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Dental Assisting Notes - Dental Assistant's Chairside Pocket Guide PDF
Dental Assisting Notes - Dental Assistant's Chairside Pocket Guide PDF
Davis Company
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Dental Assisting
Notes
Dental Assistant’s Chairside Pocket Guide
Minas Sarakinakis
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.
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 scientific 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.
√HIPAA Compliant
√OSHA Compliant
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ASA I
■ Patient is healthy.
■ Patient can either climb two flights of stairs or walk for two
city blocks without experiencing any shortness of breath.
ASA II
ASA III
ASA IV
EMERG
ASA V
Emergency Kit
Every dental office should maintain a custom designed emer-
gency kit ready for use that is easily accessible and portable.
Each emergency kit in a dental office 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 beneficial 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.
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)
■ Artificial 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 first 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
Vital Signs
In dentistry, pulse, respiration, and blood pressure are routinely
taken to assess the patient’s health before treatment.
EMERG
Blood Pressure
Pulse Rate
A 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.)
Respiration
During 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
CPR
EMERG
Medical Emergencies
Most medical emergencies can be prevented from happening in
a dental office 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 office 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 office.
Symptoms & Signs
■ Chest pain
■ High blood pressure
■ High pulse
■ Nausea
■ Pain radiating to shoulder or even to lower jaw
10
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 office 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.
Hypoglycemia
Hypoglycemia or insulin shock occurs when blood glucose levels
drop significantly.
Symptoms & Signs
■ Fast onset
■ Irritability
EMERG
■ 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.
Hyperglycemia
Hyperglycemia is less likely to occur in a dental office 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 significantly 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.
12
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
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 & Signs
Because 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 floor.
14
Dental Emergencies
Management procedures described in the following are to be
performed only by licensed dentists or, in some cases, by dental
hygienists.
Abscess
Periodontal
Symptoms & 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 Related
Symptoms & 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
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 Tooth
Symptoms & 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.
16
EMERG
YellowProcess Black
Adderall Amphetamine/dextro- Dry mouth/Monitor vital signs, keep
amphetamine appointments short
Process YellowProcess
18
Advil Ibuprofen Potential postoperative bleeding
Aggrenox Dipyridamole–ASA Contact physician before performing a procedure
in which bleeding is expected
Aldactone Spironolactone Dry mouth
MagentaProcess
Allegra Fexofenadine HCl Dry mouth
Ambien Zolpidem tartrate Dry mouth
3822_Tab 2_0018-0025.indd 18
CyanProcess Magenta
Amoxil Amoxicillin Compromised contraception
Ativan Lorazepam Dry mouth
Augmentin Penicillin–clavulanate Candida, compromised contraception
Process CyanProcess
MEDS
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
AZT Zidovudine Bleeding of the gums
Boniva Ibandronate Potential necrosis of jaw bone
YellowProcess Black
Buspar Buspirone Dry mouth
Calan Verapamil HCl Dry mouth/Monitor vital signs, provide a
Process YellowProcess
stress-free appointment
19
MagentaProcess
Cialis Tadalafil Dry mouth
3822_Tab 2_0018-0025.indd 19
Claritin Loratadine Dry mouth
CyanProcess Magenta
MEDS
Clozaril Clozapine Dry mouth
Continued
Process CyanProcess
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Combivent Albuterol–ipratropium Dry mouth, teeth may appear discolored
Concerta Methylphenidate HCl Dry mouth/Use vasoconstrictors with caution
Cortef Hydrocortisone Candida
YellowProcess Black
Coumadin Warfarin Contact physician before performing a procedure
in which bleeding is expected
Process YellowProcess
20
Darvocet Propoxyphene– Stomatitis
acetaminophen
Deltasone Prednisone Delayed healing, Candida
Demerol Meperidine Hypotension (postural)
MagentaProcess
Denavir Penciclovir Affects taste
Depakote Valproic Acid Dry mouth
3822_Tab 2_0018-0025.indd 20
CyanProcess Magenta
MEDS
Process CyanProcess
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Dilantin Phenytoin sodium Gingival hyperplasia
Dilaudid Hydromorphone Dry mouth
Duragesic Fentanyl (transdermal) Hypotension, dry mouth
Effexor Venlafaxine HCl Dry mouth
YellowProcess Black
Elavil Amitriptyline HCL Dry mouth, hypotension/Do not use
Process YellowProcess
vasoconstrictors
21
MagentaProcess
Halcion Triazolam Dry mouth, stomatitis
Haldol Haloperidol Dry mouth
3822_Tab 2_0018-0025.indd 21
Hyzaar Losartan–hydrochlorothiazide Dry mouth
CyanProcess Magenta
MEDS
Imitrex Sumatriptan Dry mouth
Inderal Propranolol HCL Dry mouth
Process CyanProcess
Continued
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Isordil Isosorbide dinitrate Hypotension
Lamictal Lamotrigine Dry mouth
Lasix Furosemide Dry mouth, hypotension
YellowProcess Black
Librium Chlordiazepoxide Dry mouth, sometimes coated tongue is noted
Lodine Etodolac Dry mouth
Process YellowProcess
22
Lopressor Metoprolol Dry mouth
Lorabid Loracarbef Candida, affects contraceptive measures
Lotrel Amlodipine–benazepril Dry mouth, gingival hyperplasia
Lovenox Enoxaparin sodium Contact physician before performing a procedure
MagentaProcess
in which bleeding is expected
Lunesta Eszopiclone Dry mouth
3822_Tab 2_0018-0025.indd 22
CyanProcess Magenta
MEDS
Process CyanProcess
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Mevacor Lovastatin Dry mouth, hypotension
Mirapex Pramipexole dihydrochloride Dry mouth
Mircette Ethinyl estradiol–desogestrel Gingival changes
Necon Ethinyl estradiol– Gingival changes
YellowProcess Black
norethindrone
Neurontin Gabapentin Dry mouth
Process YellowProcess
23
MagentaProcess
OxyContin Oxycodone Dry mouth, hypotension
Pamelor Nortriptyline HCl Hypotension/Do not use vasoconstrictors
3822_Tab 2_0018-0025.indd 23
CyanProcess Magenta
MEDS
Patanol Olopatadine HCl Dry mouth
Paxil Paroxetine Dry mouth
Pepcid Famotidine Dry mouth
Process CyanProcess
Continued
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Penicillin VK Penicillin Candida, hairy tongue, reduces contraceptive
action
Plavix Clopidogrel Contact physician before performing a procedure
in which bleeding is expected
YellowProcess Black
Protonix Pantoprazole Excessive salivation
Proventil Albuterol Dry mouth, teeth discoloration
Process YellowProcess
24
Prozac Fluoxetine Dry mouth, hypotension
Requip Ropinirole Dry mouth, hypotension
Restoril Temazepam Dry mouth, taste alterations
Serax Oxazepam Dry mouth, coated tongue
MagentaProcess
Serevent Salmeterol Candida
3822_Tab 2_0018-0025.indd 24
Seroquel Quetiapine Dry mouth
CyanProcess Magenta
MEDS
Process CyanProcess
Timoptic Timolol malate Dry mouth
9/3/2014 2:22:00 PM
Commonly Prescribed Medications That Affect the Mouth
and Teeth—cont’d
Trade Name Generic Name Dental Effects/Management
Trivora-28 Levonorgestrel–ethinyl Gingival changes
estradiol
Tofranil Imipramine HCL Dry mouth, hypotension/Do not use
vasoconstrictors
YellowProcess Black
Topamax Topiramate Dry mouth
Trileptal Oxcarbazepine Dry mouth
Process YellowProcess
25
MagentaProcess
Xanax Alprazolam Dry mouth
3822_Tab 2_0018-0025.indd 25
Zithromax Azithromycin Candida, hairy tongue, reduces contraceptive
CyanProcess Magenta
MEDS
action
Zomig Zolmitriptan Affects taste
Zyprexa Olanzapine Dry mouth, hypotension
Process CyanProcess
The medications in green are those often prescribed by dentists. Text in red indicates implications for the dental visit.
CHAIR-
SIDE
Dentition
Tooth Eruption Tables
26
CHAIR-
SIDE
Tooth Numbering
Tooth numbering systems provide a consistent method for iden-
tifying teeth for charting and descriptive purposes.
Universal System
Permanent dentition Maxillary
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
A B C D E F G H I J
Primary Maxillary
dentition
Mandibular
T S R Q PO N M L K
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Permanent dentition Mandibular
28
CHAIR-
SIDE
Universal System
(Permanent Dentition)—cont’d
Tooth Number Tooth Name
25 Mandibular right central incisor
26 Mandibular right lateral incisor
27 Mandibular right canine
28 Mandibular right first premolar
29 Mandibular right second premolar
30 Mandibular right first 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 finish at the lower
right third molar as #32.
30
CHAIR-
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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
E┐ D┐ C┐ B┐ A┐ ┌A ┌B ┌C ┌D ┌E
32
Class II
■ Interproximal caries in posterior teeth (mesial, distal)
CHAIR-
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Class III
■ Interproximal caries in anterior teeth with no incisal edge
involvement
Class IV
■ Interproximal caries in anterior teeth with incisal edge
involvement
34
Class VI
■ Caries on incisal edge of anterior teeth or cusps of posterior
teeth due to defects
CHAIR-
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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
36
Continued
CHAIR-
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Dental Abbreviations—cont’d
Abbreviation Meaning
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-inflammatory drugs
PA Periapical radiograph
PANO Panoramic radiograph
Perm Permanent
PFM Porcelain fused to metal crown
PFS Pits and fissure sealants
PLD Partial lower denture
Pre-Med Premedication
PRN As needed
PSR Periodontal Screening Record
PUD Partial upper denture
Px Prognosis
38
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 Relationship
Class I occlusion molar relationship is defined as the type of
occlusion in which the mesiobuccal cusp of the maxillary first
molar contacts the buccal grove of the mandibular first molar.
Class I Occlusion Canine Relationship
Class I occlusion canine relationship is defined 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
first premolar.
CHAIR-
SIDE
40
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.
Crossbite
Ideally, 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.
42
CHAIR-
SIDE
Overbite
An excessive overlap in a vertical direction between maxillary
and mandibular incisors.
Overbite
Overjet
An excessively buccal positioning of the maxillary incisors in
relation to mandibular incisors.
Overjet
44
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 reflex
■ Before suture removal or removal of loosely attached
primary teeth
CHAIR-
SIDE
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)
46
CHAIR-
SIDE
48
Maxillary Injections
Ophthalmic
Maxillary nerve
nerve
Trigeminal
ganglion
Anterior superior
alveolar nerve
Middle
superior
alveolar
nerve
Posterior
superior
alveolar
nerve
Dental plexus
Mandibular
nerve
CHAIR-
SIDE
50
CHAIR-
SIDE
52
CHAIR-
SIDE
Nasopalatine Block
■ Block injection.
■ Anterior portion of hard palate between canines.
■ Use a 27-gauge short needle.
54
Lingual nerve
Mylohyoid nerve
CHAIR-
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56
CHAIR-
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58
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 first 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 fibrosis of the lungs is often found
■ Patients with sickle cell anemia
■ Patients who have congestive heart failure (CHF)
CHAIR-
SIDE
60
CHAIR-
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Chairside Concepts
Four-Handed Dentistry
■ Minimizes stress and fatigue for dentist and assistant.
■ Provides efficient 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.
62
10
2
Operator’s
zone
9 3
Assistant’s
zone
8 4
Transfer zone
7 5
6
Left-handed dentist 12
11 1
Static zone Operator’s
zone
10 2
Assistant’s
zone
9 3
8 4
Transfer zone 7 5
6
CHAIR-
SIDE
Right-Handed Dentist
Dentist’s zone 7–12
Assistant’s zone 2–4
Transfer zone 4–7
Static 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.
64
CHAIR-
SIDE
66
Basic Principles
■ The operator is able to maintain vision on the operative
field, 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 flow 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.
CHAIR-
SIDE
Instrument Transfer
■ Pen grasp: The position commonly used to hold a pen or
pencil and is widely used for most operative instruments.
68
CHAIR-
SIDE
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.
70
Instrument Sterilization
Sterilization Methods
■ Steam Autoclave (steam under pressure)
INFECT
CONTROL
72
INFECT
CONTROL
Pathogen
Chain of
Host Infection Source
Entry
Standard Precautions
Application
■ Apply to all patients
■ Integrate and expand Universal Precautions to include
organisms spread by blood and the following:
■ Body fluids, secretions, and excretions except sweat,
whether or not they contain blood
■ Nonintact (broken) skin
■ Mucous membranes
74
Bloodborne Pathogens
Examples
■ Hepatitis B virus (HBV)
■ Hepatitis C virus (HCV)
■ Human immunodeficiency virus (HIV)
Characteristics
■ Are transmissible in health care settings
■ Can produce chronic infection
■ Are often carried by persons unaware of their infection
INFECT
CONTROL
Hand Hygiene
■ Hands are the most common mode of pathogen
transmission.
■ Reduce spread of antimicrobial resistance.
■ Prevent health care–associated infection.
76
Guidelines
■ Use hand lotions to prevent skin dryness.
■ Consider compatibility of hand care products with gloves.
■ Keep fingernails short.
■ Avoid artificial nails.
■ Avoid hand jewelry that may tear gloves.
INFECT
CONTROL
78
Gloves
■ Minimize the risk of HCP acquiring infections from patients.
■ Prevent microbial flora from being transmitted from HCP to
patients.
■ Reduce contamination of the hands of HCP by microbial
flora that can be transmitted from one patient to another.
■ Are not a substitute for hand washing.
Sterile Glove Donning Technique
Peel 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 fit 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
■ Unfold the cuffs down over your gown sleeves. Make sure
your gloved fingertips do not touch your bare forearms or
wrists.
INFECT
CONTROL
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.
82
INFECT
CONTROL
Program Evaluation
■ Develop standard operating procedures.
■ Evaluate infection control practices.
■ Document adverse outcomes.
■ Document work-related illnesses.
■ Monitor health care–associated infections.
84
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 first 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 films
(F-speed), digital radiography, and 3-D cone imaging.
RADIOL
86
RADIOL
88
RADIOL
X-Ray Processor
■ Manual: Rarely used today because of extended period of
time to develop and process radiographs.
■ Automatic: Faster and more efficient with controlled
temperature and time.
Automatic processors house a roller transport system that
carries radiographs through the developer and fixer solutions
and through a rinse and air dry cycle.
90
Processing Solutions
■ Developing solution: Reacts with exposed silver halide
crystals forming black metallic silver and softens emulsion
of the film.
■ 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 film on the glass top of the machine with
the emulsion facing up.
■ Place films 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 film and process as normal.
RADIOL
Speed
■ D speed
■ E speed
■ F speed (the fastest film available, which means it requires
less amount of radiation)
92
RADIOL
Density
■ Density is the overall darkness or blackness of the film.
■ Density is controlled by mAs (milliampere seconds).
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.
94
Critical Organs
Organs that are more susceptible to radiation exposure during
dental procedures are:
■ Skin
■ Thyroid gland
■ Bone marrow
■ Lens of the eye
Patient Protection
■ Lead apron and thyroid collar.
■ High-speed film 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 film or
digital sensors.
RADIOL
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.
96
RADIOL
Exposing Techniques
Paralleling Technique
■ Place the film/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 film.
■ Direct the central x-ray beam through the contact areas
between the teeth.
■ Use film size #1 or #2.
Tube
X-rays
Film
98
Tube
Imaginary
line
X-rays
Film
RADIOL
Occlusal Technique
■ Occlusal technique is used to examine large areas of the
upper or lower jaw.
■ Use film size #4.
■ It is often used in children.
■ Place film 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 film.
Recommended Sequence of Exposing an FMX
Note: 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 modification.
Teeth to expose, by number:
■ 6, 7 ■ 17, 18, 19
■ 8, 9 ■ 12, 13
■ 10, 11 ■ 14, 15, 16
■ 22, 23 ■ 28, 29
■ 24, 25 ■ 30, 31, 32
■ 26, 27 ■ R premolar BW
■ 4, 5 ■ R molar BW
■ 1, 2, 3 ■ L premolar BW
■ 20, 21 ■ L molar BW
Extraoral
Panoramic
Panoramic exposures provide a complete picture of the entire
oral cavity and surrounding structures.
In a panoramic x-ray, both the film and the tubehead rotate
around the patient’s head, producing individual images that,
when combined in a single film, produce an image of the upper
and lower jaw and surrounding structures.
100
Cephalometric
Cephalometric 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: Identifies fractures in the ramus
and condyle of the mandible.
■ Submentovertex projection: Identifies 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
Digital Radiography
102
RADIOL
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.
104
RADIOL
Amalgam Carrier
■ To carry amalgam
■ Single or double ended
■ Various sizes depending on size of the cavity preparation
106
Amalgam Well
■ To hold amalgam after trituration and before placing into
the cavity
■ Made in various sizes and from different materials
INSTR
Anesthetic Syringe
■ To deliver anesthetic solution
■ Aspirating capabilities to avoid injection of anesthetic
directly in a blood vessel
■ Various types
108
INSTR
Cement Spatula
■ To mix temporary and permanent cements as well as
various filling materials
Chisel
■ To smooth and plane enamel within the cavity preparation
110
Condenser
■ To condense permanent and temporary filling materials in
the cavity preparation
INSTR
Cotton Forceps
■ To carry objects in and out of the mouth
■ Locking type available
■ Various sizes
112
INSTR
Discoid-Cleoid
■ To create occlusal anatomy in permanent and temporary
filling materials
INSTR
Explorer
116
Hoe
■ To smooth the cavity preparation
INSTR
Hollenback Carver
■ To contour anatomy in interproximal areas in permanent
and temporary restorative materials
118
Mouth Mirror
■ To retract soft tissue
■ To provide indirect vision
■ To reflect light
■ Disposable or not
■ Single or double sided
■ Various sizes and styles
INSTR
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
120
INSTR
122
INSTR
124
INSTR
Inverted Cone
126
Round
INSTR
128
Endodontic Spreader
■ To assist in the lateral condensation of the gutta percha
■ Can also be used to condense the final filling of the root
INSTR
Endodontic Stand
■ To hold for easy access of files and burs
File (K-Type)
■ To contour and shape the root canals before obturation
130
Gutta-Percha
■ To fill root canal during the obturation process
■ Various sizes
■ Pliable when heated
INSTR
Paper Points
■ To dry root canals before obturation
■ Various sizes
132
Bone File
■ To smooth alveolar bone following tooth extraction
INSTR
134
INSTR
136
INSTR
Mouth Props
■ To hold patient’s mouth open
■ Various shapes and sizes
138
Periosteal Elevator
■ To separate tissue from bone and/or tooth
■ Various shapes and sizes
INSTR
Rongeurs
■ To smooth and contour alveolar bone after tooth extraction
■ Hinged forceps
140
Straight Elevator
■ To luxate and elevate the tooth from its socket
■ Various shapes and sizes
INSTR
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
142
INSTR
Bird Beak
■ To bend and contour wire
144
INSTR
Bracket Remover
■ To remove brackets upon completion of orthodontic
treatment
146
Elastics
INSTR
Ligature-Tying Pliers
■ To tie ligatures onto arch wire
Three-Prong Bender
■ To bend and contour wire
148
Wire
INSTR
Wire Cutter
■ To cut wire
150
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 confidentiality.
■ 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 benefit 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
Anterior teeth: The teeth and tissues located toward the front
of the mouth; the maxillary and mandibular incisors and
canines.
152
RESOURCE
Distal: Toward the back of the dental arch (or away from the
midline).
RESOURCE
156
RESOURCE
158
RESOURCE
Palate: The hard and soft tissues forming the roof of the mouth
that separates the oral and nasal cavities.
160
RESOURCE
Pulp cavity: The space within a tooth that contains the pulp.
162
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.
RESOURCE
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.
RESOURCE
Dental Questions
When was your last dental visit?
¿Cuándo fue su última visita dental?
Swallow.
Trague.
Bite down.
Muerda hacia abajo.
Chin up.
El mentón arriba.
Web References
American Dental Association
http://www.ada.org
American Heart Association
http://www.americanheart.gov
Centers for Disease Control and Prevention
http://www.cdc.gov
Dental Assistant National Board
http://www.danb.org
Medline Plus
http://www.nlm.nih.gov
National Institute for Occupational Safety and Health
http://www.cdc.gov/niosh
RESOURCE
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?identifier = 1108.
American Society of Anesthesiologists. (2009). ASA Physical
Status Classification 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 Notification
[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.
168
RESOURCE
170
A Anesthesia/anesthetics, 45–58
Abscess(es), 15–16 152 color coding, 48
Abutment, 152 general, 157
Acid etching, 152 injections, 48–58
Acorn burnisher, 106 local, 46–47, 159
Acute radiation exposure, 94 syringe, 108
Adhesive, 152 topical, 45–46
Airway(s), obstructed, 9–10 Angina pectoris, 10–11
Albuterol, 24 Anode, 89
Albuterol–ipratropium, 20 Anterior mandibular forceps,
Alcohol-based hand wash, 133
77 Anterior superior alveolar
Alendronate sodium, 21 (ASA) injection, 52
Alprazolam, 25 Anterior teeth, 152
Alveolar, 152 Antibiotic prophylaxis regimen,
Alveolar osteitis, 16 5
Alveoloplasty, 152 Antisepsis, surgical, 77
Amalgam, 152 Antiseptic hand wash, 77
Amalgam carrier, 106–107 Anxiolysis, 153
Amalgam wall, 107 Apicoectomy, 153
American Dental Assistant’s Articaine, 47
Association (ADAA) Articulating paper holder, 109
Code of Ethics for Dental Aspiration, foreign body, 13
Assistants of, 151 Atenolol, , 24
American Society of Automated external
Anesthesiologists (ASA) defibrillator, 9
classification system for Avulsed tooth, 16–17
physical status, 1–2 Avulsion, 153
Amiodipine, 23 Azithromycin, 25
Amitriptyline HCl, 21
Amlodipine–benazepril, 22 B
Amoxicillin, 18 Band(s), orthodontic, 145
Amphetamine/ Band pusher, orthodontic, 144
dextroamphetamine, 18 Benign, 153
Analgesia, 152 Benzocaine, 46
INDEX
INDEX
INDEX
INDEX
INDEX
Propoxyphene–acetaminophen, extraoral, 86
20 film types, 92–93
Propranolol HCl, 21 history of, 85
Prosthesis(es), 162 infection control sites, 104–105
Prosthodontic retainer, 163 intraoral, 85
Provisional, 162 introduction to, 85–86
Pulp cavity, 162 radiation effects, 94–96
Pulpectomy, 162 radiographic beam
Pulpitis, 162 characteristics, 93–94
Pulpotomy, 162 types of, 85–86
Pulse rate, 7 uses of, 85
Rebase, 163
Q Reimplantation, 163
Quadrant, 163 Reline, 163
Quetiapine, 24 Removable partial denture,
Quinapril, 18 163
Removable prosthesis, 162
R Respiration, 7–8
Rabeprazole, 18 Restoration, 155, 158
Radiation exposure Resuscitation, cardiopulmonary,
acute, 94 8–10.
chronic, 95 Retainer(s), 163
maximum permissible dose, Retrograde filling, 163
95 Reverse Towne projection, 101
operator protection from, 96 Ritonavir, 23
patient protection from, 95 Roentgen, W.C., 85
Radiograph(s). See specific Rongeurs, 140
types Root, 163
Radiographic beam Root canal, 163
characteristics, 93–94 Root canal therapy, 163
Radiology, 85–105 Root planing, 164
dental radiographs, 97–102. Root tip picks, 140
digital, 102–104. Ropinirole, 24
equipment, 87–93
duplicating-related, 91–92 S
extraoral x-ray unit, 90 Salmeterol, 24
intraoral x-ray unit, 87–89 Scaling, 164
x-ray processor, 90–91 Scalpel handle with blades, 141
errors due to, 96 Scissors, 142–143
180
INDEX
W X
Warfarin, 20 X-ray, 165
Water lines, 83–84 X-ray processor, 90–91
Water supply, contamination of,
83–84 Z
Waters projection, 101 Zidovudine, 19
Web references, 167–168 Zolpidem tartrate, 18
Weingart pliers, 149
Wire(s), orthodontic, 149
Wire cutter, orthodontic, 150
182