1. Chapter 33 Delivering Dental Care
Copyright 2003, Elsevier Science (USA).
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2. Introduction
The clinical assistant assumes the important responsibility of preparing the treatment areas, assisting in procedures, and providing expanded functions.

3. Preparing for Your Patient
Review the 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 for planned treatment of the day.

4. Preparing the Treatment Area
The treatment room is clean, disinfected, and ready for the next patient.
The patient’s record, radiographs, and laboratory results are all in place.
The appropriate sterile preset tray and other supplies are in place.
The dental chair is positioned to seat the patient.
Equipment is moved out of the way for the patient and dental team.      

5. Admitting the Patient
Pleasantly greet the patient in the reception area by name.
Escort the 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.

6. Seating the Patient
Ask the patient to sit on the side of the dental chair and then swing his or her legs onto the base of the chair.
Lower or slide the chair arm into position.
Place the disposable patient napkin over the patient’s chest and clasp the corners using a napkin chain.
Inform the patient before adjusting the chair.
Position the operating light over the patient’s chest, and turn on.
Review once again that all treatment room preparations are complete.
Wash hands and put on personal protective equipment.

7. Team Dentistry Goals of work simplification
Decrease the number of instruments to be used for a procedure.
Sequence the instruments on a tray by their use.
Minimize the stress and fatigue by using correct positioning of the patient, dentist and assistant.
Use the appropriate moisture control techniques.
Transfer of instruments and dental materials as necessary.
Use the least amount of motion during the transfer of instruments and materials.
Allow the assistant to perform expanded functions.

8. Operating Zones
Basic concept required for practicing efficient and comfortable team dentistry (Figures 33-5 and 33-6).

9. Fig. 33-5

10. Fig. 33-6

11. 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 positioning adjustments will be made by the operator.

12. Principles of Team Positioning- cont’d
Positioning the operator
Criteria
Seated as far back as possible, with the front edge of the stool just touching the back of the knees.
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.
Height of chair allows the operator’s forearms when bent at the elbow to be parallel to the floor.

13. Principles of Team Positioning- cont’d
Positioning the dental assistant
Criteria
Seated well back on the stool.
Feet rest 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.

14. Four-Handed Dentistry
An ergonomically sound way to practice dentistry using the skills of the dental assistant, while including work simplification techniques.

15. Instrument Transfer and Exchange
Benefits
Standarized operating sequence.
Reduces the amount of time in the dental chair for the patient.
Increased productivity.
Less fatigue and stress.

16. Instrument Transfer and Exchange- cont’d
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.

17. Fig , A to C Basic grasps.

18. Instrument Transfer and Exchange- cont’d
Principles of instrument transfer
The assistant must understand the sequence of the treatment procedure and anticipate when an instrument transfer will be required.
The transfer of instruments should be accomplished with a minimum of motion involving only the fingers, wrist, and elbow.
Instruments are transferred in the position of use.
An instrument is transferred so the dentist can grasp the instrument for its appropriate use.
The instrument being transferred must be positioned in the dentist's hand firmly.
The assistant will transfer dental instruments and dental materials with his or her left hand.

19. Instrument Transfer and Exchange- cont’d
Variations in instrument transfer
Mirror and explorer
Cotton pliers
Handpiece
Instruments with hinges

20. The Expanded-Function Dental Assistant
Expanded function refers to specific intraoral tasks that are completed as a procedure or part of a procedure by the clinical dental assistant that have been delegated by the dentist.
Increased productivity
Less stress on dentist
More patients seen
Increased job satisfaction

21. The Expanded-Function Dental Assistant- cont’d
Credentialing
Dental supervision (direct vs. indirect)

22. The Expanded-Function Dental Assistant- cont’d
Working as the operator
Understanding dental anatomy
Operator positioning
Intraoral mirror skills
Using an intraoral fulcrum
Understanding cavity preparations
Instrumentation
Application of dental materials
Evaluation of the expanded function