Delivering Dental Care Chapter 33 Copyright © 2005 by Elsevier Inc. All rights reserved.

Introduction The clinical assistant assumes the important responsibility of preparing the treatment areas, assisting the dentist in procedures, and completing expanded functions. Copyright © 2005 by Elsevier Inc. All rights reserved.

Preparing for Your Patient Review Patient Record Administrative Staff Review any changes in personal information. Clinical Staff Review for any health problems that may alter dental treatment. Medical Alerts. Review progress notes planned for treatment of the day. Copyright © 2005 by Elsevier Inc. All rights reserved.

Preparing the Treatment Area Treatment room clean, disinfected, and ready for the next patient. Patient records, radiographs, and laboratory results in place. Sterile preset tray and other supplies in place. Dental chair positioned to seat the patient. Equipment moved out of the way for the patient and dental team.       Copyright © 2005 by Elsevier Inc. All rights reserved.

Admitting the Patient Pleasantly greet patient in the reception area by name. Escort patient to the treatment area. Place the patient’s personal items in a safe place out of the way of the procedure. Initiate conversation with the patient. Ask if there are any questions that you can answer about treatment for the day. Copyright © 2005 by Elsevier Inc. All rights reserved.

Seating the Patient Seat patient from side of the dental chair. Lower or slide the chair arm into position. Place patient napkin. Inform the patient before adjusting the chair. Position operating light. Complete treatment room preparations. Wash hands and place on personal protective equipment. Copyright © 2005 by Elsevier Inc. All rights reserved.

Team Dentistry Goals of Work Simplification Decrease number of instruments. Sequence instruments on a tray by their use. Follow correct positioning of the patient, dentist, and assistant. Use appropriate moisture control techniques. Transfer instruments and dental materials as necessary. Use the least amount of motion. Allow assistant to perform expanded functions. Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-1 Concept of 4-handed dentistry (Courtesy A-dec.) Copyright © 2005 by Elsevier Inc. All rights reserved.

Principles of Team Positioning Positioning the Patient Criteria Patient is lowered to supine position. Patient slides up in chair so head is even with top of headrest. Final adjustments made by the operator. Copyright © 2005 by Elsevier Inc. All rights reserved.

Principles of Team Positioning-cont’d Positioning the Operator Criteria Seated as far back as possible. Thighs parallel to the floor, or knees slightly lower than the hips. Feet kept flat on the floor. Backrest of the chair positioned to support the lower portion or small of the back. Operator’s forearms bent at the elbow and parallel to the floor. Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-3 Position of the operator Copyright © 2005 by Elsevier Inc. All rights reserved.

Principles of Team Positioning-cont’d Positioning the Dental Assistant Criteria Seated back on the stool. Feet on the base or foot ring of the stool. Positioned as close as possible to the dental chair. Legs parallel to the patient’s chair. Eye level 4 to 6 inches above the eye level of the operator. Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-4 Position of the Dental Assistant Copyright © 2005 by Elsevier Inc. All rights reserved.

Operating Zones Basic concept required for practicing efficient and comfortable team dentistry Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-5 Operating zones for a right-handed operator Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-6 Operating zones for a left-handed operator Copyright © 2005 by Elsevier Inc. All rights reserved.

Four-Handed Dentistry An ergonomically sound way to practice dentistry using the skills of the dental assistant, while including work simplification techniques. Copyright © 2005 by Elsevier Inc. All rights reserved.

Instrument Transfer and Exchange Benefits Standardized operating sequence Reduces the amount of time in the dental chair for the patient Increases productivity Less fatigue and stress Copyright © 2005 by Elsevier Inc. All rights reserved.

Operator’s Grasp Three Basic Grasps Pen Grasp: The instrument is held in the same manner as a pen. Palm Grasp: The instrument is held securely in the palm of the hand. Palm-thumb Grasp: The instrument is held in the palm of the hand, and the thumb is used to stabilize and guide the instrument. Copyright © 2005 by Elsevier Inc. All rights reserved.

Fig. 33-7 Basic Instrument Grasps Copyright © 2005 by Elsevier Inc. All rights reserved.

Principles of Instrument Transfer Understand the sequence of procedure and anticipate when an instrument transfer is required. Transfer dental instruments and dental materials with left hand. Transfer of instruments should be accomplished with a minimum of motion involving only the fingers, wrist, and elbow. Instruments transferred in position of use. Instrument is transferred so dentist can grasp the instrument for its appropriate use. Instrument being transferred must be positioned in the dentist's hand firmly. Copyright © 2005 by Elsevier Inc. All rights reserved.

Instrument Transfer and Exchange-cont’d Variations in Instrument Transfer Mirror and explorer Cotton pliers Handpiece Instruments with hinges Copyright © 2005 by Elsevier Inc. All rights reserved.

The Expanded-Function Dental Assistant Expanded Function refers to specific intraoral procedures or part of a procedure by the clinical dental assistant that have been delegated by the dentist. Advantages Increases productivity Lessens stress on dentist More patients are seen Increases job satisfaction Copyright © 2005 by Elsevier Inc. All rights reserved.

Working as the Operator Understand dental anatomy Follow guidelines for operator positioning Develop intraoral mirror skills Use an intraoral fulcrum Understand cavity preparations Adapt instrumentation Application of dental materials Evaluation of the expanded function Copyright © 2005 by Elsevier Inc. All rights reserved.