Chapter 33 Delivering Dental Care

What are the 4 instruments that need to be transferred differently?

1. Mirror and Explorer- delivered simultaneously using two-handed exchange. 2. Cotton Pliers- delivered while pinching "beaks" to avoid dropping the item being held in the pliers. 3. Handpiece- avoid tangling hoses 4. Instruments with Hinges- Held at the hinge and transferred by directing its handles into the dentist's palm. Scissors are places over dentist's fingers.

In terms of the clock concept, where is the static zone located for a right-handed operator?

12 o'clock-to-2 o'clock position.

What are the most essential requirements for the operator?

Access and vision

What are approved educational training programs for EFDA?

Accredited dental-assisting programs, programs approved by the state dental board but not accredited, specific courses approved by the state dental board.

What occurs when the dentist or assistant stretches to reach an instrument or gain access to the patient's mouth?

Accumulated stress contributes to circulatory problems, lower-back pain, and other muscle aches and pains.

How does reviewing the patient records differ from administrative staff and clinical staff?

Administrative- check for changes in personal information Clinical- check for health problems that could alter treatment, look for medical alerts, review progress notes for planned treatment

When should sterile preset tray be opened?

After the patient is seated and before treatment

Why is the correct positioning of the dental team essential in the clinical area?

Allows access and visibility to all areas of the patient's mouth while providing maximum comfort and support to the dentist and assistant.

What should you discuss in your brief morning meeting of the day before the patient's arrive?

Any changes in schedules or procedures, change in patient health that could alter treatment, additional supplies or equipment needed, preparation for apprehensive patients, and assignments of expanded functions.

Why are different instrument exchange procedures necessary?

Because of variations in the instrument designs.

The ____________ _ ___________ comprises the five categories that describe the range of movement by the clinical assistant when he or she is assisting.

Classification of Motion

How would you prepare the treatment area?

Clean and disinfect for next patient, place patient records, radiographs, and lab results, sterile present tray and other supplies in place, dental chair positioned to seat patient and additional equipment moved out of way.

Would a chairside assistant be considered administrative staff or clinical staff?

Clinical

What signal is used by the dentist to indicate need for the mirror and explorer?

Dentist places one hand on each side of patient's mouth in a position ready to receive the instrument.

Who benefits from a standardized operating sequence?

Dentist, dental assistant, and patient.

When the dentist assigns or entrusts a specific procedure to the dental assistant, the dentist has _____________ that procedure

Delegated

Who or what dictates whether the expanded function must be under the direct or indirect supervision of the dentist?

Dental Practice Act for that specific state

What are some areas the assistant must have competency in?

Dental anatomy, cavity preparation, adapting instrumentation, applying dental materials, evaluation of expanded functions

The dentist provides ___________ _________ when he or she is physically in the same treatment area overseeing an expanded-function procedure.

Direct Supervision

Static Zone

Directly behind the patient. Area with rear delivery or a unit that holds the handpieces, air-water syringe, and additional counter space. RH: 12-2 LH: 10-12

An ___________ ____________ is a dental procedure that is delegated to the dental assistant by the dentist that requires advanced skill.

Expanded Function

How does four-handed dentistry affect ergonomics and the concept of team dentistry?

Enhances treatment process by reducing stress and fatigue of both the dentist and assistant. Better uses the time of the dental team and increases productivity.

Class I Motion

Fingers only

The process by which a skilled dental assistant and dentist work together as a team to perform clinical tasks is ______________ _____________.

Four-handed Dentistry

During a procedure, the assistant transfers instruments using the left hand and holds the ____________ in the right hand.

HVE

What is indirect vision? Why is it more difficult to use a mirror for indirect vision?

Indirect vision describes viewing an object through the use of a mirror. Much trial and error is involved in learning to use a mirror for indirect vision because the object is viewed in reverse.

Where should radiographs be placed?

Illuminated view box

The dentist provides __________ _____________ when he or she is present in the immediate area to oversee the dental assistant's expanded function.

Indirect Supervision

___________ __________ is the method of viewing something through the use of a mirror.

Indirect Vision

Palm Grasp

Instrument held in palm of the hand

Palm-Thumb Grasp

Instrument held in the palm with the thumb stabilizing and guiding

Pen Grasp

Instrument held like a pen

If the transfer of instruments is done with the assistant's left hand, what is the function of the assistant's right hand?

It is kept free to provide suction and ready for the next instruments or materials.

Depending on the instrument, the assistant will use the _________________ of the left hand when retrieving a used instrument from a right-handed dentist.

Last two fingers or middle and index fingers

What affects the operator's position within the operating zone?

Location of the zone changes according to whether the operator is right or left handed. Position varies within the zone depending on the treatment to be delivered.

What might result from a failure to meet standards for these tasks?

Loss of productivity for dentist, inconvenience/discomfort for patient, and unnecessary stress for everyone.

What area of the body is most likely to be fatigued by the end of the day?

Lower back; occurs because of too much reaching, twisting, and turning that goes on while seated in the work position.

Besides the assistant, what else could be located in the assistant's zone?

Mobile dental unit and assistant's stool

The chairside assistant should use __________ hand(s) in the transfer of an explorer.

One

Depending on the operator's position, indirect vision could be used for which of the following tooth surfaces?

Occlusal area of tooth #3

By following the clock concept, the dental team is using the four _________ ________ of positioning when implementing four-handed dentistry.

Operating Zones

Example of class I motion.

Picking up an instrument or a single object from a flat surface

What are some examples of functions that require proper use of a fulcrum?

Placement of a dental liner and base, removal of dental cement, placement of retraction cord, suture removal, coronal polishing, placement of sealants, placement of separators, and the application of ligature and elastomerics.

How does ergonomics play a role in team dentistry?

Reduces fatigue, stress, and injury during procedures, making them go more smoothly and efficiently.

What is the correct positioning for the operator?

Seated as far back as possible, thighs parallel to floor or knees slightly lower than hips, feet flat on the floor, backrest positioned to support small of back, forearms bent at elbow and parallel to the floor.

What is the correct positioning of the dental assistant?

Seated well back on stool, feet on foot ring, close as possible to the dental chair, eye level 4-6 inches higher than the eye level of the operator.

List appropriate PPE.

Safety eyewear, gloves, lab jacked with long cuffed sleeves, and face mask.

What are some of the tasks that should be completed during preparation for the apprehensive patient?

Scheduling a longer appointment, using premedication, and using pain control measures such as nitrous oxide.

What is the key term that describes the focus of four-handed dentistry?

Teamwork

Define "grasp"

The correct way an instrument or handpiece is held

What is indirect supervision?

The dentist must be in the area, but not specifically in the same treatment room as the EFDA, and must be available to evaluate the EFDA's expanded function.

What is direct supervision?

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

What is proper position of the dental chair for receiving the patient?

Upright and at the lowest height

How should the assistant position the working end of an instrument for transfer for work on tooth #13?

Upward toward the maxillary

What affects the manner in which the operator grasps and holds an instrument?

The instrument type, the way its used, and the area of the mouth in which it's being used.

Which hand is used primarily to transfer instruments to a right-handed dentist?

The left hand

Besides the assistant, what may be located in the assistant's zone?

The mobile cabinet or rear delivery countertop

What is four-handed dentistry?

The process by which the operator and assistant work together to perform clinical procedures in an ergonomically structured environment.

What is the role of the dental assistant in four-handed dentistry?

Throughout the procedure, dentist relies on clinical assistant to have the supplies, instruments, and materials ready for transfer into the dentist's hands.

What are the main goals of team dentistry?

To deliver the best and most effective care to the patient and to increase productivity.

Instrument transfer or exchange takes place in which zone?

Transfer Zone

Example of class II motion.

Transferring an instrument with use of pen grasp, or mixing dental material. For business assistant it would be typing on a keyboard or using a computer mouse.

What can you ask the patient to do to make access to specific areas of the mouth easier?

Turn his or her head left or right.

The exchange of surgical instruments is best executed with the use of a __________ transfer.

Two-handed

Example of class III motion.

Using a slow-speed handpiece while polishing. For business assistant it would be answering phones.

How do moisture-control techniques simplify work?

Visibility of the work field in the mouth is increased.

Is use of PPE recommended for cleaning and disinfecting the treatment room?

Yes

Assistant's Zone

Zone in which assistant is positioned RH: 2-4 LH: 8-10

Operator's Zone

Zone in which clinician is positioned. RH: 7-12 LH: 12-5

Transfer Zone

Zone in which instruments and dental materials are exchanged between clinician and assistant. RH: 4-7 LH: 5-8

Class IV Motion

entire arm and shoulder

Class V Motion

entire upper torso

Class II Motion

fingers and wrist

Class III Motion

fingers, wrist, and elbow

A ________________ is a finger rest that is used while one is working intraorally with a dental instrument or handpiece

fulcrum

What is another term for a finger rest?

fulcrum

A _________ is the manner in which a specific instrument or handpiece is held.

grasp

Should the assistant use one hand or both hands to transfer a single instrument?

one-handed transfer (single-handed transfer).

How should the operator maintain their forearms when providing dental treatment on a patient?

parallel to the floor.

In relation to the operator, should the assistant be positioned lower or higher when seated properly?

positioned higher

Where are instruments exchanged during a procedure?

transfer zone

State two goals of the dental team that would simplify dental treatment in the dental office.

using ergonomically correct dental equipment; using preset trays during dental procedures; minimizing stress and fatigue during performance of dental procedures by ensuring specific, ergonomically correct positioning of the patient, dentist, and assistant; following the principles of motion economy during the transfer of instruments and dental materials; using appropriate moisture-control techniques to enhance visualization of the working field in the mouth; and delegating expanded functions of practice as legally defined within the state.

What is indirect vision?

viewing an object through a mirror