General Chairside Lesson II - IV 1

Introduction The clinical assistant assumes the important responsibility of preparing treatment areas, assisting the dentist in procedures, and carrying out expanded functions. What is four-handed dentistry? (Process by which the operator and assistant work together to perform clinical procedures in an ergonomically structured environment.) List and discuss various advance preparation procedures a dental assistant can complete to increase the smooth flow of patient care throughout the day. (Obtain the patient record, know the upcoming procedure[s], and have the supplies and equipment ready.) What might result from a failure to meet standards for these tasks? (Loss of productivity for the dentist, inconvenience or discomfort for the patient, and unnecessary stress for everyone.) 2

Team Dentistry Four and Six handed dentistry Doctor and Assistant; Doctor and 2 Auxiliaries Purposes: Relieve fatigue/Reduce stress Increase production Increase patient comfort Improved quality of care Components of work simplification Decreased number of instruments. Sequencing of instruments on the tray by their use Correct positioning of the patient, dentist, and assistant Use of appropriate moisture-control techniques. Transfer of instruments and dental materials as necessary Use of the least possible amount of motion Performance of expanded functions by the assistant What are the main goals of this concept? (To deliver the best and most effective care to the patient and to increase productivity.) How does ergonomics play a role in team dentistry? How do the appropriate moisture-control techniques simplify work? (Visibility of the work field in the mouth is increased.) Expanded functions allow the dentist to use time more effectively and efficiently. 3

Fig. 33-1 The concept of four-handed dentistry is shown in the positioning of the patient and dental team. (Courtesy of A-dec.) How does four-handed dentistry affect ergonomics and the concept of team dentistry? (The use of proper four-handed procedures enhances the treatment process by reducing stress and fatigue of both dentist and dental assistant. Four-handed dentistry also better uses the time of the dental team, increasing productivity.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

Principles of Team Positioning Patient Lowered to the supine position Head even with the top of the headrest Final adjustments made by the operator Define: supine and subsupine/Trendelenburg position Why is correct positioning of the dental team essential in the clinical area? (Correct positioning allows access and visibility to all areas of the patient’s mouth while providing maximum comfort and support to the dentist and dental assistant.) What occurs when the dentist or dental 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 pain.) What can you ask the patient to do to make access to specific areas of the mouth easier? (Turn his or her head to the left or right.) 5

Principles of Team Positioning Operator positioning Seated as far back as possible. Thighs parallel to the floor or knees slightly lower than the hips Feet 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 What are the most essential requirements for the operator? (Access and vision.) 6

Fig. 33-3 Position of the operator when seated correctly. Is this operator positioned correctly (Yes.) Note the neutral elbow position. Note how the weight of the operator is supported by the straight back and feet that are flat on the floor. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

Principles of Team Positioning Dental assistant 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 The dental assistant has to anticipate the needs of the dentist during treatment and maintain access to the area of concentration. 8

Fig. 33-4 Position of the dental assistant when seated correctly. Is the dental assistant positioned correctly? (Yes.) This position will allow the dental assistant to sit 4 to 6 inches above the clinician to allow the assistant to have access to the concentration area. Note the neutral elbow position. Note how the feet are supported by the ring at the base of the stool. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9

Operating Zones of Activity Basic concept required for the efficient, comfortable practice of team dentistry Operating zones are based on the “clock” concept. This concept is the best way to identify the working position of the dental team, dental equipment, and supplies needed to perform a procedure. What affects the operator’s position within the operating zone? The operator’s zone is the zone in which the clinician is positioned. The transfer zone is the zone in which instruments and dental materials are exchanged between the clinician and the dental assistant. The assistant’s zone is the area in which the assistant is positioned. The static zone is directly behind the patient. This is the area with rear delivery or a unit that holds the handpieces, air-water syringe, and additional counter space. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Fig. 33-5 Operating zones for a right-handed operator. What is the operator zone for a right-handed clinician? (12 o’clock to 5 o’clock.) What is the transfer zone for a right-handed clinician? (4 o’clock to 7 o’clock.) What is the assistant’s zone for a right-handed clinician? (2 o’clock to 4 o’clock.) What is the static zone for a right-handed clinician? (12 o’clock to 2 o’clock.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Fig. 33-6 Operating zones for a left-handed operator. What is the operator zone for a left-handed clinician? (5 o’clock to 8 o’clock.) What is the transfer zone for a left-handed clinician? (5 o’clock to 8 o’clock.) What is the assistant’s zone for a left-handed clinician? (8 o’clock to 10 o’clock.) What is the static zone for a left-handed clinician? (10 o’clock to 12 o’clock.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Operating Zones Operator Zone area where the person who completes the procedure is seated Assistant Zone area where the dental assistant is positioned Transfer Zone area where instruments and dental materials are exchanged between the dental assistant and the dentist

Team Dentistry Static Zone located directly behind the patient Operator Zone (right handed) 7 to 12 o'clock Transfer Zone (right handed) 4 to 7 o'clock Assistant's Zone (right handed) 2 to 4 o'clock Static Zone (right handed) 12 to 2 o'clock

Team Dentistry Operator's zone (left handed) 12 to 5 o'clock Transfer zone (left handed) 5 to 8 o'clock Assistant's zone (left handed) 8 to 10 o'clock Static zone (left handed) 10 to 12 o'clock

Operator’s Grasps Three basic grasps Pen grasp: The instrument is held in the same manner as a pen. Used with angled shank instruments Palm grasp: The instrument is held securely in the palm of the hand. Used with pliers or hinged instruments Palm-thumb grasp: The instrument is held in the palm of the hand and the thumb is used to stabilize and guide the instrument. Used with straight shank instruments Can you define the term “grasp”? (Grasp is the correct way an instrument or handpiece is held.) What affects the manner in which the operator grasps and holds an instrument? (The instrument type, the way it is used, and the area of the mouth in which it is being used.) 16

Fig. 33-7 Basic instrument grasps. A, Pen grasp. B, Palm grasp Fig. 33-7 Basic instrument grasps. A, Pen grasp. B, Palm grasp. C, Palm-thumb grasp. Can you identify the grasps pictured on the slide? (A, pen grasp; B, palm grasp; C, palm-thumb grasp.) Can you identify when each grasp would be used? (Pen grasp, explorer; palm grasp, surgical forceps; palm-thumb grasp, cotton pliers.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Classification of Motions Class I: finger movement only Class II: finger and wrist movement only Class III: finger, wrist and elbow movement only Class IV: entire arm from the shoulder movement Class V: entire upper torso movement

Principles of Instrument Transfer Understand the sequence of procedures and anticipate when an instrument transfer is required. Transfer dental instruments and dental materials with the left hand when working with right-handed operator. Transfer with right hand when working with left-handed operator Transfer of instruments should be accomplished with a minimum of motion, involving only the fingers, wrist, and elbow. Instruments are transferred in their position of use. An instrument is transferred so that the dentist can grasp the instrument for its appropriate use. An instrument being transferred must be positioned firmly in the dentist's hand. If transfer of dental instruments is done with the dental assistant’s left hand, what is the function of the dental assistant’s right hand? (The right hand is kept free to provide suction and ready the next materials and instruments.) When instruments are being transferred, the working end or the position of use is pointed downward for mandibular areas or upward for maxillary areas. Why is it important to transfer instruments to the dentist in their position for use? (So the dentist does not have to reposition the instrument in his or her hands before use.) Assistant transfer technique is usually a single-handed technique. 19

Instrument Transfer Pickup instrument from tray using thumb, index and middle finger Come in parallel to instrument in operator’s hand Retrieve instrument using last two fingers (ring and pinky fingers) Place new instrument firmly in operator’s hand

Principles of Instrument Transfer Variations in instrument transfer Mirror and explorer Cotton pliers Handpiece Instruments with hinges Why are different instrument-exchange procedures necessary? (Because of variations in instrument design.) The dental assistant delivers the mirror and explorer simultaneously, using a two-handed exchange. What signal is used by the dentist to indicate the need for the mirror and explorer? (The dentist places one hand on each side of the patient’s mouth in a position ready to receive the instrument.) The dental assistant delivers the pliers to the dentist while pinching the “beaks” to avoid dropping the item being held in the pliers. Take care to avoid tangling the hoses during handpiece transfer. Rubber dam forceps, surgical forceps, orthodontic pliers, and scissors should be transferred with care. Hold the instrument at the hinge and transfer by directing their handles into the dentist’s palm (Scissors are placed over the dentist’s fingers.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21

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. Apply dental materials. Evaluate the expanded function. A dental assistant carrying out an expanded function assumes the role of an operator. It is imperative that the EFDA become knowledgeable and competent in the areas listed on this slide. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22