dental clinic
DESCRIPTION
dentistryTRANSCRIPT
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A-Dental Clinic design
Reception area
Administrative area
Treatment area: Dental operatory
Sterilization area Sterilization area
Dental laboratory
Dentists private office
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B- clinical equipments
patient dental chairs
Dental unit
Operator and assistant stools
Dental Operating Lights Dental Operating Lights
Dental unit waterlines
Oral evacuation system
compressors
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patient dental chairs
stable base and lift mechanism (hydraulic type is quieter than screwstable base and lift mechanism (hydraulic type is quieter than screwdrive type)Seamless and removable upholstery for easy cleaning/repair (allvinyl is recommended, because it can withstand disinfectionprocedures)Adjustable headrest for patient comfort and operator visibilityErgonomic contoured designMovable armrests for easy patient access and wheelchair transfersAuto preset positioning and auto return with safety stopFoot controls or a touch pad to adjust the chair position
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Dental unit
Types of dental unit delivery system
1-Over-the-Patient Delivery
2-Rear Delivery
3-Side Delivery3-Side Delivery
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Dental unit
1-Over-the-Patient Delivery
Advantages The most ergonomically-
sound system for the dentist
Easily converts to left-handed or right-handedMoves up or down with
Disadvantages The most visible system to
patients in terms of seeing the instruments
Is very confining for patients Patients may bump into unit
if they rise up suddenlyNot generally recommended Moves up or down with
the chair to maintain a constant relationship
Provides the most practical use of space
Allows dentist and assistant to handle instruments and switches
Allows the dentist to release the handpiecewithout looking up
if they rise up suddenly Not generally recommended
for treating children or patients with conditions that result in aggressive behavior or unpredictable movements
Patient's feet can get tangled in the handpiece cords
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Dental unit
Advantages Least expensive system and
easily combinable with an assistant cart for little additional expense
Easily converts to left-handed or right-handed
The least-visible system for patients
Disadvantages Ergonomically less sound for
the dentist, who must twist to reach handpieces or instruments
Places the dentist at increased risk for sharps injuries from dental burs, due to the location of the handpiece holder near the dentist's forearm
2-Rear Delivery
patients Easy patient access to dental
chair Allows handpieces to be
transferred and burs to be changed by the assistant
Easy to connect to in-wall utilities
dentist's forearm Cords can become tangled and
difficult to position for efficient use
Requires two entries to operatory--one for the dentist, and one for the assistant
Makes working alone or standing up difficult for the dentist
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Dental unit
Advantages
Provides easy patient access to chair
Less confining to patients
Easy to connect to in-wall utilities
Disadvantages
3-Side Delivery
Disadvantages
Most do not convert to left-handed and right-handed
Handpieces inaccessible to assistant, so dentist must change burs
Ergonomically less sound for the dentist, who must twist to reach for handpieces or instruments
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Dental Operating Lights
Wall mounted Dental unit
mounted
Ceiling hung
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LEDs offer many advantages over traditional halogen
bulbsbulbs
lower energy
longer life 12-25 year life compared to 3-6 months,
brighter than halogen products
No heat in the beam, for dentist &patient comfort.
The cooler temperature also means no premature curing
during restorations, allowing you to provide the highest
quality of care to your patients
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A-Compressed Air
Compressed air is used throughout the office to
propel handpieces, dry teeth, clean out hand-
held instruments before sterilization, and to do
lab work. The compressor is most often located lab work. The compressor is most often located
in the dental mechanical room. Supply lines are
typically fabricated of 1/2" copper pipe.
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B-Electricity
Electricity powers:1-the chair itself2-chair-mounted accessories like the dental light
and fiber optic lights on the handpieces.and fiber optic lights on the handpieces.3-X-ray equipment, X-ray view boxes, cabinetry,
and smaller instruments and accessories.4-If the dentist has chairside computers, a
dedicated electrical circuit with surgesuppression is usually installed
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D-Dental Vacuum
A dental vacuum system ("suction") collects waste gases,liquids, solids, and debris from the mouth. The centralvacuum pump, found in the mechanical room, draws thewaste material into a main trunk line of 1"-2 diameter.Once the waste reaches the treatment room, liquidsdrain into the sanitary sewer system and gases aredrain into the sanitary sewer system and gases areexhausted to the outside of the building.
E-DrainIf a cuspidor is used, a drain line must be provided forwastewater. Drain wastewater flows into the main sewerline.
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Dental Handpiece
Low-Speed Handpiece
Speed ranges from 10,000 to 30,000 rotations per
minute (rpm).
Straight in appearance.
Straight attachment receives a long-shank Straight attachment receives a long-shank
laboratory bur
Contra-angle attachment receives latch type
rotary instruments and mandrel.
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High-Speed Handpiece
Operates from air pressure.
Operates at speeds up to 450,000 rpm.
Maintains a water-coolant system. Maintains a water-coolant system.
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C-Dental Radiology
the kilovoltage range for most
dental x-ray machines: 65 to
100 kV
milliamperage range for dental milliamperage range for dental
radiography:7 to 15 mA
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Filter Absorbing material, usually aluminum,placed in the path of the beam of radiation toplaced in the path of the beam of radiation toremove a high percentage of the low energy(longer wavelength) x-rays.. they are addedfiltration, Inherent filtration, and Total filtration.
Collimator A diaphragm, usually lead, designedto restrict the dimensions of the useful beam. toan appropriate size. Intraoral beam diameter iscollimated to 2 3/4 in. (7 cm) at the skin surface.
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Types of X-Rays
Intraoral Radiographs
Extraoral Radiographs
Digital RadiographsDigital Radiographs
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X-ray Generator - alternating Current(AC) versus
Constant potential (DC):
constant potential units typically operate at 60 or 65 Kv
compared to the 70 kVp of an alternating unit
Constant potential units (DC) produce lowercontrast conventional films compared to AC
Constant potential units (DC) produce lowercontrast conventional films compared to ACunits at any given kVp, but these units typicallyoperate at a slightly lower kV than AC units,which decreases this difference. Constantpotential units may reduce patient exposureslightly and may produce more consistentexposures at the very short exposure timesassociated with digital radiography
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Intraoral Radiographs
Periapical X-rays Bite-wing X-ray Occlusal X-ray
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Extraoral Radiographs Panoramic X-rays requires a special machine. The
tube head that emits the X-rays circles behind
your head while the film circles across the front.
That way, the full, broad view of the jaws is
captured on one film. Devices attached to the X-
ray machine hold your head and jaw in place. theray machine hold your head and jaw in place. the
process is very safe. It often uses less radiation
than intraoral X-rays.
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Cephalometric projectionsare X-rays taken of the
entire side of the head. They are used to look at
the teeth in relation to the jaw and the person's
profile. Orthodontists use cephalometric
projections to determine the best type of
orthodontic treatment.orthodontic treatment.
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Cone-beam computed tomography (CBCT)
provides three-dimensional images. You stand or sitwhile the machine rotates around your head. Thebeam is cone-shaped, instead of fan-shaped as in astandard medical CT. It uses less radiation than amedical CT scan but far more than any standarddental X-ray. CBCT is particularly useful for dentalimplant selection and placement.implant selection and placement.
. A major advantage of CT is its ability to imagebone and soft tissue at the same time
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Standard computed tomography (CT) usually
must be done in a radiologist's office or a
hospital.The radiation exposure is higher for this
type of CT than for a cone-beam CT. A standard
CT scan may be done to determine size and
placement location for implants.
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Digital Radiographs
one of the newest X-ray techniques. Standard X-ray
film is replaced with a flat electronic pad or sensor.
The image goes into a computer, where it can be
viewed on a screen, stored or printed out. Digital X-
rays taken at different times can be compared using arays taken at different times can be compared using a
process that highlights differences between the
images. Tiny changes therefore can be caught earlier.
Used properly, digital X-rays use about half the
radiation of conventional film.
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Radiation dose and protection
The dosage of X-ray radiation received by a
dental patient is typically small (around
0.150 mSv for a full mouth series, according to
ADA website), equivalent to a few days' worthADA website), equivalent to a few days' worth
of background environmental radiation
exposure
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For pregnant dental personnel, the radiationexposure limit is 0.5 mSv per month.
Individual doses in basic dental radiography (intra-oral, panoramic and cephalometric) are low.
Individual doses from more complex imaging (CTscans and multiple slice cross-sectionaltomography) can be substantially higher
Individual risks in dental radiography are small butare greater in the younger age groups (below 30years)
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Protection of Staff
lead apron must always be provided to any person,
whether a member of staff or a family member/member of
the public, who holds or supports a patient during a dental
X-ray.
By ensuring that operators of X-ray units adhere to safe By ensuring that operators of X-ray units adhere to safe
working practices, e.g. by remaining at a distance of at least
2 m from the patients head during exposures and not
standing in the path of the primary beam, they will not be
exposed to any risks from the routine operation of the
units. If the room is too small the operator should stand
behind a protective screen or outside the examination
room.
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Sterilization and Disinfection
of Patient Care Items
Critical items
Penetrate soft tissue or contact bone (e.g. all surgical instruments,
periodontal scalers, etc.) Cleaning followed by , sterilization
Semi-critical items
Contact mucous membranes or non-intact skin (e.g. mouth
mirrors amalgam condensers, reusable impression trays,
handpieces, etc.) Cleaning followed by, sterilization*
Non-critical items Contact intact skin, but not mucous
membranes, or do not directly contact the patient (e.g.
radiograph head/cone, blood pressure cuff, facebow, pulse
oximeter, etc. Cleaning followed by low-level disinfection
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The instrument processing area
should have clear separation of clean and dirty
areas with separate sections for:
receiving, cleaning and decontamination;
preparation and packaging; preparation and packaging;
sterilization;
storage
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Sterilization
Heat-tolerant instruments are usually sterilized by
A-steam under pressure (i.e. autoclaving),
B- Unsaturated chemical vapor
C-dry heat C-dry heat
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A-steam under pressure (autoclaving)
There are three types of steam sterilizers based on how
air leaves the unit.
1-gravity displacement (performs type N cycles),
2-vacuum assisted (performs type B cycles)2-vacuum assisted (performs type B cycles)
3- positive steam flush with pressure pulses (performs
type S cycles
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B-chemical vapor sterilizers
Unsaturated chemical vapor sterilizers (Harvey
sterilizer or Chemiclave) use a special chemical
solution instead of water to generate a killing
vapor. Operational conditions are 132C/270F vapor. Operational conditions are 132C/270F
with a pressure of 172 kPa/25 psi for 20
minutes.
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C-Dry heat sterilization
Involves heating of air and then transferring heat
energy to instruments. The process requires
temperatures higher than steam or unsaturated
chemical vapor sterilizers. Operational chemical vapor sterilizers. Operational
temperatures vary from 160C to 190C
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Plasma Low Temperature Sterilization
with Vaporized Hydrogen Peroxide
low temp sterilizer (PlazMax) that
provides an efficient sterilization for heat
& moisture sensitive equipment& moisture sensitive equipment
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Management of Contaminated Dental
Unit Waterlines
Dental unit waterlines (DUWL) are colonised by
bacteria derived from the incoming mains water
and to a lesser extent by oral bacteria that enter
the waterlines via suck back through the the waterlines via suck back through the
handpiece
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Methods used to reduce biofilm
formation
1-Anti-retraction valves and flushing
Most dental unit waterlines incorporate anti-retractionvalves to prevent back-siphonage up stream into thesurgery plumbingsurgery plumbing
An integral component of airturbine handpieces. Inthe handpieces the valve reduces suck back of fluidsfrom the oral cavity.
Flushing the waterlines for 2 minutes at the start ofthe day and for 20-30 seconds between patientsreduces the bacterial count by approximately 97%