dental assisting notes dental assistant's chairside pocket guide, 1 e (2015) [unitedvrg]

Always at your side ... • F. A. Davis Company

Dental Assisting

NotesDental Assisting

NotesDental Assistant’s Chairside Pocket Guide

Minas Sarakinakis

Purchase additional copies of this book at your health science bookstore or directly from F. A. Davis by shopping online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN)

FA Davis’s Notes Book

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F. A. Davis Company

1915 Arch StreetPhiladelphia, PA 19103www.fadavis.com

Copyright © 2015 by F. A. Davis Company

Copyright © 2015 by F. A. Davis Company. All rights reserved. This product is pro-tected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.

Printed in China by Imago

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Publisher: Quincy McDonaldDevelopmental Editor: David PayneDirector of Content Development: George W. LangDesign and Illustration Manager: Carolyn O’Brien

Reviewers: Cynthia Baker, DDS, CDA; Kim Best, CDA; Cynthia K. Bradley, CDA, CDPMA, CPFDA, EFDA, BA; Denise Campopiano, CDA, RDH, BS; Alison Collins, CDA, MS; Cynthia S. Cronick, CDA, AAS, BS; DeAnna Davis, CDA, RDA, MEd; Danielle Furgeson, CDA, RDH, EFDA, MS; Vita M. Hoffman, CDA, AS; Ann E. Kiyabu, CDA; Dr. Connie Kracher, PhD, MSD; Aamna Nayyar, BSc, BDS, DDS; Judith E. Romano, RDH, BS, MA; Angela E. Simmons, CDA, CPFDA, BS.

As new scientifi c information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

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INDEXRESOURCEINSTRRADIOLINFECT CONTROL

CHAIR-SIDEMEDSEMERG

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Contacts • Phone/E-Mail

Name

Ph: e-mail:

Name

Ph: e-mail:

Name

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Name

Ph: e-mail:

Name

Ph: e-mail:

Name

Ph: e-mail:

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EMERG

1

Emergency Preparedness

ASA Classifi cations

The American Society of Anesthesiologists (ASA) has introduced a classifi cation system to determine a patient’s physical status.

ASA I

■ Patient is healthy.■ Patient can either climb two fl ights of stairs or walk for two

city blocks without experiencing any shortness of breath.

ASA II

■ Evidence of some mild systemic disease present.■ Patient can climb one fl ight of stairs or walk two city blocks

but may experience some shortness of breath.■ Examples: Epilepsy, asthma, allergies, pregnancy.

ASA III

■ Severe systemic disease that interferes with but does not inhibit daily life.

■ Individual may be able to climb one fl ight of stairs or walk one city block but more than likely would have to stop because of shortness of breath.

■ Examples: Type I diabetes, heart failure, hypertension.

ASA IV

■ Severe systemic disease that inhibits daily activities and can be fatal.

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EMERG

2

■ Individual is unable to climb a fl ight of stairs or walk one city block and may even experience shortness of breath at rest.

■ Examples: Uncontrolled, diabetes, heart failure, angina, type two hypertension.

ASA V

■ Patient is rapidly deteriorating and will not survive.

Emergency Kit

Every dental offi ce should maintain a custom designed emer-gency kit ready for use that is easily accessible and portable. Each emergency kit in a dental offi ce should contain at least the following components:

■ Portable oxygen: Used in every medical emergency EXCEPT hyperventilation.

■ Epinephrine: Used in anaphylactic emergencies.■ Nitroglycerin: Used in angina, myocardial infarction (MI),

and congestive heart failure emergencies.■ Diphenhydramine: Used to manage allergic reactions.■ Albuterol: Used in asthma attacks.■ Glucose: Used in patients who are conscious and have

hypoglycemia (low blood sugar).■ Glucagon: Used in unconscious patients with hypoglycemia.

It is administered intramuscularly.■ Lorazepam: Used in emergencies involving seizures

or hyperventilation. It is usually administered intramuscularly.

■ Atropine: Used in low blood pressure emergencies.■ Aspirin: Extremely benefi cial drug in patients with signs

of MI.■ Steroids: Although considered an essential drug due to the

slow onset (1 hour), steroids such as hydrocortisone can be used in managing allergic reactions.


EMERG

3Besides the afore mentioned substances, a few items should be included in the emergency kit, such as:

■ One-way valve pocket mask■ Syringes for administering the intramuscular drugs■ Sterile gauze and bandages■ Ice pack■ Automated external defi brillator (AED)

Premedication Guidelines

The American Dental Association (ADA) notes that some indi-viduals may require antibiotic prophylaxis before certain dental procedures. These dental procedures involve manipulation of the gingival tissue, the periapical region of a tooth, or perforation of the oral mucosa.

Only dentists and physicians can prescribe antibiotic prophylaxis.

The two groups of patients for whom antibiotic prophylaxis is

recommended are:

■ Individuals with certain heart conditions that predispose them to infective endocarditis (IE)■ Artifi cial heart valves■ History of having previously contracted IE■ Heart transplant that had complications and valve

problems■ Certain congenital heart conditions such as:

• Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts or conduits

• A completely repaired congenital defect of the heart with prosthetic material or device, whether placed by surgery or by catheter intervention, during the fi rst 6 months after the procedure

• Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device


EMERG

4

Patients should check with their cardiologists if they have any questions about whether they fall into one of these categories.

The recommendations for antibiotic prophylaxis for IE state that the antibiotic should be taken 30 to 60 minutes before the procedure for it to reach adequate levels in the blood. However, if the antibiotic is inadvertently not administered before the pro-cedure, the dosage may be administered up to 2 hours after the procedure.

If a patient who is required to have antibiotic prophylaxis is already taking antibiotics for a separate condition, the dentist must prescribe a different class of antibiotic from the one the patient is already taking.

■ Individuals who have a total joint replacement and run the risk of developing infection at the prosthetic site.

Even though the American Academy of Orthopedic Surgeons (AAOS) recommends antibiotic prophylaxis for all patients with total joint replacement, the ADA and AAOS are in the process of developing evidence-based guidelines to help determine when antibiotic prophylaxis is recommended before a dental proce-dure for patients with orthopedic implants.


EMERG

5

Antibiotic Prophylaxis Regimen

Route of

Administration Drug

Dose: One Dose 30–60 Min

Before Appointment

Adult Children

Oral Amoxicillin 2 g 50 mg/kg

Unable to take oral meds

AmpicillinCefazolin

2 g IV or IM1 g IV* or IM

50 mg/kg IV or IM50 mg/kg IV or IM

Unable to take oral meds or allergic to penicillins

CephalexinClindamycinAzithromycin

2 g600 mg500 mg

50 mg/kg20 mg/kg15 mg/kg

Unable to take oral meds or allergic to penicillins

CefazolinClindamycin

1 g IV or IM600 mg IV or

IM

50 mg/kg IV or IM20 mg/kg IV or IM

*IM, intramuscular; IV, intravenous.

Vital Signs

In dentistry, pulse, respiration, and blood pressure are routinely taken to assess the patient’s health before treatment.


EMERG

6

Blood Pressure

Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.

The blood pressure is recorded as a fraction of the systolic blood pressure over the diastolic blood pressure. The force of blood against the blood vessel walls during ventricular contraction is called systolic pressure, and the force of blood against the blood vessel walls during ventricular relaxation is called diastolic pressure.


EMERG

7

Blood Pressure Types In Adults

Systolic (mm Hg) Diastolic (mm Hg)

Normal <120 <80

Prehypertension 120–139 80–89

Hypertension stage 1 140–159 90–99

Hypertension stage 2 ≥160 ≥100

Pulse RateA pulse is the rhythmic dilation of an artery caused by the con-traction and expansion of the arterial wall as blood is pushed out of the heart. It is commonly used to measure one’s heart rate. A person’s pulse can be measured in various areas but is usually felt in the carotid artery in the neck, the brachial artery in the arm, or the radial artery in the wrist. When measuring pulse, one should also assess rhythm and strength. Pulse should be recorded for 1 minute. (In dentistry, it is common to measure the pulse rate for 30 seconds and then multiply by 2.)

Normal Pulse Rates

Pulse Category Heart Rate (bpm)

Adults and children 10 years old and older 60–100

Children younger than 10 years but older than 1 year

60–140

Babies 1 year old and younger 100–160

Adult marathon runners 40–60

bpm, beats per minute.

RespirationDuring respiration, oxygen and carbon dioxide are exchanged in the human body. It is measured by the respiration rate (RR). In an adult at rest, the normal RR is between 12 and 20 breaths/min.


EMERG

8

Normal Respiration Rates

Age Category Respiratory Rate (breaths/min)

Adults 12–20

Children 15–25

Newborns 40–50

Chain of Survival (AHA)

■ Early access: Immediate recognition of cardiac arrest and activate emergency response system (EMS) CALL 911.

■ Begin early CPR: Chest compressions and ventilations.■ Early defi brillation: Use the AED.■ Early advanced care: Provided by EMS personnel.

CPR

Sequence of Steps for CPR: CABBegin the CAB sequence if the person is unresponsive, is not breathing, or has no pulse within 10 seconds.

■ Chest compressions: Perform 30 compressions of the sternum to a depth of at least 2 in. for adults, about 2 in. for children, and about 1½ in. for infants at a rate of 100/min. Allow complete recoil of chest wall.

■ Airway: Ensure that the ability of the victim to breathe is not obstructed by performing a head tilt and chin lift.

■ Breathing: Perform two ventilations.

Reassess CABs after 2 min.


EMERG

9Automated External Defi brillator

External defi brillators are becoming vital pieces of equipment in dental offi ces as part of a protocol for managing medical emer-gencies. Early defi brillation saves lives.

■ Turn machine on.■ Follow audio and visual instructions.■ Place pads as directed.■ Follow instructions; stay clear for shock if indicated.■ If machine indicates, continue with CPR.

Obstructed Airway Management (Heimlich Maneuver)Obstructed airways may occur anywhere at any time. A foreign object can become lodged, not allowing the victim to breathe.

If a victim shows the universal sign of choking (grasping the throat with both hands), do the following:

■ Ask whether the person is choking. If she responds, avoid physical contact and encourage her to cough. If she cannot respond, be ready to perform abdominal thrusts.

■ Stand behind the victim, wrap your hands around her waist, and place your fi st, thumb fi rst, above the navel but below the breast bone.


EMERG

10

■ Perform abdominal thrusts using quick upward motions.■ Continue until the foreign object is expelled or until the

victim becomes unconscious due to lack of oxygen in the brain.

■ If the patient becomes unconscious, call 911 and begin CPR.

If, because of pregnancy or the size of the victim, one cannot perform abdominal thrusts, chest thrusts are the best alternative.

Medical Emergencies

Most medical emergencies can be prevented from happening in a dental offi ce by being aware of the patient’s medical health history. Regardless of the precautions taken by the dental staff, however, medical emergencies do happen. Therefore, all dental assistants should have up-to-date credentials on CPR, obstructed airway management, and obtaining vital signs.

Medical emergencies in a dental offi ce are best dealt with as a team. The entire dental team (dentist, assistant, hygienist, and front desk personnel) should practice medical emergency scenarios, so that individual roles are preassigned and duties predetermined.

Angina Pectoris

Lack of oxygen to the heart muscle will lead to myocardial is -chemia with severe chest pain. It has been reported that angina is one of the most frequently encountered medical emergencies in a dental offi ce.

Symptoms & Signs■ Chest pain■ High blood pressure■ High pulse■ Nausea■ Pain radiating to shoulder or even to lower jaw


EMERG

11Management■ Administer 100% oxygen.■ Administer nitroglycerin.■ If pain has not subsided 10 minutes after nitroglycerin

administration, call EMS.■ If patient has no known angina condition, call EMS

immediately and follow the fi rst two steps above.

Broken Instrument

By maintaining instruments in good working condition and dis-carding instruments that have become oversharpened and thin, one can prevent broken tips in a patient’s mouth.

In the event that a tip is broken in a patient’s mouth, without alarming the patient, ask him or her not to swallow. Do not rinse because you may dislodge the tip unknowingly. Try to isolate the area, gently dry it out, and locate the tip. If the tip is visible, use a curette or cotton pliers to gently retrieve it. If the tip is not visible, take a radiograph to determine its location. If the tip is deeply lodged, the patient may need to be referred to an oral surgeon for surgical removal.

Diabetic Emergency

Obtaining an accurate medical history in the dental offi ce is extremely important, especially for patients with metabolic dis-orders, such as diabetes. There are three types of diabetes. Type

1 diabetes occurs when the body makes too little or no insulin, also called insulin-dependent diabetes. Type 2 diabetes occurs when the body cannot use the insulin it makes, also called non–insulin-dependent diabetes. Gestational diabetes occurs in preg-nant women.

HypoglycemiaHypoglycemia or insulin shock occurs when blood glucose levels drop signifi cantly.

Symptoms & Signs■ Fast onset■ Irritability


EMERG

12

■ Clammy skin■ Rapid breathing

Management■ Stop all dental procedures and remove all objects from the

mouth.■ If the patient is conscious, give oral glucose.■ Fully recline the patient’s chair.■ If the patient is unconscious, administer glucose

intravenously or glucagon intramuscularly.■ Call EMS.

HyperglycemiaHyperglycemia is less likely to occur in a dental offi ce and is triggered by low insulin levels in the blood.

Symptoms & Signs■ Slow onset■ Dry skin■ Deep breathing■ Nausea■ Vomiting■ Drowsiness

Management■ Determine what type of diabetic emergency is at hand.■ Administration of glucose will not harm a patient with

hyperglycemia, but it will signifi cantly help a hypoglycemic one.

■ Managing hyperglycemia requires administration of precisely the right amount of insulin. Thus, a physician must administer it, so that the patient’s condition will not turn to hypoglycemia because of an overdose of insulin.

■ Call EMS.

Fainting (Syncope or Vasovagal Episode)

Syncope, more commonly known as fainting, is perhaps the most common cause of loss of consciousness in a dental offi ce. It is usually triggered by fear, anxiety, pain, or fasting.


EMERG

13Symptoms & Signs■ Lightheadedness■ Nausea or vertigo (dizziness)■ Pupil dilation■ Perspiration■ Pallor (paleness)■ Bradycardia (low pulse)■ Loss of consciousness

Management■ Stop all dental procedures and remove all objects from the

mouth.■ Place patient in supine position with head below heart level

to facilitate blood return.■ Administer oxygen (4 L/min).■ Loosen tight clothing.■ Monitor vital signs.■ Keep patient in supine position even after recovery until

ready to be elevated to a seated position.■ If patient is not recovering, call EMS.

Foreign Object Aspiration

Foreign body aspirations in dentistry can be prevented by the use of screens, gauze, or rubber dams. Fixed prostheses should also be secured with fl oss before trying them intraorally. Aspira-tion of a foreign object is a serious, potentially life-threatening situation. If the aspiration leads to the patient choking while in the dental offi ce, follow the instructions for obstructed airway management as described earlier. If the patient becomes uncon-scious, call 911 and begin CPR, as described previously.

Hyperventilation

During hyperventilation, the patient breathes at a much faster rate, consuming more carbon dioxide than is produced, resulting in changes in the pH of the blood. Hyperventilation is triggered by many conditions, including anxiety and fear.


EMERG

14

Symptoms & Signs■ Very fast breathing■ Dizziness■ Heart palpitations■ Muscle spasms■ Tingling of the extremities

Management■ Position the patient in a position in which he or she feels

comfortable (preferably upright).■ Assist in trying to control the patient’s breathing.■ Check vital signs.■ Consider administering lorazepam intramuscularly.■ If condition does not improve, contact EMS.

Seizures

Seizures result from abnormal electrical activity in the brain.Risk factors include genetic predisposition and systemic imbal-

ances caused by metabolic disorders, use of certain drugs, infec-tions, cancer, and trauma.

Symptoms & SignsBecause of the various types of seizures, the symptoms may vary slightly. However, common symptoms include the following:■ Convulsions■ Heavy breathing■ Muscle contraction■ Loss of consciousness■ Frothy mouth

Management■ Stop treatment immediately and make sure you remove all

objects from the patient’s mouth to avoid injury.■ Place the patient in a supine position on his or her left side

to avoid aspiration.■ Loosen tight clothing.■ Protect the patient from injury by gentle restraint and do not

attempt to move to the fl oor.


EMERG

15■ Administer oxygen.■ If the patient becomes unconscious, call EMS and begin CPR.

Dental Emergencies

Management procedures described in the following are to be performed only by licensed dentists or, in some cases, by dental hygienists.

Abscess

PeriodontalSymptoms & Signs■ Pain■ Swelling■ Pus■ Bleeding gums

Management■ Débridement of the periodontal pocket, root planing, and

scaling if indicated and clinically possible■ Local delivery of antimicrobial solutions and placement of

antibiotics■ If pocket is deep (>6–7 mm), referral to periodontist may be

appropriate for surgical resolution and reduction of the pocket depth.

Tooth RelatedSymptoms & Signs■ Pain (can be severe).■ Swelling.■ Pus.■ Bad taste and odor.■ Pain on tapping.■ No temperature sensitivity.■ Many times a parulis is visible on the gingival margin apical

to the abscessed tooth.■ Fever.


EMERG

16

Management■ Drain the abscess to relieve the pressure.■ Prescribe systemic antibiotics.■ Prescribe mild pain control medication.■ Perform root canal or extraction depending on tooth

condition and patient preference.

Alveolar Osteitis (Dry Socket)Symptoms & Signs■ Radiating pain (can be severe)■ Visible bone■ Bad breath■ Foul taste■ Bleeding from the extraction site■ Gray tissue surrounding the extraction site

Management■ Administer local anesthesia.■ Clean and irrigate socket.■ Place medicaments in the socket.■ Stress postoperative instructions.■ Prescribe antibiotics and perhaps pain medication.■ Replace medicaments if necessary.■ Evaluate in a few days.

Avulsed ToothSymptoms & Signs■ Tooth completely out of the socket■ Pain■ Swelling

Management■ Obtain a radiograph of the area to rule out bone fragments

in the socket or socket fracture and collapse.■ If the tooth is temporary (deciduous), do nothing; let the

permanent tooth erupt.■ If the tooth is permanent (succedaneous) and is preserved

without excessive manipulation, attempt to reinsert it back to the socket and splint it to adjacent teeth.


EMERG

17■ If reimplantation is successful, root canal treatment and

crown restoration will be necessary.■ If reimplantation fails, discuss alternative restorative options

with the patient.

Broken ToothSymptoms & Signs■ Caused by trauma or decay■ Temperature sensitivity

Management■ Obtain a radiograph to evaluate root integrity.■ Restore (restorations will vary depending on the amount of

the broken tooth and the condition of the remaining tooth structure).

■ Root canal or extraction may be necessary.■ Discuss alternative restorative options.

Cracked Tooth Syndrome (CTS)Symptoms & Signs■ Caused by trauma or decay■ Temperature sensitivity

Management■ Obtain a radiograph to evaluate root integrity.■ Confi rm CTS with bite stick (bite and release test).■ Restore (restorations will vary depending on the amount of

the broken tooth and the condition of the remaining tooth structure).

■ Root canal or extraction may be necessary.■ Discuss alternative restorative options.


18

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ercept

Alters taste

En

do

cetO

xycod

on

e–acetamin

op

hen

Dry m

ou

th

Fosam

axA

lend

ron

ate sod

ium

Rare cases o

f osteo

necro

sis

Halcio

nT

riazolam

Dry m

ou

th, sto

matitis

Hald

ol

Halo

perid

ol

Dry m

ou

th

Hyzaar

Losartan

–hyd

roch

loro

thiazid

eD

ry mo

uth

Imitrex

Su

matrip

tanD

ry mo

uth

Ind

eralP

rop

rano

lol H

CL

Dry m

ou

th

Co

ntin

ued


22

MEDS

Co

mm

on

ly Prescrib

ed M

edicatio

ns T

hat A

ffect the M

ou

th

and

Teeth

—co

nt’d

Tra

de

Na

me

Ge

ne

ric N

am

eD

en

tal E

ffects

/Ma

na

ge

me

nt

Isord

ilIso

sorb

ide d

initrate

Hyp

oten

sion

Lamictal

Lamo

trigin

eD

ry mo

uth

LasixFu

rosem

ide

Dry m

ou

th, h

ypo

tensio

n

Libriu

mC

hlo

rdiazep

oxid

eD

ry mo

uth

, som

etimes co

ated to

ng

ue is n

oted

Lod

ine

Eto

do

lacD

ry mo

uth

Lop

ressor

Meto

pro

lol

Dry m

ou

th

Lorab

idLo

racarbef

Can

did

a, affects con

traceptive m

easures

Lotrel

Am

lod

ipin

e–ben

azepril

Dry m

ou

th, g

ing

ival hyp

erplasia

Loven

ox

En

oxap

arin so

diu

mC

on

tact ph

ysician b

efore p

erform

ing

a pro

cedu

re in

wh

ich b

leedin

g is exp

ected

Lun

estaE

szop

iclon

eD

ry mo

uth

Luvo

xFlu

voxam

ine m

aleateD

ry mo

uth

LyricaP

regab

alinD

ry mo

uth

Med

rol

Meth

ylpred

niso

lon

eC

and

ida, d

elayed h

ealing


MEDS

23C

om

mo

nly P

rescribed

Med

ication

s Th

at Affect th

e Mo

uth

an

d T

eeth—

con

t’d

Tra

de

Na

me

Ge

ne

ric N

am

eD

en

tal E

ffects

/Ma

na

ge

me

nt

Mevaco

rLo

vastatinD

ry mo

uth

, hyp

oten

sion

Mirap

exP

ramip

exole d

ihyd

roch

lorid

eD

ry mo

uth

Mircette

Eth

inyl estrad

iol–d

esog

estrelG

ing

ival chan

ges

Neco

nE

thin

yl estradio

l–n

oreth

ind

ron

eG

ing

ival chan

ges

Neu

ron

tinG

abap

entin

Dry m

ou

th

No

rvascA

mlo

dip

ine

Dry m

ou

th, g

ing

ival hyp

erplasia

No

rvirR

iton

avirC

and

ida

Orth

o-n

ovu

mN

oreth

ind

ron

e–ethin

yl estrad

iol

Gin

gival ch

ang

es

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on

tinO

xycod

on

eD

ry mo

uth

, hyp

oten

sion

Pam

elor

No

rtriptylin

e HC

lH

ypo

tensio

n/D

o n

ot u

se vasoco

nstricto

rs

Patan

ol

Olo

patad

ine H

Cl

Dry m

ou

th

Paxil

Paro

xetine

Dry m

ou

th

Pep

cidFam

otid

ine

Dry m

ou

th

Co

ntin

ued


24

MEDS

Co

mm

on

ly Prescrib

ed M

edicatio

ns T

hat A

ffect the M

ou

th

and

Teeth

—co

nt’d

Tra

de

Na

me

Ge

ne

ric N

am

eD

en

tal E

ffects

/Ma

na

ge

me

nt

Pen

icillin V

KP

enicillin

Can

did

a, hairy to

ng

ue, red

uces co

ntracep

tive actio

n

Plavix

Clo

pid

og

relC

on

tact ph

ysician b

efore p

erform

ing

a pro

cedu

re in

wh

ich b

leedin

g is exp

ected

Pro

ton

ixP

anto

prazo

leE

xcessive salivation

Pro

ventil

Alb

utero

lD

ry mo

uth

, teeth d

iscolo

ration

Pro

zacFlu

oxetin

eD

ry mo

uth

, hyp

oten

sion

Req

uip

Ro

pin

irole

Dry m

ou

th, h

ypo

tensio

n

Resto

rilT

emazep

amD

ry mo

uth

, taste alteration

s

Serax

Oxazep

amD

ry mo

uth

, coated

ton

gu

e

Sereven

tS

almetero

lC

and

ida

Sero

qu

elQ

uetiap

ine

Dry m

ou

th

Teg

retol

Carb

amazep

ine

Dry m

ou

th, sto

matitis

Ten

orm

inA

teno

lol

Dry m

ou

th, affects taste

Tim

op

ticT

imo

lol m

alateD

ry mo

uth


MEDS

25C

om

mo

nly P

rescribed

Med

ication

s Th

at Affect th

e Mo

uth

an

d T

eeth—

con

t’d

Tra

de

Na

me

Ge

ne

ric N

am

eD

en

tal E

ffects

/Ma

na

ge

me

nt

Trivo

ra-28Levo

no

rgestrel–eth

inyl

estradio

lG

ing

ival chan

ges

To

franil

Imip

ramin

e HC

LD

ry mo

uth

, hyp

oten

sion

/ Do

no

t use

vasoco

nstricto

rs

To

pam

axT

op

iramate

Dry m

ou

th

Trilep

talO

xcarbazep

ine

Dry m

ou

th

Ultram

Tram

ado

lD

ry mo

uth

, hyp

oten

sion

Valiu

mD

iazepam

Dry m

ou

th

Versed

Mid

azolam

Increased

salivation

Wellb

utrin

Bu

pro

pio

n H

CL

Dry m

ou

th

Xan

axA

lprazo

lamD

ry mo

uth

Zith

rom

axA

zithro

mycin

Can

did

a, hairy to

ng

ue, red

uces co

ntracep

tive actio

n

Zo

mig

Zo

lmitrip

tanA

ffects taste

Zyp

rexaO

lanzap

ine

Dry m

ou

th, h

ypo

tensio

n

Th

e med

ication

s in g

reen are th

ose o

ften p

rescribed

by d

entists. T

ext in red

ind

icates imp

lication

s for th

e den

tal visit.


26

CHAIR-SIDE

Dentition

Tooth Eruption Tables

Deciduous (Primary) Dentition

Teeth Age of Eruption (months)

Central incisors 6–8

Lateral incisors 7–9

Canines 15–20

First molars 12–16

Second molars 20–30


27

CHAIR-SIDE

Permanent (Adult) Dentition

Arch Teeth

Age of Eruption

(years)

Maxillary Central incisors 7–9


Canines 11–13

First premolars 10–11

Second premolars 10–13

First molars 6


Third molars (wisdom teeth) 17–21

Mandibular Central incisors 6–7


Canines 8–9

First premolars 10–12

Second premolars 11–13

First molars 6


Third molars (wisdom teeth) 17–21


28

CHAIR-SIDE

Tooth Numbering

Tooth numbering systems provide a consistent method for iden-tifying teeth for charting and descriptive purposes.

Universal System

1

Permanent dentition

Permanent dentition

Maxillary

Maxillary

Mandibular

Mandibular

Primary dentition

A B C D E F G H I J

T S R Q P O N M L K

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 28.


29

CHAIR-SIDE

Universal System (Permanent Dentition)

Tooth Number Tooth Name

1 Maxillary right third molar

2 Maxillary right second molar

3 Maxillary right fi rst molar

4 Maxillary right second premolar

5 Maxillary right fi rst premolar

6 Maxillary right canine

7 Maxillary right lateral incisor

8 Maxillary right central incisor

9 Maxillary left central incisor

10 Maxillary left lateral incisor

11 Maxillary left canine

12 Maxillary left fi rst premolar

13 Maxillary left second premolar

14 Maxillary left fi rst molar

15 Maxillary left second molar

16 Maxillary left third molar

17 Mandibular left third molar

18 Mandibular left second molar

19 Mandibular left fi rst molar

20 Mandibular left second premolar

21 Mandibular left fi rst premolar

22 Mandibular left canine

23 Mandibular left lateral incisor

24 Mandibular left central incisor


30

CHAIR-SIDE

Universal System (Permanent Dentition)—cont’d


25 Mandibular right central incisor

26 Mandibular right lateral incisor

27 Mandibular right canine

28 Mandibular right fi rst premolar

29 Mandibular right second premolar

30 Mandibular right fi rst molar

31 Mandibular right second molar

32 Mandibular right third molar

Begin counting from the upper right third molar as #1 to the upper left third molar as #16, then move to the lower left third molar as #17, and fi nish at the lower right third molar as #32.


31

CHAIR-SIDE

Universal System (Primary Dentition)


A Primary maxillary right second molar

B Primary maxillary right fi rst molar

C Primary maxillary right canine

D Primary maxillary right lateral incisor

E Primary maxillary right central incisor

F Primary maxillary left central incisor

G Primary maxillary left lateral incisor

H Primary maxillary left canine

I Primary maxillary left fi rst molar

J Primary maxillary left second molar

K Primary mandibular left second molar

L Primary mandibular left fi rst molar

M Primary mandibular left canine

N Primary mandibular left lateral incisor

O Primary mandibular left central incisor

P Primary mandibular right central incisor

Q Primary mandibular right lateral incisor

R Primary mandibular right canine

S Primary mandibular right fi rst molar

T Primary mandibular right second molarBegin counting from the upper right second molar as #A to the upper left second

molar as #J, then move to the lower left second molar as #K, and fi nish at the lower right second molar as #T.


32

CHAIR-SIDE

Palmer Notation SystemIn the Palmer notation system, all quadrants are given their own bracket. Teeth are noted within each bracket based on their rela-tion to the midline. The orientation of the bracket notes the quadrant. Letters are used for deciduous teeth.

Permanent Teeth

Upper Right

8┘ 7┘ 6┘ 5┘ 4┘ 3┘ 2┘ 1┘

8┐ 7┐ 6┐ 5┐ 4┐ 3┐ 2┐ 1┐

Lower Right

Upper Left

└1 └2 └3 └4 └5 └6 └7 └8

┌1 ┌2 ┌3 ┌4 ┌5 ┌6 ┌7 ┌8

Lower Left

Deciduous Teeth (Baby Teeth)

Upper Right Upper Left

E┘ D┘ C┘ B┘ A┘ └A └B └C └D └E

E┐ D┐ C┐ B┐ A┐ ┌A ┌B ┌C ┌D ┌E

Lower Right Lower Left


33

CHAIR-SIDE

Cavity (Caries) Classifi cation

Cavities (caries) are perhaps the most common dental disease. Caries is defi ned as an infectious bacterial disease that affects the tooth and the surrounding structures. G.V. Black has intro-duced a system classifying the various types of caries found on teeth based on location and tooth surfaces affected.

Class I■ Pit and fi ssure caries


Class II■ Interproximal caries in posterior teeth (mesial, distal)



34

CHAIR-SIDE

Class III■ Interproximal caries in anterior teeth with no incisal edge

involvement


Class IV■ Interproximal caries in anterior teeth with incisal edge

involvement



35

CHAIR-SIDE

Class V■ Caries in the gingival third of anterior and posterior teeth


Class VI■ Caries on incisal edge of anterior teeth or cusps of posterior

teeth due to defects



36

CHAIR-SIDE

Charting

Charting of existing and diagnosed procedures is important to maintain an accurate record of the patient’s oral status.

Color Coding

Color Meaning

Red Treatment pending

Blue or black Existing restorations

Tooth Surface Abbreviations

Abbreviation Meaning

M Mesial

D Distal

La Labial

B Buccal

L Lingual

I Incisal

O Occlusal

DO Disto-occlusal

MO Mesio-occlusal

MOD Mesio-occlusal-distal


37

CHAIR-SIDE

Dental Abbreviations


Abs Abscess

ADA American Dental Association

ADAA American Dental Assistant Association

Adj Adjustments

AM or Amal Amalgam

Anes Anesthesia

Ant Anterior

BOP Bleeding on probing

Br Bridge

BWX Bitewing radiograph

C or Com Composite

Cem Cement

CLD or FLD Complete lower denture or full lower denture

Consult Consultation

CPR Cardiopulmonary resuscitation

CRN or Cr Crown

CUD or FUD Complete upper denture or full upper denture

Deci Deciduous

Del Delay

Dent Denture

Dx or Diag Diagnosis

Epi Epinephrine

Ex or Exam Examination

EXT Extraction

Continued


38

CHAIR-SIDE

Dental Abbreviations—cont’d


FGC Full gold crown

Fl Fluoride

FMX Full mouth radiographic series

FPD Fixed partial denture (i.e., bridge)

FX Fracture

Fx Function

HIPAA Health Insurance Portability and Accountability Act

Hist History

HP Handpiece

I & D or I/D Incise and drain

MSDS Manufacturer’s safety data sheet

NKA No known allergies

NKDA No known drug allergies

NSAIDS Nonsteroidal anti-infl ammatory drugs

PA Periapical radiograph

PANO Panoramic radiograph

Perm Permanent

PFM Porcelain fused to metal crown

PFS Pits and fi ssure sealants

PLD Partial lower denture

Pre-Med Premedication

PRN As needed

PSR Periodontal Screening Record

PUD Partial upper denture

Px Prognosis


39

CHAIR-SIDE

Dental Abbreviations—cont’d


PX or P Prophylaxis

RCT Root canal therapy

RPD Removable partial denture

Rx Prescription

TMJ Temporomandibular joint

Tx Treatment

Tx Pl Treatment plan

UCR Usual, customary, and reasonable

Xylo Xylocaine

ZOE Zinc oxide eugenol

Occlusion

The relationship of the maxillary teeth with the mandibular teeth when they come together is described as occlusion.

The ideal occlusion occurs when maxillary and mandibular teeth contact at maximum level.

Class I Occlusion Molar RelationshipClass I occlusion molar relationship is defi ned as the type of occlusion in which the mesiobuccal cusp of the maxillary fi rst molar contacts the buccal grove of the mandibular fi rst molar.

Class I Occlusion Canine RelationshipClass I occlusion canine relationship is defi ned as the type of occlusion in which the maxillary canine contacts the distal half of the mandibular canine and the mesial half of the mandibular fi rst premolar.


40

CHAIR-SIDE


Class II Occlusion Molar RelationshipClass II occlusion molar relationship is defi ned as the type of occlusion in which the mesiobuccal cusp of the maxillary fi rst molar occludes in the space between the mandibular second premolar and the mandibular fi rst molar.

Class II Occlusion Canine RelationshipClass II occlusion canine relationship is defi ned as the type of occlusion in which the distal surface of the maxillary canine is located mesially to the distal surface of the mandibular canine.

Class II Division 1The molar relationships are like that of Class II, and the anterior teeth are protruded.



41

CHAIR-SIDE

Class II Division 2The molar relationships are Class II, but the central teeth are retroclined, and the lateral teeth are seen overlapping the centrals.


Class III Occlusion Molar RelationshipClass III occlusion molar relationship is defi ned as the type of occlusion in which the buccal groove of the mandibular fi rst molar occludes mesial to the mesiobuccal cusp of the maxillary fi rst molar.

Class III Occlusion Canine RelationshipClass III occlusion canine relationship is defi ned as the type of occlusion in which the distal surface of the mandibular canine occludes mesially from the mesial surface of the maxillary canine.



42

CHAIR-SIDE

Misalignment or Malocclusion

Teeth and arches can be positioned in such a way that can cause problems with occlusion, aesthetics, and function. Some exam-ples of misaligned teeth are described.

CrossbiteIdeally, the maxillary teeth should occlude facially or buccally to the mandibular teeth. Deviations from this norm, such as the maxillary incisors being lingual to mandibular incisors or maxil-lary or mandibular posterior teeth being excessively lingual or buccal to the norm, will result in what is called crossbite.




43

CHAIR-SIDE

End to EndCusp-to-cusp or incisal edge-to-incisal edge contact.




44

CHAIR-SIDE

OverbiteAn excessive overlap in a vertical direction between maxillary and mandibular incisors.

Overbite


OverjetAn excessively buccal positioning of the maxillary incisors in relation to mandibular incisors.

Overjet



45

CHAIR-SIDE

Open BiteAnterior teeth do not occlude when the posterior teeth are in occlusion.


Anesthesia

One of the primary responsibilities of a dentist is to eliminate dental disease as painlessly as possible. Science and chemistry have provided the dental profession with several agents to achieve topical, local, and general anesthesia so the patient can be as comfortable and pain free as possible during dental procedures.

Topical Anesthetics

Topical anesthetics are administered to achieve terminal nerve ending anesthesia. It is short lasting and can be used for a variety of reasons:

■ Before local anesthetics■ To manage patient’s gag refl ex■ Before suture removal or removal of loosely attached

primary teeth


46

CHAIR-SIDE

Most Common Topical Anesthetics

Benzocaine 20% Concentration

Cetacaine 14% Benzocaine2% Tetracaine

Lidocaine 5% In liquid form

Oraqix (mostly used in dental hygiene procedures)

2.5% Prilocaine2.5% Lidocaine

Local Anesthetics

Local anesthetics are used before treatment to provide tempo-rary anesthesia (no feeling) to the teeth and soft tissue. The mode of action is to block nerves that identify pain from sending impulses to the brain. Local anesthetics vary in the duration of their effect:

■ Short acting (30 minutes)■ Intermediate acting (60 minutes)■ Long acting (90 minutes)


47

CHAIR-SIDE

Most Common Local Anesthetics

Generic Name Trade Name

Vaso-

constrictor

Vasoconstrictor

Concentration

2% Lidocaine with epinephrine

Xylocaine Octocaine

Yes 1 : 100,000

2% Mepivicaine with levonordefrin

Carbocaine Yes 1 : 20,000

3% Mepivicaine plain

Carbocaine No N/A

4% Articaine Septocaine Yes 1 : 100,0001 : 200,000

Prilocaine Citanest Forte Yes 1 : 100,000

Bupivacaine Marcaine Yes 1 : 200,000

2% Lidocaine Xylocaine No N/A


48

CHAIR-SIDE

Anesthesia Color Coding

Anesthetic Color

2% Lidocaine with epinephrine 1 : 100,000

2% Lidocaine with epinephrine 1 : 50,000

Lidocaine plain

Mepivacaine 2% with levonordefrin 1 : 20,000

Mepivacaine 3%

Prilocaine 4% with epinephrine 1 : 200,000

Prilocaine 4%

Bupivacaine 4% with epinephrine

Articaine 4% with epinephrine

Preparation for Injection

■ Review medical history.■ Wipe injection site with 2 × 2 gauze to remove excess saliva.■ Apply topical anesthetic and let it remain for 2 to 3 minutes.■ Assemble and hand anesthetic syringe to doctor for

injection.■ Most commonly used needles:

■ 30-gauge short (blue cap) for infi ltrations and maxillary blocks

■ 27-gauge long (yellow cup) for mandibular blocks


49

CHAIR-SIDE

Injection Types

Maxillary Injections

Maxillarynerve

Ophthalmic nerve

Mandibularnerve

Anterior superior alveolar nerve

Middlesuperior alveolar nerve

Posterior superior alveolar nerve

Greater and lesser palatine nerves

Dental plexus

Trigeminalganglion



50

CHAIR-SIDE

Posterior Superior Alveolar (PSA)■ Infi ltration injection is used for maxillary posterior molars.■ Use a 27-gauge short needle.



51

CHAIR-SIDE

Middle Superior Alveolar (MSA)■ Infi ltration injection is used for maxillary premolars.■ Use a 27-gauge short needle.



52

CHAIR-SIDE

Anterior Superior Alveolar (ASA)■ Infi ltration injection is used for maxillary anterior teeth.■ Use a 27-gauge short needle.



53

CHAIR-SIDE

Greater Palatine Block■ Block injection.■ Anesthetizes posterior portion of hard palate.■ Use a 27-gauge short needle.



54

CHAIR-SIDE

Nasopalatine Block■ Block injection.■ Anterior portion of hard palate between canines.■ Use a 27-gauge short needle.



55

CHAIR-SIDE

Mandibular Injections

Inferior alveolar nerve

Lingual nerve

Mylohyoid nerve



56

CHAIR-SIDE

Inferior Alveolar Nerve Block■ Block injection.■ Unilateral effect to the midline.■ Use a 30-gauge long needle.



57

CHAIR-SIDE

Buccal Nerve Block■ Block injection.■ Soft tissue buccal to fi rst molars.■ Use a 30-gauge long needle.



58

CHAIR-SIDE

Mental Nerve Block■ Block injection.■ Premolars, canines, incisors.■ Use a 30-gauge long needle.


Nitrous Oxide Sedation

Nitrous oxide is the most commonly used sedative in dentistry. It is commonly used in oral and periodontal surgery, in patients with high levels of apprehension and anxiety, in children, and in patients with developmental and behavioral conditions.


59

CHAIR-SIDE

Indications

■ To reduce fear and anxiety■ Used in children to eliminate negative experience of

restraining■ Used in patients with special needs■ Used in patients with high gag refl ex■ Used in patients who have diffi culty reaching profound local

anesthesia■ To enhance the action of local anesthesia■ To prevent triggering other medical conditions (e.g., stress

may increase blood pressure, trigger angina incidents)

Contraindications

■ Patients unable to breathe adequately through their nose due to respiratory infections, blocked sinuses

■ Patients who have undergone eye or ear surgery■ Patients with hypoxia or chronic obstructive pulmonary

disease (COPD)■ Patients with history of drug addiction■ Patients taking sleep medications or antidepressants■ Pregnant women during fi rst trimester even though their

physicians should be contacted if N2O-O2 is considered for their treatment

■ Patients treated with bleomycin sulfate treatment for neoplasm in which fi brosis of the lungs is often found

■ Patients with sickle cell anemia■ Patients who have congestive heart failure (CHF)

Medical Assessment of the Patient Before Administration

Patients who are considered candidates for N2O-O2 inhalation sedation should complete a detailed medical history form to be reviewed by the dentist. If at any moment there is a doubt about their suitability for nitrous oxide, the physician should be con-sulted, and if necessary, the appointment should be rescheduled.


60

CHAIR-SIDE

Upon verifying the patient’s suitability, an informed consent should be signed and all details, and potential side effects should be explained to the patient. Before the actual administration of the gas, the patient’s vital signs must be measured and recorded and an examination of the airway should take place. The patient or the parent (if a minor) must also have been informed before the appointment to eat light to avoid vomiting. In children, special attention should also be paid for enlarged adenoids and tonsils. After the procedure, detailed records of the time, fl ow, and oxygenation procedures should be recorded.

Pharmacological and Physiological Effects of Nitrous Oxide

When ammonium nitrate is heated to high temperatures, it yields nitrous oxide and water. Nitrous oxide is a colorless, “sweet”-tasting gas, and it is the only inorganic gas that is used for seda-tion in humans. Nitrous oxide affects the central nervous system (CNS) by dulling the perception of painful stimuli and creating a more relaxed, carefree attitude in the patient. The exact mecha-nism is not completely known; it is believed, however, that this drug increases the release of endorphins in the body, which in turn block opioid receptors in the CNS, thus elevating the pain threshold. It is a relatively safe drug and has no effect on the cardiovascular system except minor vasodilatation. The pulse and heart rate remain unaffected, and there is no effect on the skeletal muscle system.

Nitrous oxide has an onset time of 2 to 5 minutes and is metabolized and excreted by the lungs. Because of its high dif-fusion rate (34 times higher than nitrogen), it is contraindicated for patients with medical conditions listed earlier, and it should never be administered without a scavenging system because it can accumulate, displacing oxygen, and overcome health care personnel. When inhaled, nitrous oxide reaches the lungs and travels via the circulatory system to the brain (limbic system) and the rest of the body. The patient experiences the following symptoms:


61

CHAIR-SIDE

■ A tingling sensation, especially in the extremities■ A warm feeling■ A feeling of well-being and euphoria■ In deeper sedation states, inability to keep the eyes open■ Nausea and vomiting (only if oversedated)

Notable: Nitrous oxide/oxygen has a fast onset and recovery.

Management of Complications and Medical Emergencies

Even though nitrous oxide has a great safety record, medical emergencies may occur while the patient is under its infl uence. The best way to manage such emergencies is to prevent them. Perform a thorough examination of the prospective recipient’s medical history to not only ensure that the patient is a “good” candidate, but also to learn of any medical condition.

Oversedation can lead to nausea and vomiting during the pro-cedure. If such an event occurs, do the following:

1. Turn the patient to his or her side to avoid aspiration. 2. Stop administering nitrous oxide immediately. 3. Give the patient 100% oxygen. 4. When the risk of vomiting has subsided, move the patient to

a contamination-free area where he or she can breathe fresh air. Measure the patient’s vital signs.

High concentrations of the gas can lead to dizziness, deep breath-ing, and eventually unconsciousness because of a lack of oxygen. In such cases, do the following:

1. Immediately stop the gas supply. 2. Give the patient 100% oxygen. 3. Measure and record vital signs. 4. Evaluate voluntary breathing and pulse. 5. Initiate cardiopulmonary resuscitation while informing the

emergency services.

REMEMBER: Nitrous oxide does not kill brain cells, but lack of oxygen does.


62

CHAIR-SIDE

Chairside Concepts

Four-Handed Dentistry

■ Minimizes stress and fatigue for dentist and assistant.■ Provides effi cient care to the patient.

Seating zones: Visualize the patient as a clock with his head on 12 o’clock and his feet on 6 o’clock and use the zones shown in the following chart to determine the appropriate seating for the dentist and the assistant.


CHAIR-SIDE

12

1

2

3

4

56

7

8

9

10

Operator’szone

Right-handed dentist

Left-handed dentist

Operator’szone

Static zone

Static zone

Assistant’szone

Assistant’szone

Transfer zone

Transfer zone

11

12

1

2

3

4

56

7

8

9

10

11


64

CHAIR-SIDE

Right-Handed DentistDentist’s zone 7–12Assistant’s zone 2–4Transfer zone 4–7Static zone 122

Positioning

■ Sit all the way back on the stool.■ Rest your feet on the stool base.■ Keep your legs parallel to the patient’s dental chair.■ Keep your eye level about 6 inches above the operator.


65

CHAIR-SIDE

Motions

■ Class I: Movement of the fi ngers only

■ Class II: Movement of the wrist and fi ngers


66

CHAIR-SIDE

■ Class III: Movement of the wrist, fi ngers, and elbow

■ Class IV: Movement of the arm and shoulder


67

CHAIR-SIDE

■ Class V: Movement of the entire torso

Basic Principles

■ The operator is able to maintain vision on the operative fi eld, thus reducing eyestrain.

■ The team conserves time and motion during instrument transfers.

■ There is a reduction in stress and strain on the operating team because of the uninterrupted fl ow of the procedure without the delays associated with locating and delivering instruments.

■ When instrument transfer is used in conjunction with the oral evacuator and the air/water syringe, the operative site will always be clean and the next instrument will be ready for use.

■ Percutaneous injuries associated with use of dental instruments can be minimized using a prescribed transfer technique.


68

CHAIR-SIDE

Instrument Transfer

■ Pen grasp: The position commonly used to hold a pen or pencil and is widely used for most operative instruments.

■ Modifi ed pen grasp: Similar to the pen grasp except the operator uses the pad of the middle fi nger on the handle of the instrument. Adds stability to the transfer.

■ Palm grasp: Hold the instrument on the palm. Used for bulky instruments such as forceps.


69

CHAIR-SIDE

■ Palm/thumb grasp: Hold the instrument in the palm and guide with the thumb. Used in holding the high volume evacuation (HVE), it provides more vertical freedom in the movement of the instrument.


70

INFECT CONTROL

Infection Control and Instruments

Instrument Classifi cation Based on Need for Infection Control

Critical■ Touch bone and/or penetrate soft tissue.■ Heat sterilize between uses or use sterile single-use,

disposable devices.■ Examples: surgical instruments, scalpel blades, periodontal

scalers, and surgical dental burs.

Semicritical■ Touch mucous membranes.■ Heat sterilize or high-level disinfect.■ Examples: Dental mouth mirrors, amalgam condensers, and

dental handpieces.

Noncritical■ Contact with intact skin.■ Clean and disinfect using a low- to intermediate-level

disinfectant.■ Examples: X-ray head, pulse oximeter, blood pressure cuff.

Instrument Processing

■ Transport

■ Transport contaminated instruments to processing and sterilization area.

■ Use a designated processing area to control quality and ensure safety.

■ Divide processing area into work areas.■ Cleaning: Use an ultrasonic cleaner.■ Packaging

■ Wrap or package instruments for sterilization.■ Wrap or place critical and semicritical items that will be

stored in containers before heat sterilization.■ Open and unlock hinged instruments.


71

INFECT CONTROL

■ Place a chemical indicator inside the pack.■ Wear heavy-duty, puncture-resistant utility gloves.

■ Sterilization: Load and operate sterilizer according to the manufacturer’s guidelines.

■ Storage: Store instruments in such a way as to maintain integrity of the package.

■ Delivery to procedure site: Deliver instruments to procedure site maintaining integrity and opening before procedure.

■ Quality control: Implement quality control test to assure sterilization effi ciency.

Instrument Sterilization

Sterilization Methods■ Steam Autoclave (steam under pressure)


INFECT CONTROL

72

■ Four cycles (heat up, sterilization, depressurization, drying).

■ Short time.■ Corrosive (may rust non–stainless steel instruments).■ Use distilled water ONLY.

■ Chemical Vapor

■ Special chemical compound■ Short time

■ Rapid Heat Transfer

■ Very short time■ Noncorrosive

■ Dry Heat

■ Long time■ Noncorrosive

■ Liquid Chemical Sterilant/Disinfectants

■ Only for heat-sensitive critical and semicritical devices.■ Powerful, toxic chemicals raise safety concerns.■ Heat-tolerant and disposable alternatives are available.

Sterilization Monitoring: Types of Indicators■ Mechanical: Measure time, temperature, pressure■ Chemical: Change in color when physical parameter is

reached


73

INFECT CONTROL

Reprinted with permission from: Henry, R., & Perno, M.G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.

■ Biological (spore tests): Use biological spores to assess the sterilization process directly


INFECT CONTROL

74

CDC Guidelines for Infection Control

Chain of Infection

CDC Guidelines for Infection Control

Chain ofInfectionHost Source

Pathogen

Entry

For an infection to occur, four conditions must be present:

■ A germ must be present (e.g., bacteria, virus, parasite).■ The germ must have a place to live and multiply such as

human, food, soil, or water.■ A susceptible host must be present.■ There must be a way for the germ to enter the host, such as

direct contact or air droplets.

Standard Precautions

Application■ Apply to all patients■ Integrate and expand Universal Precautions to include

organisms spread by blood and the following:■ Body fl uids, secretions, and excretions except sweat,

whether or not they contain blood■ Nonintact (broken) skin■ Mucous membranes


75

INFECT CONTROL

Elements■ Hand washing■ Use of personal protective equipment (PPE) (gloves, masks,

eye protection, gowns)■ Patient care equipment■ Environmental surfaces■ Injury prevention

Bloodborne Pathogens

Examples■ Hepatitis B virus (HBV)■ Hepatitis C virus (HCV)■ Human immunodefi ciency virus (HIV)

Characteristics■ Are transmissible in health care settings■ Can produce chronic infection■ Are often carried by persons unaware of their infection

Exposure Prevention Strategies

■ Engineering controls: Isolate or remove the hazard■ Work practice controls: Change the manner of performing

tasks■ Administrative controls: Policies, procedures, and

enforcement measures

Postexposure Management Program

■ Clear policies and procedures■ Education of dental health care personnel (DHCP)■ Rapid access to clinical care■ Postexposure prophylaxis (PEP)■ Testing of source patients and health-care personnel (HCP)■ Wound management■ Exposure reporting■ Assessment of infection risk■ Type and severity of exposure


INFECT CONTROL

76

■ Bloodborne status of source person■ Susceptibility of exposed person

Hand Hygiene

■ Hands are the most common mode of pathogen transmission.

■ Reduce spread of antimicrobial resistance.■ Prevent health care–associated infection.



77

INFECT CONTROL

Terms and Defi nitions

■ Hand washing: Washing hands with plain soap and water■ Antiseptic hand wash: Washing hands with water and soap

or other detergents containing an antiseptic agent■ Alcohol-based hand rub: Rubbing hands with an alcohol-

containing preparation■ Surgical antisepsis: Washing hands with an antiseptic soap

or an alcohol-based hand rub before operations by surgical personnel

Guidelines

■ Use hand lotions to prevent skin dryness.■ Consider compatibility of hand care products with gloves.■ Keep fi ngernails short.■ Avoid artifi cial nails.■ Avoid hand jewelry that may tear gloves.


INFECT CONTROL

78

Personal Protective Equipment

■ A major component of Standard Precautions■ Protects the skin and mucous membranes from exposure to

infectious materials in spray or spatter■ Should be removed when leaving treatment areas

Masks and Face Shield

■ Wear a surgical mask and either eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth.

■ Change masks between patients.■ Use clean, reusable face protection between patients; if

visibly soiled, clean and disinfect.


79

INFECT CONTROL

Clothing

■ Wear gowns, lab coats, and uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material.

■ Change if visibly soiled.■ Remove all barriers before leaving the work area.

Gloves

■ Minimize the risk of HCP acquiring infections from patients.■ Prevent microbial fl ora from being transmitted from HCP to

patients.■ Reduce contamination of the hands of HCP by microbial

fl ora that can be transmitted from one patient to another.■ Are not a substitute for hand washing.

Sterile Glove Donning TechniquePeel open the outer pack from the corners. The inner pack is sterile.

■ Pick up the cuff of the right glove with your left hand. Slide your right hand into the glove until you have a snug fi t over the thumb joint and knuckles. Your bare left hand should only touch the folded cuff; the rest of the glove remains sterile.


INFECT CONTROL

80


81

INFECT CONTROL

■ Slide your right fi ngertips into the folded cuff of the left glove. Pull out the glove and fi t your left hand into it.

■ Unfold the cuffs down over your gown sleeves. Make sure your gloved fi ngertips do not touch your bare forearms or wrists.


INFECT CONTROL

82

All photos in the gloving sequence are reprinted with permission from: Johansson, C., & Chinworth, S. A. (2012). Mobility in Context: Principles of Patient Care Skills, ed 1. Philadelphia: F.A. Davis Company; pp. 102–103, Fig. 4-12.

Environmental Surfaces

■ May become contaminated■ Do not require as stringent decontamination procedures

Categories■ Clinical contact surfaces

■ High potential for direct contamination from spray or splatter or by contact with DHCP’s gloved hand

■ Housekeeping surfaces■ Do not come into contact with patients or devices■ Limited risk of disease transmission

Recommendations■ Use barrier precautions (e.g., heavy-duty utility gloves,

masks, protective eyewear) when cleaning and disinfecting environmental surfaces.


83

INFECT CONTROL

■ Physical removal of microorganisms by cleaning is as important as the disinfection process.

■ Follow manufacturer’s instructions for proper use of Environmental Protection Agency (EPA)–registered hospital disinfectants.

■ Do not use sterilants or high-level disinfectants on environmental surfaces.

Clinical Contact Surfaces■ Risk of transmitting infections is greater than for

housekeeping surfaces.■ Surface barriers can be used and changed between patients.

OR

■ Clean and then disinfect using an EPA-registered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant.

Water LinesProblem: Contamination of Water Supply■ Microbial biofi lms form in small-bore tubing of dental units.■ Biofi lms serve as a microbial reservoir.■ Primary source of microorganisms is municipal water

supply.

Solutions to the Problem■ Independent reservoir.■ Chemical treatment.■ Filtration.■ Combinations.■ Sterile water delivery systems.■ Use sterile saline or sterile water as a coolant or irrigator

when performing surgical procedures.■ Use devices designed for the delivery of sterile irrigating

fl uids.■ Clean and heat sterilize intraoral devices that can be

removed from air and waterlines.■ Follow manufacturer’s instructions for cleaning, lubrication,

and sterilization.■ Do not use liquid germicides or ethylene oxide.■ Use barriers and change between uses.


INFECT CONTROL

84

■ Clean and disinfect at an intermediate level the surface of devices if visibly contaminated.

■ Do not advise patients to close their lips tightly around the tip of the saliva ejector.

Medical Waste Management


■ Properly label containment to prevent injuries and leakage.■ Medical wastes are “treated” in accordance with state and

local EPA regulations.■ Processes for regulated waste include autoclaving and

incineration.

Program Evaluation

■ Develop standard operating procedures.■ Evaluate infection control practices.■ Document adverse outcomes.■ Document work-related illnesses.■ Monitor health care–associated infections.


RADIOL

85

Introduction to Radiology

Dental radiology is one of the most important factors contribut-ing to quality and reliable diagnosis and treatment of patients. Dental assistants must understand the concepts behind the physics of radiology and must be competent in exposing accu-rate, diagnostic, and quality radiographs and images.

Brief History

In 1895, Wilhelm C. Roentgen discovered x-rays by accident while he was experimenting with the production of cathode rays. Many other scientists continued to research these new rays, and in 1896, Edmund Kells, a dentist, recorded the fi rst practical use of x-rays in dentistry. Throughout the years, several devel-opments and improvements have been implemented in dental radiology, such as the panoramic concept, high-speed fi lms (F-speed), digital radiography, and 3-D cone imaging.

Uses of Dental Radiology

■ Diagnostic: Identify disease in the teeth and the surrounding hard tissue.

■ Qualitative: Evaluate quality and clinical functionality of placed restorations.

■ Legal: Document and record conditions at a specifi c time frame.

■ Forensic: Help identify deceased individuals.

Types of Dental Radiology

■ Intraoral: Procedures in which the fi lm or digital devices that record images are placed inside the patient’s mouth. Examples of intraoral x-rays are periapical (PA) x-rays and bitewing (BW) x-rays.


RADIOL

86

■ Extraoral: Procedures in which the fi lm or digital devices that record images are located outside the patient’s mouth. Examples of extraoral x-rays are panoramic, cephalometric, and lateral skull.


RADIOL

87

Dental Radiology Equipment

Intraoral X-Ray Unit

Components■ Control panel: Contains all setting adjustments buttons,

master switch, indicator light, and exposure button. It can be located in the x-ray area only if a remote exposure button is available to limit the operator’s exposure to radiation or outside the x-ray area.■ Exposure button: Controls the fl ow of electricity to

generate x-rays.■ Kilovoltage selector (kVp): Controls the penetrating power

of the x-ray beam. Normal kVp range is between 70 and 90 kVp.

■ Milliamperage selector (mA): Controls the number of electrons produced. Higher mA increases the number of electrons.

■ Extension arm: Positions the tubehead during x-ray procedures and contains wiring that connects the tubehead and the control panel. It is easily adjustable and folds for effi cient storage.


RADIOL

88

Reprinted with permission from: Henry, R., & Perno, M. G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.

■ Tubehead: Metal housing of the x-ray tube. It also contains transformers, oil that prevents overheating for the production of x-rays, and aluminum or lead glass.■ Important components in the tubehead are the collimator,

aluminum disc (which restricts the size of the x-ray beam before exiting the tubehead), and aluminum fi lters (which fi lter out low-wavelength x-rays).


RADIOL

89

Reprinted with permission from: Henry, R., & Perno, M. G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.

■ X-ray tube: Located inside the tubehead and is the device where the x-rays are produced. It contains the following:■ Anode: A positive electrode composed of the tungsten

target embedded in a copper housing. The tungsten target acts as a focal spot and transforms the electron waves into x-rays.

■ Cathode: A negative electrode made of a tungsten fi lament embedded in molybdenum housing. The tungsten fi lament is where electrons are produced.

The x-ray tube is in a vacuum state (no air is present).


RADIOL

90

Extraoral X-Ray Unit

Panoramic machines have similar components and produce x-rays under the same principles as the intraoral units.

X-Ray Processor

■ Manual: Rarely used today because of extended period of time to develop and process radiographs.

■ Automatic: Faster and more effi cient with controlled temperature and time.

Automatic processors house a roller transport system that carries radiographs through the developer and fi xer solutions and through a rinse and air dry cycle.


RADIOL

91

Processing Solutions■ Developing solution: Reacts with exposed silver halide

crystals forming black metallic silver and softens emulsion of the fi lm.

■ Fixer solution: Removes all unexposed silver halide crystals and hardens emulsion.

Both of these solutions are available in powder, liquid concen-trate, and ready-to-use liquid forms.

Duplicating

Duplication of radiographs must occur in a dark room.Procedure for duplication:

■ Open duplicating machine.■ Place duplicating fi lm on the glass top of the machine with

the emulsion facing up.■ Place fi lms to be duplicated on the top and close the lid.■ Turn on exposing light of the duplicating machine for the

manufacturer’s recommended time.■ Remove duplicating fi lm and process as normal.


RADIOL

92

Dental Radiology Film Types

Dental radiology fi lm is made of a semifl exible acetate fi lm base that is coated with an emulsion of silver halide, silver bromide, and silver iodide crystals.

Intraoral Film

Speed■ D speed■ E speed■ F speed (the fastest fi lm available, which means it requires

less amount of radiation)


RADIOL

93Size■ #0, smallest fi lm used in pediatric patients■ #1, used in pediatric patients and often for lower anterior

PAs■ #2, most commonly used for adult BW and PA x-rays■ #4, used in occlusal exposures

Extraoral Film

■ Is placed outside the mouth.■ Requires a cassette to protect it.■ Requires intensifying screens.■ Green sensitive (rare earth–intensifying screens).■ Blue sensitive (calcium tungstate–intensifying screens).

Duplicating Film■ Sensitive to light.■ Emulsion only in one side.■ Side with emulsion appears dull.■ Available in all sizes, including 8-in x 10-in sheets.

Characteristics of Radiographic Beam

Contrast

■ Radiographic images appear in a range of shades from black to white with several shades of gray in between.

■ Higher kVp produces lower contrast.


RADIOL

94

Density

■ Density is the overall darkness or blackness of the fi lm.■ Density is controlled by mAs (milliampere seconds).

Factors Infl uencing Contrast and Density

Factor Effect

Milliamperage (mA)

Decreased Decreased density

Increased Increased density

Kilovoltage (kVp)

Increased Increased density, low contrast

Decreased Decreased density, high contrast

Time (sec)

Decreased Decreased density

Increased Increased density

Radiation Effects

X-rays are a type of ionizing radiation that is harmful and causes biologic changes in living tissue.

Exposure to radiation has a cumulative effect, meaning that tissue undergoes damage and changes over a period of time.

Acute Radiation Exposure

Acute radiation exposure occurs when large amounts of radia-tion are absorbed by tissue over a short period of time (i.e., exposure to nuclear fallout).


RADIOL

95Chronic Radiation Exposure

Chronic radiation exposure occurs when small amounts of radia-tion are absorbed by tissue over an extended period of time. During chronic exposure, symptoms of damage may not be noticeable until years after the original exposure.

Critical Organs

Organs that are more susceptible to radiation exposure during dental procedures are:

■ Skin■ Thyroid gland■ Bone marrow■ Lens of the eye

Maximum Permissible Dose

According to the National Council on Radiation Protection and Measurements (NCRP), the maximum permissible dose (MPD) is the highest amount of radiation that the human body can receive without enduring any injury.

■ MPD for occupational exposure: 5.0 rem/year.■ MPD for non-occupational exposure: 0.1 rem/year.

Patient Protection

■ Lead apron and thyroid collar.■ High-speed fi lm or use of digital systems.■ Proper technique that minimizes the number of retakes.■ Exposure factors such as kVp and mA to minimum levels,

allowing diagnostic quality radiographs.■ Use of aiming devices to avoid patient holding the fi lm or

digital sensors.


RADIOL

96

Operator Protection

■ Monitoring: use of monitoring devices such as badges.■ Proper equipment operation.■ Knowledge of safety regulation.■ ADA and FDA guidelines state that pregnant operators must

use a lead apron during exposure of dental radiographs. The embryo or fetus will not receive detectable amounts of radiation if a lead apron is used.

ALERT: Keep radiation exposure to as low as reasonably achievable.

Errors Due to Temperature, Solutions, Contamination, and Film Handling

■ Underdeveloped fi lm: Appears light; indicates not enough developing time.

■ Overdeveloped fi lm: Appears dark; indicates excessive developing time.

■ Fixer spots: White spots; indicate fi xer came into contact with fi lm prior to developing.

■ Developer spots: Dark spots; indicate developer came into contact with fi lm prior to developing.

■ Brown or yellow stains: Indicate inadequate chemicals.■ Fingerprint: Indicates fi lm touched by fi ngers.■ Overlapping: Indicates fi lms are in contact during

processing.■ Developer/fi xer cutoff: Indicates inadequate chemical levels.■ Light lean in the dark room: Film appears black.■ Fogged fi lm: Indicates inappropriate safe light.


RADIOL

97

Most Common Types of Dental Radiographs

Intraoral

Periapical (PA)A PA radiograph captures the entire tooth and its surrounding structures. It is used primarily to identify periapical pathology. Exposure techniques include the paralleling (aiming devices) and bisecting the angle techniques. PA radiographs are taken in both the anterior and posterior teeth.

Bitewing (BW)A BW radiograph captures the posterior upper and lower teeth, mainly the crown portion. There are two types of BW radio-graphs. Premolar BWs include the fi rst and second premolars and mesially extend up to and distal to the canines. Molar BWs

include the fi rst and second molars. Exposure techniques include BW tabs or the use of aiming devices.

Intraoral SeriesA full-mouth survey (FMX) is a series of usually 18 fi lms: 14 PA and 4 BW x-rays. An FMX survey is necessary to perform a comprehensive dental examination.


RADIOL

98

Exposing TechniquesParalleling Technique■ Place the fi lm/sensor parallel to the long axis of the tooth of

interest.■ Direct the central x-ray beam perpendicular to the long axis

of the tooth and the fi lm.■ Direct the central x-ray beam through the contact areas

between the teeth.■ Use fi lm size #1 or #2.

Film

X-rays

Tube

The use of XCP (extension cone paralleling) devices is recom-mended for the paralleling technique for more accurate and operator-free errors.


RADIOL

99Bisecting Technique■ Bisecting technique is not an ideal technique but is useful in

special situations, such as in children and patients with shallow, narrow mouths or fl at palates.

■ Place the fi lm against the tooth of interest.■ Aim the central beam perpendicular to the imaginary

bisector of the angle formed between the long axis of the tooth and the fi lm.

■ Use fi lm size #1 or #2.

Plastic bite blocks, aiming rings, and Eezee-Grip (Rinn) holders can be used with the bisecting techniques.

Film

X-rays

Tube

Imaginaryline


RADIOL

100

Occlusal Technique■ Occlusal technique is used to examine large areas of the

upper or lower jaw.■ Use fi lm size #4.■ It is often used in children.■ Place fi lm on the occlusal surface of the teeth with the white

portion facing the arch to be examined. Ask the patient to gently bite on the fi lm.

Recommended Sequence of Exposing an FMXNote: This is just a recommendation and is based on providing the patient with the most comfortable experience while at the same time ensuring that all teeth have been exposed with no double takes and minimal aiming device modifi cation.

Teeth to expose, by number:

■ 6, 7■ 8, 9■ 10, 11■ 22, 23■ 24, 25■ 26, 27■ 4, 5■ 1, 2, 3■ 20, 21

Extraoral

PanoramicPanoramic exposures provide a complete picture of the entire oral cavity and surrounding structures.

In a panoramic x-ray, both the fi lm and the tubehead rotate around the patient’s head, producing individual images that, when combined in a single fi lm, produce an image of the upper and lower jaw and surrounding structures.

■ 17, 18, 19■ 12, 13■ 14, 15, 16■ 28, 29■ 30, 31, 32■ R premolar BW■ R molar BW■ L premolar BW■ L molar BW


RADIOL

101Procedure■ Explain to the patient the procedure.■ Ask the patient to remove all metal objects from the neck

up.■ Place a lead apron with no thyroid collar on the patient.■ Position the patient while standing “as tall as possible,” with

the midsagittal* plane perpendicular to the fl oor and the Frankfort** plane parallel to the fl oor.

■ Instruct the patient to bite on the bite stick located on the machine to focus on the focal trough***.

■ Ask the patient to swallow, place the tongue on the roof of the mouth, and remain still during exposure.

*Midsagittal plane: Imaginary line that divides the patient’s face into left and right sides

**Frankfort plane: Imaginary line that passes from the bottom of the eye socket to the upper portion of the ear canal

***Focal trough: An imaginary three-dimensional zone in which the panoramic images appear clear

CephalometricCephalometric examination is mostly used in orthodontics during the treatment planning phase. In addition, it is often used to identify trauma, disease, and developmental abnormalities.

Cephalometric and other extraoral examination follow the pan-oramic guidelines mentioned previously.

Other Extraoral Examinations■ Reverse Towne projection: Identifi es fractures in the ramus

and condyle of the mandible.■ Submentovertex projection: Identifi es zygomatic arch

fractures and presents the base of the skull.■ Waters projection: Evaluates the sinus area.■ Cone-beam computed tomography (commonly referred to

by the acronym CBCT) is a medical imaging technique consisting of x-ray computed tomography in which the x-rays are divergent, forming a cone.


RADIOL

102

CBCT has become increasingly important in treatment planning and diagnosis in implant dentistry, as well as in orthodontics and endodontics.

Digital Radiography


■ The use of digital radiography is increasing rapidly.■ It uses a sensor rather than a fi lm to record electron

impulses and then digitizes the image through a computer, producing a diagnostic image.

■ It requires much less radiation exposure to produce diagnostic quality images (50%–80% less radiation).

■ The same intraoral x-ray units may be used.■ It is applied both in intraoral and extraoral examinations.■ Several systems are available.■ The same positioning principles apply as for traditional

radiography.■ Start-up costs for this technology are expensive.


RADIOL

103Types of Digital Radiography

Direct Digital Imaging■ A sensor is placed in the patient’s mouth, and it is exposed

to x-rays.■ The sensor can be wired or wireless.■ The sensor captures the exposed image and transfers it to

the computer.

Indirect Digital Imaging■ An already existing radiograph.■ A CCD (charge coupled device).■ A computer.■ Existing radiograph is digitized using the CCD device and

transferred to the computer using a scanner.■ Inferior quality as the result is a copy and not the original

image.

Storage Phosphor Imaging■ Wireless.■ A reusable phosphor plate is used instead of a sensor.■ Acts as an intensifying screen.■ Image is captured and then via a laser scanner is transferred

to the computer.

Advantages versus Disadvantages

Advantages■ Up to 80% less radiation exposure.■ Great tool in patient education.■ Apart from initial investment, lower cost because of the lack

of developing solutions and fi lm.


RADIOL

104

Disadvantages■ High initial start-up cost.■ Sensor size being bulky creates problems to some patients.■ Because sensors cannot be sterilized, special attention must

be paid to infection control.

Infection Control Sites

Areas of radiography equipment that are likely to be contami-nated are as follows:

■ Tubehead■ PID■ Control panel■ Dental chair■ Lead apron■ Counter surfaces■ Darkroom equipment■ Computer hardware (e.g., mouse, keyboard)■ Sensor protective sleeves■ Holding and aiming devices■ Film

Infection Control Checklist

Prior to Exposure■ Cover or disinfect

■ X-ray machine■ Work area■ Lead apron■ Dental chair

■ Wash hands (operator)■ Put on gloves (operator)


RADIOL

105During Exposure■ Dry and wipe the exposed fi lm with a paper towel.■ Place fi lm in a disposable container.

After Exposure■ Dispose of all contaminated items.■ Place fi lm-holding devices in designated area for

contaminated objects.■ Remove gloves.■ Wash hands.■ Remove lead apron.

Infection control checklist modifi ed from: Ianucci, J., & Jansen Howerton, L. (2011). Dental Radiography: Principles and Techniques, ed 4. St Louis: Saunders.


106

INSTR

General Dentistry Instruments

Acorn Burnisher

■ To burnish permanent and temporary fi lling materials


Amalgam Carrier

■ To carry amalgam■ Single or double ended■ Various sizes depending on size of the cavity preparation


INSTR

107


Amalgam Well

■ To hold amalgam after trituration and before placing into the cavity

■ Made in various sizes and from different materials



INSTR

108

Anesthetic Syringe

■ To deliver anesthetic solution■ Aspirating capabilities to avoid injection of anesthetic

directly in a blood vessel■ Various types



INSTR

109Articulating Paper Holder

■ To hold articulating paper in place during occlusion checks



INSTR

110

Cement Spatula

■ To mix temporary and permanent cements as well as various fi lling materials


Chisel

■ To smooth and plane enamel within the cavity preparation



INSTR

111Composite Instrument

■ To carry and place composite material in the cavity preparation


Condenser

■ To condense permanent and temporary fi lling materials in the cavity preparation



INSTR

112

Cotton Forceps

■ To carry objects in and out of the mouth■ Locking type available■ Various sizes



INSTR

113Dental Dam Clamps

■ To stabilize dental dam■ Various shapes and sizes to accommodate various teeth



INSTR

114

Dental Dam Forceps

■ To place and remove clamp


Dental Dam Frame

■ To hold and support dental dam



INSTR

115Dental Dam Punch

■ To punch holes in the dental dam for teeth involved


Discoid-Cleoid

■ To create occlusal anatomy in permanent and temporary fi lling materials



INSTR

116

Explorer


Gingival Margin Trimmer

■ To create bevels in the gingival margins of the preparation



INSTR

117Hatchet

■ To remove unsupported enamel rods

Hoe

■ To smooth the cavity preparation



INSTR

118

Hollenback Carver

■ To contour anatomy in interproximal areas in permanent and temporary restorative materials


Liner Placement Instrument

■ To mix and place various types of liners into the cavity preparation



INSTR

119Matrix Band Retainer (Toffl emire)

■ To hold and support the matrix band during restorations


Mouth Mirror

■ To retract soft tissue■ To provide indirect vision■ To refl ect light■ Disposable or not■ Single or double sided■ Various sizes and styles


INSTR

120

Periodontal Probe

■ To measure pocket depths■ Various measuring increments■ Various types and shapes


Spoon Excavator

■ To remove decay■ Multiple secondary functions■ Single or double ended■ Various size and shapes


INSTR

121

Friction Grip Burs

Diamond



INSTR

122

Fissure: Cross-Cut Straight



INSTR

123Fissure: Cross-Cut Tapered



INSTR

124

Fissure: Plain Straight



INSTR

125Fissure: Plain Tapered



INSTR

126

Inverted Cone



INSTR

127Pear Shape


Round



INSTR

128

Basic Endodontic Instruments

Broach

■ To remove pulp tissue from the canal

Endodontic Condenser (plugger)

■ To assist in vertical condensation of the gutta percha■ Can also be used to condense the fi nal fi lling of the root

canal


INSTR

129Endodontic Explorer

■ To locate access openings of canal during endodontic treatment.

Endodontic Spreader

■ To assist in the lateral condensation of the gutta percha■ Can also be used to condense the fi nal fi lling of the root


INSTR

130

Endodontic Stand

■ To hold for easy access of fi les and burs

File (K-Type)

■ To contour and shape the root canals before obturation


INSTR

131Gates Glidden

■ To enlarge the pulp chamber■ Attaches to slow speed (latch type)

Gutta-Percha

■ To fi ll root canal during the obturation process■ Various sizes■ Pliable when heated


INSTR

132

Paper Points

■ To dry root canals before obturation■ Various sizes

Sodium Hypochlorite Syringe


INSTR

133

Basic Oral Surgery Instruments

Anterior Mandibular Forceps

■ To remove anterior mandibular teeth

Bone File

■ To smooth alveolar bone following tooth extraction


INSTR

134

Chisel and Mallet

■ To assist in splitting tooth or bone

Cryer Elevators (East and West)

■ To assist in elevating roots when crown portion of tooth is broken


INSTR

135Hemostat

■ To hold on to tissue or bone pieces■ Various sizes and shapes■ Longer beaks

Reprinted with permission from: Bidwell, J., & Grafft, D. (Forthcoming). Surgical Procedures for Surgical Technology and Surgical Assisting, ed 1. Philadelphia: F.A. Davis Company.


INSTR

136

Mandibular Molar Universal Forceps (Cowhorn)

■ To remove lower molar teeth

Mandibular Universal Forceps (151)

■ To remove all lower teeth


INSTR

137Maxillary Left Forceps (88L)

■ To remove trifurcated maxillary left fi rst and second molars

Maxillary Right Forceps (88R)

■ To remove trifurcated maxillary right fi rst and second molars


INSTR

138

Maxillary Universal Forceps (150)

■ To remove all upper arch teeth

Mouth Props

■ To hold patient’s mouth open■ Various shapes and sizes


INSTR

139Needle Holder

■ To hold on to the suture needle■ Various shapes and sizes■ Short beaks with indentation to hold on to the needle

securely

Periosteal Elevator

■ To separate tissue from bone and/or tooth■ Various shapes and sizes


INSTR

140

Rongeurs

■ To smooth and contour alveolar bone after tooth extraction■ Hinged forceps

Root Tip Picks

■ To remove broken root tips■ Various shapes and sizes


INSTR

141Scalpel Handle with Blades

■ To cut tissue■ Can be disposable■ Blades come in various shapes and sizes

Straight Elevator

■ To luxate and elevate the tooth from its socket■ Various shapes and sizes


INSTR

142

Surgical Curette

■ To remove abscessed or granulation tissue■ Various sizes■ Can be single or double ended

Suture Scissors

■ To cut off sutures■ Rounded or straight end


INSTR

143Tissue Scissors

■ To cut excess tissue■ Various shapes and sizes

Reprinted with permission from: Bidwell, J., & Grafft, D. (Forthcoming). Surgical Procedures for Surgical Technology and Surgical Assisting, ed 1. Philadelphia: F.A. Davis Company.


INSTR

144

Basic Orthodontics Instruments

Band Pusher

■ To push bands into place during orthodontic procedures

Bird Beak

■ To bend and contour wire


INSTR

145Bands and Brackets

Bracket Placement Pliers

■ To carry and place brackets on tooth for cementation or bonding


INSTR

146

Bracket Remover

■ To remove brackets upon completion of orthodontic treatment

Distal End Cutter

■ To cut distal end of arch wire after placement in brackets


INSTR

147Elastic Placement Pliers

■ To place elastics around brackets and wires

Elastics


INSTR

148

Ligature-Tying Pliers

■ To tie ligatures onto arch wire

Three-Prong Bender

■ To bend and contour wire


INSTR

149Weingart Pliers

■ To place and remove arch wire or brackets

Wire


INSTR

150

Wire Cutter

■ To cut wire


RESOURCE

151

Dental Assistant Profession

The American Dental Assistant’s Association (ADAA) has defi ned a Code of Ethics for Dental Assistants that delineates the profes-sion (www.adda.org).

Profession Preservation

The concept of profession preservation encourages the dental assistant to assume the obligation of maintaining and enriching the profession based on the needs of the individuals the profes-sion of dentistry is committed to serve. This concept can be achieved as follows.

Professionalism

The dental assistant should at all times:

■ Maintain confi dentiality.■ Perform only duties allowed by state law.■ Prove competency in allowed duties.■ Show respect for dentists.

Professional Development

The dental assistant should constantly strive to enrich his or her knowledge of the profession and to upgrade and perfect hand and technical skills for the benefi t of the employer and the human beings he or she serves.

Involvement

Every dental assistant should exhibit a commitment to the pro-fession by being involved with professional associations in a local, state, or national level to better the profession via construc-tive feedback and recommendation.


RESOURCE

152

Common Dental Terminology

Abscess: Acute or chronic, localized infl ammation with a concentration of pus, associated with tissue destruction and frequently swelling, usually secondary to infection.

Abscess, periapical: Acute or chronic infl ammation and pus formation at the end of a tooth root in the alveolar bone secondary to infection.

Abscess, periodontal: Abscess of the gingiva or periodontal tissue as a result of periodontal infection.

Abutment: A tooth or implant used to support a fi xed prosthesis.

Acid etching: Use of an acid, most commonly phosphoric acid, to prepare the tooth enamel or dentin surface to provide retention for bonding.

Adhesive: Any chemical substance that joins or creates close adherence of two or more surfaces.

Alveolar: Referring to the bone surrounding the tooth.

Alveoloplasty: Surgical procedure for soothing and recontouring alveolar bone, usually in preparation for a prosthesis.

Amalgam: An alloy used in direct dental restorations.

Analgesia: Loss of pain sensations without loss of consciousness.

Anterior teeth: The teeth and tissues located toward the front of the mouth; the maxillary and mandibular incisors and canines.


RESOURCE

153Anxiolysis: Reduction of anxiety using a pharmacologic agent

such as a benzodiazepine or nitrous oxide.

Apicoectomy: Amputation of the apex of a tooth.

Avulsion: Separation of tooth from its socket due to trauma.

Benign: The nonmalignant character of a neoplasm.

Bicuspid: A tooth with two cusps.

Bilateral: Pertaining to the right and left sides.

Biopsy: Removal of tissue for histologic evaluation.

Bitewing radiograph: Interproximal view radiograph of the coronal portion of the tooth.

Bonding: Process by which two or more components are made integral by mechanical or chemical adhesion at their interface.

Bruxism: Abnormal grinding of the teeth.

Buccal: Pertaining to or around the cheek.

Calculus: Hard mineralized material adhering to crowns or roots of teeth.

Canal: Space inside the root portion of a tooth containing pulp tissue.

Caries: Commonly used term for tooth decay.

Cavity: Decay in tooth caused by caries; also referred to as carious lesion.

Cement base: Material used under a fi lling to replace lost tooth structure.


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154

Cementum: Hard connective tissue covering the tooth root.

Cephalometric radiograph: A radiographic head fi lm used in the scientifi c study of the measurements of the head with relation to specifi c reference points.

Cleft palate: Congenital deformity resulting in lack of fusion of the soft or hard palate (or both), either partial or complete.

Clenching: The clamping and pressing of the jaws and teeth together in centric occlusion frequently associated with psychological stress or physical effort.

Composite: A dental restorative material made up of disparate or separate parts (e.g., resin and quartz particles).

Coronal: The clinical crown of a tooth.

Curettage: Scraping and cleaning the walls of a cavity or gingival pocket.

Cyst: Pathological cavity, usually lined with epithelium, containing fl uid or soft matter.

Cyst, odontogenic: Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).

Cyst, periapical: Cyst at the apex of a tooth with a nonvital pulp.

Débridement: Removal of subgingival or supragingival plaque and calculus that obstructs the ability to perform an evaluation.

Decay: The lay term for carious lesions in a tooth; decomposition of tooth structure.

Deciduous: Having the property of falling off or shedding; a name used for the primary teeth.


RESOURCE

155Dental prophylaxis: Scaling and polishing procedure performed

to remove coronal plaque, calculus, and stains.

Dentin: That part of the tooth that is beneath enamel and cementum.

Dentition: The teeth in the dental arch.

Denture: An artifi cial prosthesis for natural teeth and adjacent tissues.

Denture base: The part of a denture that makes contact with soft tissue and retains the artifi cial teeth.

Diagnostic cast: Plaster or stone model of teeth and adjoining tissues; also referred to as study model.

Diastema: A space, such as one between two adjacent teeth in the same dental arch.

Direct restoration: A restoration fabricated inside the mouth.

Displaced tooth: A partial evulsion of a tooth.

Distal: Toward the back of the dental arch (or away from the midline).

Dry socket: Localized infl ammation of the tooth socket after extraction caused by infection or loss of blood clot; alveolitis.

Edentulous: Without teeth.

Enamel: Hard calcifi ed tissue covering dentin of the crown of a tooth.

Evaluation, comprehensive: Typically used by a general dentist or specialist when evaluating a patient comprehensively. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues. It may require interpretation


RESOURCE

156

of information acquired through additional diagnostic procedures. This would include the evaluation and recording of the patient’s dental and medical history and a general health assessment.

Evaluation, limited oral: A problem-focused evaluation limited to a specifi c oral health problem. This may require interpretation of information acquired through additional diagnostic procedures. Defi nitive procedures may be required on the same date as the evaluation.

Evaluation, periodic oral: An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation.

Excision: Surgical removal of bone or tissue.

Exostosis: Overgrowth of bone.

Extraoral: Outside the mouth.

Exudate: A material usually resulting from infl ammation or necrosis that contains fl uid, cells, or other debris.

Facial: The surface of a tooth directed toward the face (including the buccal and labial surfaces) and opposite the lingual surface. Facial surface equals buccal surface in the posterior or the labial in the anterior.

Filling: A term used for the restoration of lost tooth structure by using materials such as metal, alloy, plastic, or porcelain.

Fixed partial denture: A prosthetic replacement of one or more missing teeth cemented or attached to the abutment teeth or implant abutments adjacent to the space.

Foramen: Natural opening into or through bone.


RESOURCE

157Fracture: The breaking of a part, especially of a bony structure;

breaking of a tooth.

Frenum: Muscle fi bers covered by a mucous membrane that attaches the cheek, lips, or tongue to associated dental mucosa.

Furcation: The anatomic area of a multirooted tooth where the roots diverge.

General anesthesia: A controlled state of unconsciousness, accompanied by a partial or complete loss of protective refl exes, including loss of ability to independently maintain airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method or combination thereof.

Gingiva: Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted.

Gingivectomy: The excision or removal of gingiva.

Gingivitis: Infl ammation of gingival tissue without loss of connective tissue.

Gingivoplasty: Surgical procedure to reshape gingiva.

Glass ionomer: Material in which the solid powdered phase is a fl uoride-containing glass powder. The material is translucent and can be used as a restoration, a liner, and a luting agent.

Graft: A piece of tissue or alloplastic material placed in contact with tissue to repair a defect or supplement a defi ciency.

Hemisection: Surgical separation of a multirooted tooth.

Implant: Material inserted or grafted into tissue; a device especially designed to be place surgically within or on the


RESOURCE

158

mandibular or maxillary bone as a means of providing for dental replacement.

Incisal: Pertaining to the biting edges of the incisor and cuspid teeth.

Indirect pulp cap: Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.

Indirect restoration: A restoration fabricated outside the mouth.

Inlay: An indirect intracoronal restoration; a dental restoration made outside the oral cavity to correspond to the form of the prepared cavity, which is then luted into the tooth.

Interproximal: Between the adjoining surfaces of adjacent teeth in the same arch.

Intracoronal: Referring to “within” the crown of a tooth.

Intraoral: Inside the mouth.

Intravenous sedation or analgesia: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective refl exes, and the ability to respond to stimulation or verbal commands. It includes intravenous administration of sedative or analgesic agent(s) (or both) and appropriate monitoring.

Labial: Pertaining to or around the lip.

Lesion: An injury or wound; area of diseased tissue.

Lingual: Pertaining to or around the tongue; surface of the tooth directed toward the tongue; opposite of facial.


RESOURCE

159Local anesthesia: The loss of pain sensation over a specifi c

area of the anatomy without loss of consciousness.

Maintenance, periodontal: Therapy for preserving the state of health of the periodontium.

Malignant: Having the properties of dysplasia, invasion, and metastasis.

Malocclusion: Improper alignment of biting or chewing surfaces of upper and lower teeth.

Maryland bridge: Fixed partial denture feature conservative retainers that are resin bonded to abutments.

Maxilla: The upper jaw.

Mesial: Toward the midline of the dental arch; opposite of distal.

Molar: Teeth posterior to the premolars (bicuspids) on either side of the jaw.

Mucous membrane: Lining of the oral cavity as well as other canals and cavities of the body; also called mucosa.

Nonintravenous conscious sedation: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective refl exes, and ability to respond to stimulation or verbal commands.

Occlusal: Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims.

Occlusal radiograph: An intraoral radiograph made with the fi lm being held between the occluded teeth.


RESOURCE

160

Occlusion: Any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.

Odontoplasty: Adjustment of tooth length, size, or shape; includes removal of enamel projections.

Onlay: An indirect restoration made outside the oral cavity that overlays a cusp or cusps of the tooth, which is then luted to the tooth.

Oral pathology: The specialty of dentistry and pathology concerned with recognition, diagnosis, investigation, and management of diseases of the oral cavity, jaws, and adjacent structures.

Orthognathic: Functional relationship of the maxilla and mandible.

Osteoplasty: Surgical procedure that modifi es the confi guration of bone.

Osteotomy: Surgical cutting of bone.

Overdenture: A removable prosthetic device that overlies and may be supported by retained tooth roots or implants.

Palate: The hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities.

Palliative: Action that relieves pain but is not curative.

Panoramic radiograph: An extraoral radiograph on which the maxilla and mandible are depicted on a single fi lm.

Partial denture: Usually refers to a prosthetic device that replaces missing teeth; see fi xed partial denture or removable partial denture.


RESOURCE

161Periapical radiograph: A radiograph made by the intraoral

placement of fi lm for disclosing the apices of the teeth.

Periodontal: Pertaining to the supporting and surrounding tissues of the teeth.

Periodontal disease: Infl ammatory process of the gingival tissues or periodontal membrane of the teeth, resulting in an abnormally deep gingival sulcus, possibly producing periodontal pockets and loss of supporting alveolar bone.

Periodontal pocket: Pathologically deepened gingival sulcus; a feature of periodontal disease.

Periodontitis: Infl ammation and loss of the connective tissue of the supporting or surrounding structure of teeth with loss of attachment.

Periradicular: Surrounding a portion of the root of the tooth.

Plaque: A soft, sticky substance that accumulates on teeth composed largely of bacteria and bacterial derivatives.

Pontic: An artifi cial tooth on a fi xed partial denture (bridge).

Post: An elongated projection fi tted and cemented within the prepared root canal, serving to strengthen and retain restorative material or a crown restoration.

Posterior: Refers to teeth and tissues toward the back of the mouth (distal to the canines); the maxillary and mandibular premolars and molars.

Premedication: The use of medications before dental procedures.

Primary dentition: The fi rst set of teeth; see deciduous.


RESOURCE

162

Prophylaxis: Scaling and polishing procedure performed to remove coronal plaque, calculus, and stains.

Prosthesis: Artifi cial replacement of any part of the body. A dental prosthesis is any device or appliance replacing one or more missing teeth and, if required, associated structures. (This is a broad term that includes abutment crowns and abutment inlays and onlays, bridge, dentures, obturators, and gingival prostheses.)

Prosthesis, fi xed: Nonremovable tooth or implant-borne dental prosthesis attached to abutment teeth or roots or implants.

Prosthesis, interim: A provisional prosthesis designed for use over a limited period of time, after which it will be replaced by a more defi nitive restoration.

Prosthesis, removable: Dental prosthesis designed to be removed and reinserted by the patient.

Provisional: Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.

Pulp: Connective tissue that contains blood vessels and nerve tissue that occupies the pulp cavity of a tooth.

Pulp cavity: The space within a tooth that contains the pulp.

Pulpectomy: Complete removal of vital and nonvital pulp tissue from the root canal space.

Pulpitis: Infl ammation of the dental pulp.

Pulpotomy: Surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing; pulp amputation.


RESOURCE

163Quadrant: One of the four equal sections into which the dental

arches can be divided; begins at the midline of the arch and extends distally to the last tooth.

Rebase: Process of refi tting a denture by replacing the base material.

Reline: Process of resurfacing the tissue side of a denture with new base material.

Reimplantation: The return of a tooth to its alveolus.

Removable partial denture: Prosthetic replacement of one or more missing teeth that can be removed by the patient; a removable bridge.

Retainer, orthodontic: Appliance to stabilize teeth after orthodontic treatment.

Retainer, prosthodontic: A part of a fi xed partial denture that attaches a pontic to the abutment tooth, implant abutment, or implant.

Retrograde fi lling: A method of sealing the root canal by preparing and fi lling it from the root apex.

Root: The anatomic portion of the tooth that is covered by cementum and is located in the alveolus (socket) where it is attached by periodontal ligaments.

Root canal: The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp.

Root canal therapy: The treatment of disease and injuries of the pulp and associated periradicular conditions.


RESOURCE

164

Root planing: A procedure designed to remove microbial fl ora, bacterial toxins, calculus, and diseased cementum or dentin on the root surfaces and in the pocket.

Scaling: Removal of plaque, calculus, and stains from teeth.

Splint: A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured, or traumatized.

Stomatitis: Infl ammation of the membranes of the mouth.

Study model: Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast.

Suture: Stitch used to repair incision or wound.

Temporomandibular joint (TMJ): The connecting hinge mechanism between the base of the skull (temporal bone) and the lower jaw (mandible).

Temporomandibular joint dysfunction: Abnormal functioning of the temporomandibular joint; also refers to symptoms arising in other areas secondary to the dysfunction.

Tissue conditioning: Material intended to be placed in contact with tissues for a limited period with the aim of assisting the return to a healthy condition.

Torus: A bony elevation or protuberance of bone; see exostosis.

Trismus: Restricted ability to open the mouth, usually caused by infl ammation or fi brosis of the muscles of mastication.

Unerupted: Refers to a tooth or teeth that have not penetrated the oral cavity.

Unilateral: One sided; pertaining to or affecting only one side.


RESOURCE

165Veneer: In the construction of crowns or pontics, a layer of

tooth-colored material, usually, but not limited to, composite, porcelain, ceramic, or acrylic resin, attached to the surface by direct fusion, cementation, or mechanical retention.

Vestibuloplasty: Any of a series of surgical procedures designed to increase relative alveolar ridge height.

Xerostomia: Decreased salivary secretion that produces a dry and sometimes burning sensation of the oral mucosa or cervical caries.

X-ray: A radiograph.

Spanish Terms

Medical Questions

The Spanish Terms section is reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; pp. 202–204.

What are your physician’s name and phone number?

¿Qué es el nombre de su médico y el número de teléfono?

Are you taking any medications? If so, what?

¿Toma medicina? ¿Si eso es el caso, qué?

Do you have any heart problems?

¿Tiene algúnos problemas cardíacso?

Do you have high blood pressure?

¿Tiene la hipertensión?

Do you have diabetes?

¿Tiene la diabetes?


RESOURCE

166

Do you have any allergies?

¿Tiene algunas alergias?

Are you allergic to any medications?

¿Es alérgico a medicina?

Do you have to take antibiotics before dental treatment?

¿Tiene que tomar antibióticos antes de tratamiento dental?

Have you recently been hospitalized?

¿Ha sido hospitalizado recientemente?

Dental Questions

When was your last dental visit?

¿Cuándo fue su última visita dental?

Are you having any problems with your teeth?

¿Tiene cualquier problemas con los dientes?

Do you have any pain?

¿Tiene dolor?

How often do you brush?

¿Con qué frecuencia se cepilla?

How often do you fl oss?

¿Con qué frecuencia se limpia con hilo dental?

Do your gums bleed when you brush, fl oss, or eat?

¿Sangran sus gomas cuando se cepilla, limpia con hilo dental o come?

When were your last dental x-rays?

¿Cuándo fueron sus últimas radiografías dentales?

Is there anything that you would like to discuss with the

dentist?

¿Hay algo que usted querria discutir con el dentista?


RESOURCE

167Treatment Directives

Open your mouth.

Abra la boca.

Close your mouth.

Cierre la boca.

Swish and spit.

Mueva y escupa.

Swallow.

Trague.

Close your teeth together.

Cierre los dientes juntos.

Bite down.

Muerda hacia abajo.

Chin up.

El mentón arriba.

Web References

American Dental Association http://www.ada.orgAmerican Heart Association http://www.americanheart.govCenters for Disease Control and Prevention http://www.cdc.govDental Assistant National Board http://www.danb.orgMedline Plus http://www.nlm.nih.govNational Institute for Occupational Safety and Health http://www.cdc.gov/niosh


RESOURCE

168

U.S. Department of Labor Occupational Safety and Health http://www.osha.gov

References

American Dental Association. (2011). Radiography/Xrays. Retrieved October, 18, 2011, from http://www.ada.org/prf/resources/topics/topics_radiography_chart.pdf.

American Heart Association. (2011). Endocarditis Prophylaxis Information. Retrieved June 22, 2011, from http://wwwamericanheart.org/presenter.jhtml?identifi er = 1108.

American Society of Anesthesiologists. (2009). ASA Physical Status Classifi cation System. Retrieved August 9, 2011, from http://www..asahg.org/clinical/physicalstatus.htm.

Bird, D., & Robinson, D. (2009). Modern Dental Assisting, ed 9. St Louis: Saunders Elsevier.

Brunick, A., & Clark, M. (2008). Handbook of Nitrous Oxide and Oxygen. St Louis: Mosby/Elsevier.

CDC. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(No. RR-10).

Chesnutt, I., & Gibson, J. (2002). Clinical Dentistry. Edinburgh: Harcourt Publishers Limited/Churchill Livingstone.

Dofka, C. (2007). Dental Terminology, ed 2. Thompson Delmar Learning.

F.A. Davis Company. (2009). Taber’s Cyclopedic Medical Dictionary, ed 21. Philadelphia: F.A. Davis Company.

Food and Drug Administration. Guidance for Industry and FDA Reviewers: Content and Format of Premarket Notifi cation [510(k)] Submissions for Liquid Chemical Sterilants/High Level Disinfectants. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, 2000. Available at http://www.fda.gov/cdrh/ode/397.pdf.


RESOURCE

169Grimes, E. (2009). Medical Emergencies. Upper Saddle River, NJ:

Pearson Prentice Hall.

Ianucci, J., & Jansen Howerton, L. (2006). Dental Radiography Principles and Techniques, ed 3. St Louis: Saunders.

Kohn, W.G., Collins, A.S., Cleveland, J.L., et al. (2003). Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 52(RR-17):1–61.

Little, J., Falace, D., Miller, C., & Rhodus, N. (2008). Dental Management of the Medically Compromised Patient, ed 7. St Louis: Elsevier/Mosby.

Malamed, S. (2004). Handbook of Local Anesthesia, ed 5. St Louis: Elsevier/Mosby.

Malamed, S. (2007). Medical emergencies in the Dental Offi ce, ed 6. St Louis: Elsevier/Mosby.

Mauriello, S., Overman, V., & Platin, E. (1995). Radiographic Imaging for the Dental Team. Philadelphia: J.B. Lippincott.

Miles DA, Van Dis ML, Jensen CW, et al.: Radiographic Imaging for Dental Auxiliaries, 3rd Ed. Philadelphia, W.B. Saunders, 1999.

Miller, C.H., & Palenik, C.J. (2004). Infection Control & Management of Hazardous Materials for the Dental Team, ed 3. St Louis: Mosby-Year Book; 260–275.

Mosby. (2012). Dental Drug Reference, ed 10. St Louis: Mosby.

Mosby. (2004). Spanish terminology for the Dental Team. St Louis: Mosby

Organization for Safety & Asepsis Procedures. (2004). From Policy to Practice: OSAP’s Guide to the Guidelines. Annapolis, MD: OSAP; 45–62.

Organization for Safety & Asepsis Procedures. (2005). Surface disinfectants for dentistry: tools for selecting and using surface disinfectants in dental settings. Infection Control In Practice. Vol 4:1.


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Pickett, F., & Gurenlian, J. (2010). Preventing Medical Emergencies: Use of Medical History, ed 2. Philadelphia: Lippincott Williams & Wilkins.

Turley, S. (2010). Understanding Pharmacology for Health Professionals, ed 4. Upper Saddle River, NJ: Pearson.

U.S. Department of Labor, Occupational Safety and Health Administration. (2001). 29CFR Part 1910.1030. Occupational Exposure to Bloodborne Pathogens; Needlesticks and Other Sharps Injuries; Final Rule. Fed Reg 66:5317–5325. As amended from and includes 29 CFR Part 1910.1030. U.S. Department of Labor, Occupational Safety and Health Administration. (1991). Occupational exposure to bloodborne pathogens; fi nal rule. Fed Reg 56:64174–64182. Available at http://www.osha.gov/SLTC/dentistry/index.html.

Williams & Wilkins. (1997). Stedman’s Concise Medical Dictionary for the Health Professions, ed 3.Baltimore, MD: Williams and Wilkins.


INDEX

171

INDEX

A

Abscess(es), 15–16 152Abutment, 152Acid etching, 152Acorn burnisher, 106Acute radiation exposure, 94Adhesive, 152Airway(s), obstructed, 9–10Albuterol, 24Albuterol–ipratropium, 20Alcohol-based hand wash,

77Alendronate sodium, 21Alprazolam, 25Alveolar, 152Alveolar osteitis, 16Alveoloplasty, 152Amalgam, 152Amalgam carrier, 106–107Amalgam wall, 107American Dental Assistant’s

Association (ADAA)Code of Ethics for Dental

Assistants of, 151American Society of

Anesthesiologists (ASA)classifi cation system for

physical status, 1–2Amiodipine, 23Amitriptyline HCl, 21Amlodipine–benazepril, 22Amoxicillin, 18Amphetamine/

dextroamphetamine, 18Analgesia, 152

Anesthesia/anesthetics, 45–58color coding, 48general, 157injections, 48–58local, 46–47, 159syringe, 108topical, 45–46

Angina pectoris, 10–11Anode, 89Anterior mandibular forceps,

133Anterior superior alveolar

(ASA) injection, 52Anterior teeth, 152Antibiotic prophylaxis regimen,

5Antisepsis, surgical, 77Antiseptic hand wash, 77Anxiolysis, 153Apicoectomy, 153Articaine, 47Articulating paper holder, 109Aspiration, foreign body, 13Atenolol, , 24Automated external

defi brillator, 9Avulsed tooth, 16–17Avulsion, 153Azithromycin, 25

B

Band(s), orthodontic, 145Band pusher, orthodontic, 144Benign, 153Benzocaine, 46

3822_Index_0171-0182.indd 1713822_Index_0171-0182.indd 171 9/3/2014 2:21:56 PM9/3/2014 2:21:56 PMProcess CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black

INDEX

172

Bicuspid, 153Bilateral, 153Biopsy, 153Bird beak, orthodontic, 144Bisecting technique, 99Bite, open, 45Bitewing (BW) radiograph, 97,

153Blood pressure, 6–7Blood pressure types, in adults,

7Bloodborne pathogens, 75Bonding, 153Bone fi le, 133Bracket(s), orthodontic, 145Bracket placement pliers, 145Bracket remover, 146Bridge(s), Maryland, 159Broach, 128Broken instrument, 11Broken tooth, 17Bruxism, 153Buccal, 153Buccal nerve block, 57Bupivacaine, 47Bupropion HCl, 25Buspirone, 19

C

CAB of CPR, 8Cabamazepine, 24Calculus, 153Canal, 153Cardiopulmonary resuscitation

(CPR), 8–10Caries, 153Cathode, 89Cavity, 153Cavity classifi cation, 33–35

Celecoxib, 19Cement base, 153Cement spatula, 110Cementum, 154Centers for Disease Control and

Prevention (CDC)infection control guidelines

of, 74–76Cephalometric radiograph, 101,

154Cetacaine, 46Chain of survival, 8Chairside, 26–69

anesthesia, 45–58basic principles, 67concepts, 62–69dentist positioning, 64dentition, 26–45four-handed dentistry, 62–64instrument transfer, 68motions, 65–67nitrous oxide sedation,

58–61Charting, 36Chisel, 110, 134Chlordiazepoxide, 22Citalopram, 19Clamp(s), dental dam, 113Class I occlusion, 39Class II occlusion, 40–41Class III occlusion, 41Cleft palate, 154Clenching, 154Clinical contact surfaces, 83Clopidogref, 24Clozapine, 19Code of Ethics for Dental

Assistantsof ADAA, 151


INDEX

173Color coding, 36

for anesthesia, 48for charts, 36

Composite, 154Composite instrument, 111Comprehensive evaluation,

155–156Computed tomography (CT),

101–102Condenser (plugger), 111

endodontic, 128Cone beam computed

tomography (CBCT), 101–102Coronal, 154Cotton forceps, 112Cowhorn forceps, 136Cracked tooth syndrome (CTS),

17Crossbite, 42Cryer elevators (east and west),

134Curettage, 154Cyst(s), 154

D

Debridement, 154Decay, 154Deciduous, 154Deciduous dentition, 26Dental abbreviations, 37–39Dental dam clamps, 113Dental dam forceps, 114Dental dam frame, 114Dental dam punch, 115Dental emergencies, 15–17Dental prophylaxis, 155Dental radiographs.

bisecting technique, 99BW, 97

cephalometric, 101exposing techniques, 98–100extraoral series, 100–102FMX, 97intraoral series, 97–100occlusal technique, 100PA, 97panoramic, 100–101paralleling technique, 98types of, 97–102

Dental terminology, 152–165Dentin, 155Dentition, 26–45

cavity classifi cation, 33–35charting, 36deciduous, 26defi ned, 155dental abbreviations, 37–39misalignment/malocclusion,

42–45occlusion, 39–41permanent, 27primary, 31, 161tooth eruption tables, 26–27tooth numbering, 28–32tooth surface abbreviations,

36Denture, 155, 160, 163Denture base, 155Diabetic emergency, 11–12Diagnostic cast, 155Diastema, 155Diazepine, 25Digital radiography, 102–104Dipyridamole–ASA, 18Direct restoration, 155Discoid-cleoid, 115Displaced tooth, 155Distal, 155


INDEX

174

Distal end cutter, orthodontic, 146

Doxazosyn mesylate, 19Dry socket, 16, 155

E

Edentulous, 155Elastic placement pliers,

orthodontic, 147Emergency kit, 2–3Emergency preparedness,

1–10antibiotic prophylaxis

regimen, 5ASA classifi cation system,

1–2chain of survival, 8CPR, 8–10dental emergencies, 15–17emergency kit, 2–3medical emergencies, 10–15premedication guidelines,

3–4vital signs, 5–8

Enamel, 155End to end, 43Endodontic instruments,

128–132broach, 128condenser (plugger), 128explorer, 129fi le (K-type), 130Gates Gidden, 131Gutta-Percha, 131paper points, 132sodium hydrochloride

springs, 132spreader, 129stand, 130

Enoxaparin sodium, 22Environmental surfaces

infection control related to, 82–84

Epinephrine, lidocaine with, 47

Eszopiclone, 22Etanercept, 21Ethinyl estradiol–desogestrel,

23Ethinyl estradiol–norethindrone,

23Etodolac, 22Evaluation(s), 155–156Excision, 156Exostosis, 156Explorer, 116, 129Extraoral, 156Extraoral x-ray unit, 90Exudate, 156

F

Face shield, infection control, 78

Facial, 156Fainting, 12–13Famotidine, 23Fentanyl (transdermal), 21Fexoenadine HCl, 18File(s)

bone, 133K-type, 130

Filling, 156Fixed partial denture, 156Fixed prosthesis, 162Fluconazole, 20Fluoxetine, 24Fluvoxamine maleate, 22Foramen, 156


INDEX

175Forceps

anterior mandibular, 133cotton, 112dental dam, 114mandibular molar universal

(Cowhorn), 136mandibular universal (151),

136maxillary left (88L), 137maxillary right (88R), 137maxillary universal (150), 138

Foreign body aspiration, 13Four-handed dentistry, 62–64Fracture, 157Frenum, 157Friction grip burs, 121–127

diamond, 121fi ssure: cross-cut straight, 122fi ssure: cross-cut tapered, 123fi ssure: plain straight, 124fi ssure: plain tapered, 125inverted cone, 126pear shape, 127round, 127

Full-mouth survey (FMX), 97Furcation, 157Furosemide, 22

G

Gabapentin, 23Gates Gidden, 131General anesthesia, 157Gingival margin trimmer, 116

157Gingivectomy, 157Gingivitis, 157Gingivoplasty, 157Glass ionomer, 157Gloves, infection control, 79–82

Graft, 157Greater palatine block, 53Gutta-Percha, 131

H

Haloperidol, 21Hand hygiene, 76–77Hand washing, 77Hatchet, 117Heimlich maneuver, 9–10Hemisection, 157Hemostat, 135Hoe, 117Hollenback carver, 118Hydrocortisone, 20Hydromorphone, 21Hyperventilation, 13–14

I

Ibandronate, 19Ibuprofen, 18Imipramine HCl, 25Implant, 157–158Incisal, 158Indirect digital imaging, 103Indirect pulp cap, 158Indirect restoration, 158Infection(s), chain of, 74Infection control, 70–84

bloodborne pathogens, 75CDC guidelines for, 74–76clinical contact surfaces–

related, 83environmental surfaces–

related, 82–84exposure prevention

strategies in, 75hand hygiene in, 76–77instruments and, 70–73


INDEX

176

classifi cation based on need for, 70

medical waste management in, 84

personal protective equipment (PPE) in, 78–84.

postexposure management program in, 75–76

program evaluation, 84radiography-related, 104–105standard precautions, 74–75water lines–related, 83–84

Inferior alveolar nerve block, 56Injection(s), 48–58

mandibular, 55–58.maxillary, 49–58.preparation for, 48types of, 49–58

Inlay 158Instrument(s), 106–150

acorn burnisher, 106amalgam carrier, 106–107amalgam wall, 107anesthetic syringe, 108articulating paper holder, 109broken, 11cement spatula, 110chisel, 110composite, 111condenser, 111cotton forceps, 112dental dam clamps, 113dental dam frame, 114dental dam punch, 115discoid-cleoid, 115endodontic, 128–132.

explorer, 116friction grip burs, 121–127general dentistry, 106–120

gingival margin trimmer, 116hatchet, 117hoe, 117Hollenback carver, 118in infection control, 70–73

classifi cation based on need for infection control, 70

liner placement, 118matrix band retainer

(Toffl emire), 119mouth mirror, 119oral surgery, 133–143orthodontic, 144–150periodontal probe, 120spoon excavator, 120sterilization of, 71–73transfer of, 68

Interim prosthesis, 162Interproximal, 158Intracoronal, 158Intraoral, 158Intraoral x-ray unit, components

of, 87–89Intravenous sedation/analgesia,

158Isosorbide dinitrate, 22

K

K-type fi le, 130Kells, E., 85

L

Labial, 158Lamotrigine, 22Lesion 158Levonordefrin, 47Levonorgestrel–ethinyl

estradiol, 25


INDEX

177Lidocaine, 46, 47Ligature-tying pliers,

orthodontic, 148Limited oral evaluation, 156Liner placement instrument,

118Lingual, 158Local anesthetics, 46–47, 159Loracarbef, 22Loratadine, 19Lorazepam, 18Losartan–hydrochlorothiazide,

21Lovastatin, 23

M

Maintenance, periodontal, 159

Malignant, 159Mallet, 134Malocclusion, 42–45, 159Mandibular injections, 55–58

buccal nerve block, 57inferior alveolar nerve block,

56mental nerve block, 58

Mandibular molar universal forceps (Cowhorn), 136

Mandibular universal forceps (151), 136

Maryland bridge 159Mask(s), in infection control,

78Matrix band retainer

(Toffl emire), 119Maxilla, 159Maxillary injections, 49–5

ASA, 52greater palatine block, 53

MSA, 51nasopalatine block, 54PSA, 50

Maxillary left forceps (88L), 137

Maxillary right forceps (88R), 137

Maxillary universal forceps (150), 138

Medical emergencies, 10–15Medical waste management, in

infection control, 84Medication(s), 18–25Mental nerve block, 58Meperidine, 20Mepivicaine with levonordefrin,

47Mesial, 159Methylprednisolone, 22Methylprenidate HCl, 20Metoprolol, 22Midazolam, 25Middle superior alveolar (MSA)

injection, 51Mirror, mouth, 119Misalignment, 42–45Molar, 159Motion(s), in chairside

dentistry, 65–67Mouth, medications effects on,

18–25Mouth mirror, 119Mouth props, 138Mucous membrane,

159

N

Nasopalatine block, 54Needle holder, 139


INDEX

178

Nerve block(s)buccal, 57inferior alveolar, 56mental, 58

Nitrous oxide sedation, 58–61complications of, 61contraindications to, 59indications for, 59medical assessment of

patient prior to, 59–60medical emergencies

associated with, 61pharmacological and

physiological effects of, 60–61

Nonintravenous conscious sedation, 159

Norethindrone–ethinyl estradiol, 23

Nortriptyline HCl, 23

O

Obstructed airway management ,9–10

Occlusal, 159Occlusal radiographs, 159Occlusion, 39–41, 160Odontogenic cyst, 154Odontoplasty, 160Olopatidine HCl, 23Onlay, 160Open bite, 45Oral pathology, 160Oral surgery instruments,

133–143anterior mandibular forceps,

133bone fi le, 133chisel, 134

Cryer elevators (east and west), 134

hemostat, 135mallet, 134mandibular molar universal

forceps, 136mandibular universal forceps

(151), 136maxillary left forceps (88L),

137maxillary right forceps (88R),

137maxillary universal forceps

(150), 138mouth props, 138needle holder, 139periosteal elevator, 139rongeurs, 140root tip picks, 140scalpel handle with blades,

141straight elevator, 141surgical curette, 142suture scissors, 142tissue scissors, 143

Oraqix, 46Orthodontic instruments,

144–150band(s), 145band pusher, 144bird beak, 144bracket placement pliers, 145bracket remover, 146brackets, 145distal end cutter, 146elastic placement pliers, 147ligature-tying pliers, 148three-prong bender, 148Weingart pliers, 149


INDEX

179wire, 149wire cutter, 150

Orthodontic retainer, 163Orthognathic, 160Osteitis, alveolar, 16Osteoplasty, 160Osteotomy, 160Overbite, 44Overdenture, 160Overjet, 44Oxazepam, 24Oxcarbazepine, 25Oxycodone, 23Oxycodone–acetaminophen,

21

P

Palate, 160Palliative, 160Palm grasp, instrument-related,

68Palm/thumb grasp, instrument-

related, 69Palmer notation system, in

tooth numbering, 32Panoramic radiograph, 100–101,

160Pantoprazole, 24Paper points, endodontic, 132Paralleling technique, in

intraoral radiography, 98Paroxetine, dental effects of, 23Partial denture, 160, 163Pen grasp, 68Penciclovir, 20Penicillin, 24Penicillin–clavulanate, 18Periapical (PA) abscess, 152Periapical (PA) cyst, 154

Periapical (PA) radiograph, 97, 161

Periodic oral evaluation, 156Periodontal, 161Periodontal abscess, 15, 152Periodontal disease, 161Periodontal maintenance, 159Periodontal pocket, 161Periodontal probe, 120Periodontitis, 161Periosteal elevator, 139Periradicular, 161Permanent dentition, 27Personal protective equipment

(PPE), 78–82Phenytoin sodium, 21Plaque, 161Pliers

bracket placement, 145elastic placement, 147ligature-tying, 148Weingart, 149

Pontic, 161Positioning in chairside

dentistry, 64Post, 161Posterior, 161Posterior superior alveolar

(PSA) injection, 50Pramipexole dihydrochloride,

23Prednisone, 20Pregabalin, 22Premedication, 161Premedication guidelines, 3–4Prilocaine, 47Primary dentition, 31, 161Probe, periodontal, 120Prophylaxis, 162


INDEX

180

Propoxyphene–acetaminophen, 20

Propranolol HCl, 21Prosthesis(es), 162Prosthodontic retainer, 163Provisional, 162Pulp cavity, 162Pulpectomy, 162Pulpitis, 162Pulpotomy, 162Pulse rate, 7

Q

Quadrant, 163Quetiapine, 24Quinapril, 18

R

Rabeprazole, 18Radiation exposure

acute, 94chronic, 95maximum permissible dose,

95operator protection from, 96patient protection from, 95

Radiograph(s). See specifi c types

Radiographic beam characteristics, 93–94

Radiology, 85–105dental radiographs, 97–102.digital, 102–104.equipment, 87–93

duplicating-related, 91–92extraoral x-ray unit, 90intraoral x-ray unit, 87–89x-ray processor, 90–91

errors due to, 96

extraoral, 86fi lm types, 92–93history of, 85infection control sites, 104–105intraoral, 85introduction to, 85–86radiation effects, 94–96radiographic beam

characteristics, 93–94types of, 85–86uses of, 85

Rebase, 163Reimplantation, 163Reline, 163Removable partial denture,

163Removable prosthesis, 162Respiration, 7–8Restoration, 155, 158Resuscitation, cardiopulmonary,

8–10.Retainer(s), 163Retrograde fi lling, 163Reverse Towne projection, 101Ritonavir, 23Roentgen, W.C., 85Rongeurs, 140Root, 163Root canal, 163Root canal therapy, 163Root planing, 164Root tip picks, 140Ropinirole, 24

S

Salmeterol, 24Scaling, 164Scalpel handle with blades, 141Scissors, 142–143


INDEX

181Sedation

nitrous oxide, 58–61nonintravenous conscious,

159Seizures, 14–15Sodium hydrochloride springs,

132Spanish terms, 165–167Spatula(s), cement, 110Spironolactone, 18Splint, 164Spoon excavator, 120Spreader, endodontic, 129Stand, endodontic, 130Steam autoclave, 71–72Sterile glove donning

technique, 79–82Sterilization, instrument, 71–73Stomatitis, 164Storage phosphor imaging, 103Straight elevator, 141Study model, 164Submentovertex projection, 101Sumatriptan, 21Surgical antisepsis, 77Surgical curette, 142Suture, 164Suture scissors, 142Syncope, 12–13

T

Tadalafi l, 19Temazepam, 24Temporomandibular joint

(TMJ), 164Terminology, 152–165Three-prong bender,

orthodontic, 148Timolol malate, 24

Tissue conditioning, 164Tissue scissors, 143Toffl emire retainer, 119Tolterodine, 20Tooth (teeth)

anterior, 152avulsed, 16–17broken, 17displaced, 155medication effects on, 18–25

Tooth eruption tables, 26–27Tooth numbering, 28–32

Palmer notation system, 32universal system, 28–31

Tooth surface abbreviations, 36

Topical anesthetics, 45–46Topiramate, 25Torus, 164Tramalol, 25Trazodone, 20Triazolam, 21Trismus, 164

U

Unerupted, 164Unilateral, 164Universal system, 28–31

permanent dentition, 29–30primary dentition, 31

V

Valproic acid, 20Vasovagal episode, 12–13Veneer, 165Ventafaxine HCl, 21Verapamil HCl, 19Vestibuloplasty, 165Vital signs, 5–8


INDEX

182

X

X-ray, 165X-ray processor, 90–91

Z

Zidovudine, 19Zolpidem tartrate, 18

W

Warfarin, 20Water lines, 83–84Water supply, contamination of,

83–84Waters projection, 101Web references, 167–168Weingart pliers, 149Wire(s), orthodontic, 149Wire cutter, orthodontic, 150
