently to minimize disruptions:

    • Use single-handed techniques for instrument transfer, especially for handpieces.

    • Maintain the appropriate grip during transfers.

Expanded Function Dental Assistant (EFDA)

  • EFDAs perform additional duties legally defined by each state.

  • EFDAs can function independently in specific intraoral skills after acquiring proper training and certification.

  • Duties may include tasks like placement of temporaries or coronal polishing.

Dental Team Dynamics

  • The dentist retains overall responsibility for patient care, even when delegating tasks to EFDAs.

  • Importance of communication between the dentist and assistants for patient expectations and evaluations.

Surgical Asepsis in Oral Surgery

  • Strict aseptic techniques must be maintained.

  • Instruments, drapes, and hands must remain sterile to prevent infection.

  • Understanding different sutures and their application is essential:

    • Types: absorbable vs. non-absorbable.

    • Removal of non-absorbable sutures and caring for healing tissue.

The matrix system for primary teeth is specifically designed to accommodate the unique anatomical features and requirements of children's dental restorations. Here’s a discussion on the types of matrix systems commonly used for primary teeth: