1. Delivering Dental Care
Chapter 33
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2. 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.

3. 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.
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4. 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.      
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5. 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.
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6. 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.
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7. 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.
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8. Fig. 33-1 Concept of 4-handed dentistry (Courtesy A-dec.)
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9. 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.
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10. 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.
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11. Fig. 33-3 Position of the operator
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12. 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.
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13. Fig. 33-4 Position of the Dental Assistant
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14. Operating Zones
Basic concept required for practicing efficient and comfortable team dentistry
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15. Fig. 33-5 Operating zones for a right-handed operator
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16. Fig. 33-6 Operating zones for a left-handed operator
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17. Four-Handed Dentistry
An ergonomically sound way to practice dentistry using the skills of the dental assistant, while including work simplification techniques.
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18. 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
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19. 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.
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20. Fig. 33-7 Basic Instrument Grasps
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21. 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.
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22. Instrument Transfer and Exchange-cont’d
Variations in Instrument Transfer
Mirror and explorer
Cotton pliers
Handpiece
Instruments with hinges
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23. 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
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24. 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
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